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Year 4- OBGYN > Normal Pregnancy & Labour > Flashcards

Normal Pregnancy & Labour Flashcards

Physiological changes in pregnancy, Antenatal screening and care, Common pregnancy issues, Normal labour, delivery and puerperium Deviations from normal labour patterns eg. delays, retained placenta, Fetal monitoring, Perineal trauma, Breastfeeding, Induction

1
Q

How many stages of labour are there?

A

3

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2
Q

between what weeks of gestation does labour normally occur?

A

37 and 42

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3
Q

What is the first stage of labour?

A

From the onset of labour (true contractions) until the cervix is fully dilated to 10cm.

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4
Q

What is the second stage of labour?

A

From 10cm cervical dilation until the delivery of the baby

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5
Q

What is the 3rd stage of labour?

A

From the delivery of the baby until the delivery of the placenta

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6
Q

Changes to the cervix during the first stage of labour

A
  1. Cervical dilation (opening up)
  2. Cervical effacement (getting thinner)
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7
Q

What is the “show” during labour?

A

The “show” refers to to the mucus plug in the cervix, which prevents bacteria from entering the uterus during pregnancy, falling out and creating space for the baby to pass through.

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8
Q

3 phases of the first stage of labour?

A
  1. Latent phase- 0-3cm
  2. Active phase- 3-7cm
  3. Transition phase- 7-10cm
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9
Q

What is the rate of progression of labour in the Latent phase of the 1st stage?

A

0.5cm per hour

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10
Q

What is the rate of progression of labour in the Active phase in the first stage of labour?

A

1cm per hour

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11
Q

What is the rate of progression of labour in the Transition phase of the 1st stage?

A

1cm per hour

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12
Q

What are the contractions like in the latent phase of the 1st stage of labour?

A

Irregular

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13
Q

What are the contractions like in the active phase of the 1st stage of labour?

A

Regular

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14
Q

What are the contractions like in the transition phase of the 1st stage of labour?

A

strong and regular

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15
Q

What are Braxton-Hicks Contractions?

A

Braxton-Hicks contractions are occasional irregular contractions of the uterus. They are usually felt during the second and third trimester. These are not true contractions and do not indicate the onset of labour.

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16
Q

What can help to reduce Braxton-Hicks contractions?

A

Staying hydrated and relaxing

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17
Q

What are the 4 signs of labour (to diagnose it)?

A
  • Show (mucus plug from the cervix)
  • Rupture of membranes
  • Regular, painful contractions
  • Dilating cervix on examination
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18
Q

What is the latent first stage of labour?

A

The latent first stage is when there are both:

  • Painful contractions
  • Changes to the cervix, with effacement and dilation up to 4cm
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19
Q

What is the established first stage of labour?

A

The **established first stage **of labour is when there are both:

  • Regular, painful contractions
  • Dilatation of the cervix from 4cm onwards
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20
Q

Defintion

Rupture of membranes (ROM):

A

The amniotic sac has ruptured.

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21
Q

Definition

Spontaneous rupture of membranes (SROM):

A

The amniotic sac has ruptured spontaneously.

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22
Q

Definition

Prelabour rupture of membranes (PROM):

A

The amniotic sac has ruptured before the onset of labour.

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23
Q

Definition

Prolonged rupture of membranes (also PROM):

A

The amniotic sac ruptures more than 18 hours before delivery.

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24
Q

Below how many weeks gestation are babies considered to be “non-viable”?

A

below 23 weeks gestation

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25
Q

Definition

Induction of labour (IOL) is

A

the process of starting labour artificially

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26
Q

How many pregnancies will require induction?

A

roughly 1 in 5

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27
Q

What is the indication for induction of labour?

A

when it is thought that delivering the baby will be safer for the baby and/or the mother, than for the baby to remain in utero.

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28
Q

NICE guidlines state that induction of labour should NOT be offered on ________ alone

A

maternal request

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29
Q

Women with uncomplicated pregnancies should be offered IOL when?

A

between 40+0 to 40+14 weeks’ gestation.

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30
Q

Why is IOL offered at full term?

A

The aim is to avoid the risks of fetal compromise and stillbirth associated with prolonged gestation (thought to be secondary to placental ageing).

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31
Q

If the patient declines an induction of labour, what should be done?

A

the frequency of monitoring from 42 weeks onwards should be increased.

32
Q

Definition

Premature rupture of membranes (PROM) is

A

a rupture of the membranes before labour begins. (>37 weeks)

33
Q

For Premature Rupture of membranes (>37 weeks), is IOL offered?

A

Yes, for PROM, offer IOL or alternatively offer expectant management for a maximum of 24 hours (any longer increases the risk of ascending infection – chorioamnionitis). 84% of women will spontaneously go into labour within the first 24 hours.

34
Q

For Preterm-premature rupture of membranes <34 weeks gestation, is IOL offered?

A

delay IOL unless obstetric factors indicate otherwise e.g. fetal distress.

35
Q

For Preterm-premature rupture of membranes >34 weeks gestation, is IOL offered?

A

the timing of IOL depends on risks vs benefits of delaying pregnancy further e.g. increased risk of infection.

36
Q

Examples of maternal health problems where IOL is offered?

A
  • hypertension
  • pre-eclampsia
  • diabetes
  • obstetric cholestasis
37
Q

Why is IOL offered for fetal growth restriction?

A

The aim is to deliver the baby prior to fetal compromise

38
Q

When is IOL offered for Intrauterine fetal death?

A

in cases of intrauterine fetal death, induction of labour should be offered if mother is physically well with intact membranes.

39
Q

Contraindications for induction of Labour

A

generally the same as for vaginal delivery eg. major placenta praevia, cord prolapse, transverse lie, active primary genital herpes, previous c-section (but can be approved by consultant), breech, triplets

40
Q

What are the main methods of induction of labour?

