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OBGYN > Normal labour > Flashcards

Normal labour Flashcards

1
Q

Stages of fetal passage through pelvis in labour

A

Engagement and descent

Internal rotation to OA

Crowning

Restitution

External rotation

Delivery of anterior shoulder

Delivery of posterior shoulder

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2
Q

1st stage of labour

A

Latent phase = period for cervix to full efface and dilate to 3cm

Active phase = 3cm to 10cm

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3
Q

Braxton-hicks

A

Mild, irregular, non progressive contractions from 30 weeks

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4
Q

Normal progression rate

A

2cm every 4 hours

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5
Q

2nd stage

A

From full dilatation to baby being born

Active 2nd stage = when mother starts expulsive efforts

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6
Q

Caput

A

swelling of fetal skull - normal if its central

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7
Q

Moulding

A

overlapping of fetal skull bones

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8
Q

Management of baby immediately after delivery

A

Double clamp cord and cut after 2-3 mins (when it stops pulsating)

Assess baby using APGAR score at 1,5 and 10 mins

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9
Q

Active management of 3rd stage - what is it, SE

A

Use of oxytocin (given as anterior shoulder is born)

Early clamping and cutting of cord

Controlled cord traction using Brandt-Andrew’s technique

Side effects: N+V, headache

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10
Q

When should active management of 3rd stage always take place?

A

In event of haemorrhage, failure to deliver placenta within 1 hour, maternal desire to shorten 3rd stage

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11
Q

Care immediately after delivery for mother

A

Give oxytocin infusion if high risk of PPH

Skin to skin contact

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12
Q

Delay of 2nd stage - when to make diagnosis

A

Nulliparous - after 1 hour of pushing.

After 2 hours, consider CS

Multiparous - after 1 hour of pushing consider CS

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13
Q

Foetal monitoring during labour (normal delivery)

A

Auscultate for a full minute every 15 mins in 1st stage, every 5 mins in 2nd stage

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14
Q

CTG indications (maternal, fetal, intrapartum)

A

Maternal: previous CS, comorbidities, post-term pregnancy, PROM, induction or APH

Fetal: IUGR, prematurity, multiple, breech, oligohydraminos

Intrapartum indications: Oxytocin use, epidural, pyrexia

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15
Q

CTG interpretation

A

DR C BRAVADO

Determine risk

Contractions

Baseline rate

Accelerations

Variability

Decelerations

Overall impression

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16
Q

CTG normal values + what this means

A

Contractions - should be 3-4 in 10 mins

Baseline rate = 100-160

Variability 5-25 (shows good CNS perfusion)

Acceleration (15 beats over baseline for 15 seconds) - presence is good

Decelerations (15 beats below baseline for 15 seconds) - presence is bad. Late decels or atypical decels = bad

17
Q

Causes of reduced variability

A

Fetal hypoxia

Sleep cycle

Drugs: benzos, methyldopa, magnesium sulphate

Prematurity

Heart block

18
Q

Management of poor CTG

A

Left lateral side

Fluids

Fetal blood sample = if <7.2 pH = abnormal so deliver

19
Q

Dawes Redmond criteria

A

At end of CTG - not to be used in labour

20
Q

Maternal monitoring during labour

A

Use partogram

Assesses using maternal vital signs, liquor colour, FHR

21
Q

Narcotic pain relief in labour - duration, SE

A

Pethidine + diamorphine: lasts 3-4 hours.

Can cause resp depression if birth within this time

Give with an antiemetic

22
Q

Epidural pain relief - action, SE, cautions

A

Reduced maternal secretion of catecholamines

Good for controlling BP

Can give a patchy block, can get hypotension + decreased mobility

Postdural puncture headache

23
Q

Epidural contraindications

A

Sepsis, infection at site of insertion, thrombocytopaenia, raised ICP, haemorrhage, CV instability

24
Q

What precautions should be taken in IOL with previous CS + grand multiparas?

A

Risk of scar dehiscence

Use oxytocin first (not prostaglandins)

25
Q

What is the incidence of induction, and rate of success at term?

A

10%, success = 60-80% at term

26
Q

What is stabilising induction?

A

when presenting part isn’t engaged so is stabilised by an assistant to prevent cord prolapse. Should happen in theatre in case of cord prolapse

27
Q

What is fetal fibronectin?

A

protein found in vaginal secretions during labour. Can be measured to assess whether preterm labour is real or not

28
Q

How can you prevent preterm labour?

A

treat BV (Clindamycin), progesterone, cerclage, amnioreduction

29
Q

What is the caution with syntometrine?

A

Increases BP

30
Q

When should postnatal depression be screened for?

A

4-6 weeks + 3-4 months

OBGYN (18 decks)

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