A
  1. vaginal prostaglandins
  2. amniotomy
  3. membrane sweep

Also Cervical ripening balloon (CRB)

41
Q

Which is the primary preferred method of induction of labour?

A

Vaginal prostaglandins

42
Q

How do vaginal prostagandins work to induce labour?

A

Prostaglandins act to prepare the cervix for labour by “ripening” it, and also have a role in the contraction of the smooth muscle of the uterus. They come as either a tablet, gel or a controlled-release pessary

43
Q

What is an amniotomy?

A

An amniotomy is where the membranes are ruptured artificially using an instrument called an amnihook.

44
Q

How does an amniotomy work to induce labour?

A

this process releases prostaglandins in an attempt to expedite labour. It is only performed when the cervix seems “ripe”.

45
Q

What is often given alongside amniotomy for IOL?

A

An infusion of artificial oxytocin (Syntocinon).

46
Q

Why is an infusion of artificial oxytocin given alongside amniotomy to induce labour?

A

to increase the strength and frequency of contractions.

47
Q

When only is amniotomy used to induce labour?

A

If the use of prostaglandins are contraindicated

48
Q

When is a membrane sweep offered?

A

at 40 and 41 weeks’ gestation to nulliparous women, and 41 weeks to multiparous women.

49
Q

Why is a membrane sweep classified as an adjunct of IOL?

A

Performing it increases the likelihood of spontaneous delivery, reducing the need for a formal induction.

50
Q

How is a membrane sweep performed?

A

The procedure is performed by inserting a gloved finger through cervix and rotating it against the fetal membranes, aiming to separate the chorionic membrane from the decidua. The separation helps to release natural prostaglandins in an attempt to kick-start labour.

51
Q

What is the Bishop Score?

A

The bishop score is an assessment of ‘cervical ripeness‘ based on measurements taken during vaginal examination. It is checked prior to induction, and during induction to assess progress (6 hours post-table/gel, 24 hours post-pessary):

52
Q

What does a Bishop Score =/> 7 suggest?

A

suggests the cervix is ripe or ‘favourable’ – this means that there is a high chance of a response to interventions made to induce labour (i.e. induction of labour is possible).

53
Q

What does a Bishop Score <4 suggest?

A

suggests that labour is unlikely to progress naturally and prostaglandin tablet/gel/pessary will be required

54
Q

What may the failure of a cervix to ripen despite the use of prostaglandins result in?

A

The need for a caesarian section

55
Q

What must be monitored prior to an induction of labour?

A

Cardiotocography (CTG)- a reassuring fetal heart rate must confirmed

56
Q

How should fetal heart rate be monitered throughout induction of labour?

A

Prior= CTG for reassuring fetal HR
After initiation, when contractions begin, assess fetal HR using continuous CTG until normal rate confirmed
Subsequently assess using intermittent auscultation

If oxytocin infusion is started, monitor using continuous CTG throughout labour

57
Q

What monitoring is required if an oxytocin infusion is started?

A

Continuous CTG

58
Q

Complications of induction of labour?

A
  • Failure of induction
  • Uterine hyperstimulation
  • cord prolapse
  • infection
  • pain
  • increased rate of further intervention vs spontaneous labour
  • uterine rupture (rare)
59
Q

What percentage of Inductions of labour fail?

A

15%

60
Q

If induction fails, what happens next?

A

Offer a further cycle of prostaglandins or a caesarian section

61
Q

What is uterine hyperstimulation (complication in 1-5% of IOL)?

A

contractions that last too long or are too frequent, leading to fetal distress.

62
Q

How is uterine hyperstimulation as a complication of IOL managed?

A

Can be managed with tocolytic agents (anti-contraction) such as terbutaline.

63
Q

Which technique of IOL can most likely lead a cord prolapse?

A

Amniotomy, particularly if the presentation of the fetal head is high.

64
Q

How is the infection risk in IOL reduced?

A

risk is reduced by using pessary vs tablet/gel, as fewer vaginal examinations are required to check progress.

65
Q

IOL is often ____ painful than spontaneous labour

A

more

66
Q

What analgesia is often required for IOL?

A

epidural analgesia

67
Q

22% of IOLs end up requiring ____ and 15% end up requiring ____

A

emergency caesarian sections and instrument deliveries!

68
Q

List some situations in which it is better to start labour early:

A
  • Prelabour rupture of membranes
  • Fetal growth restriction
  • Pre-eclampsia
  • Obstetric cholestasis
  • Existing diabetes
  • Intrauterine fetal death
69
Q

What is a cervical ripening balloon (CRB)?

A

a silicone balloon that is inserted into the cervix and gently inflated to dilate the cervix. This is used as an alternative where vaginal prostaglandins are not preferred, usually in women with a previous caesarean section, where vaginal prostaglandins have failed or multiparous women (para ≥ 3).

70
Q

Complications of uterine hyperstimulation:

A
  • Fetal compromise, with hypoxia and acidosis
  • Emergency caesarean section
  • Uterine rupture
71
Q

What is Cardiotocography?

A

Cardiotocography (CTG) is used to measure the fetal heart rate and the contractions of the uterus. It is also known as electronic fetal monitoring.

72
Q

What is electronic fetal monitoring also known as?

A

Cardiotocography

73
Q

There are 2 transducers placed on the abdomen for CTG, where are they placed and why?

A
  • One above the fetal heart to monitor the fetal heartbeat
  • One near the fundus of the uterus to monitor the uterine contractions
74
Q

In CTG, The transducer above the fetal heart monitors the heartbeat using?

A

Doppler Ultrasound

75
Q
A

Year 4- OBGYN (12 decks)

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