O+G- Labour + Antenatal care Flashcards
How many stages of labour are there?
a) 3
b) 4
c) 5
d) 6
a) 3
There are three stages of labour – dilation, expulsion and delivery of the placenta
At what cervical dilation is a woman in active labour?
a) 6
b) 10
c) 3
d) 8
c) 3
The active phase of labour begins when the cervix is 3cm dilated
Which term describes a first pregnancy?
a) multiparous
b) gravidy
c) Postpartum
d) primiparous
d) primiparous
Primiparous refers to a first pregnancy.
Multiparous refers to any subsequent pregnancies.
Gravity means the number of times a person has been pregnant.
What is Parturition?
• Parturition is the process whereby the foetus and placenta are expelled from the uterus, which usually occurs between 37-42 weeks
Parturition occurs in three stages which are?
- Dilation (latent/active)
- Expulsion of the foetus
- Delivery of the placenta
In first pregnancies, the process lasts around ___ hours. In subsequent pregnancies, it is a lot shorter
In first pregnancies, the process lasts around 18 hours. In subsequent pregnancies, it is a lot shorter
Stage 1 - Dilation
occures in two phases which are?
– the latent phase and the active phase
Stage 1 - Dilation
Latent phase- what are the three key points to know?
- 0-3cm dilation
- Irregular contractions every 5-30mins, lasting 30secs
- Cervical effacement is completed
Stage 1 - Dilation
Active phase- what are the three key points to know?
- 4-10cm dilation
- Regular contractions every 3-5mins, lasting +1min
• Average cervical dilation in the active phase is around 1cm/h in nulliparous women and around 2cm/ in multiparous women
• Should last for around 2-6hrs
Stage 1 of labour – What are assessments of the mother
- Observations: temperature & blood pressure (4 hourly), pulse (hourly), urine (protien/ketones), contraction frequency ( 30 mins) (strength, length, frequency)
- Cervix: dilation, effacement, position
- Amniotic fluid: intact membranes/colour of liquor
Stage 1 of labour – What are assessments of the foetus
- Presentation/position/engagement
- Heart rate (Pinard stethoscope or hand-held doppler)
- External foetal monitoring (cardiotocograph)
- Foetal scalp blood sampling
Explain Stage 2 of labour
Expulsion of the Foetus
Divided into a passive and active stage
- The passive stage lasts for a few minutes, but can be longer
- The active stage last for an average of 40 minutes (20 mins in multiparous)
- Active stage ends with the delivery of the foetus
Explain stage 3 of labour?
- The time from delivery of the fetus to delivery of the placenta
- Lasts around 15 minutes
- Normal blood loss is 500ml
Stage 3 of Labour
– Assessment of the Mother and foetus
- Full dilation of the cervix confirmed by vaginal examination if the head is not visible
- Valsalva manoeuvre – woman will get an expulsive reflex with each contraction, will take a deep breath, hold it, and strain down
Explain the mechanism of labour
- Engagement
- Descent
- Flexion
- Internal rotation
- Extension
- Restitution
- External rotation
- Delivery of the shoulders and foetal body
What are the three fetal changes after birth?
1. The gas exchange takes place in the baby’s lungs
- Lung liquid squeezed out of the thorax during vaginal delivery
- Baby takes first gasp - air-liquid interface which moves rapidly down the lungs
- Blood supply to lungs increases dramatically
2. Placental circulation is switched off when the cord is cut
3. Foetal heart shunts become closed.
- Pressure change in atria causes the foramen ovale to close
- Prostaglandins cause the ductus arteriosus to close
- Ductus venosus closes within minutes of birth – can take up to a week
WHat is the APGAR Score
The APGAR score is a tool to measure the physical condition of a newborn infant. It is usually recorded at 1 and 5 minutes
What is the third phase of labour?
a) Delivery of the placenta
b) Latent dilatation
c) Expulsion of the foetus
d) Active dilatation
a) Delivery of the placenta
It is important not to forget stage 3, the delivery of the placenta. This can easily be forgotten in the excitement of the delivery of the baby
How often should the mother be monitored in the first stage of labour?
a) 3hrs
b) 2hrs
c) 4hrs
d) Half an hour
c) 4hrs
It is recommended that mothers are monitored every 4 hours in stage 1 of labour
What does ‘G’ stand for in APGAR?
a) Growth
b) Grunting
c) Gas
d) Grimace
d) Grimace
Appearance, Pulse, Grimace, Activity, Respiratory effort
By what weeks gestation should the “Booking Appointment” be?
a) 8 weeks
b) 14 weeks
c) 10 weeks
d) 12 weeks
c) 10 weeks
Ideally should have taken place by 10 weeks, but many women have their booking appointment between 8 and 12 weeks.
How many ANC appointments should a nulliparous uncomplicated women have?
a) 7
b) 10
c) 12
d) 8
b) 10
At what week does the measurement of fundal height begin?
a) 16 weeks
b) 30 weeks
c) 20 weeks
d) 25 weeks
d) 25 weeks
This allows a pregnancy to be mapped so ensure baby is growing as should be
What is ‘Antenatal Care?’
• Antenatal care is care given to every pregnant woman by midwives and on occasion Obstetricians
The needs of each pregnant women should be reassessed at each appointment throughout the entire pregnancy
How many appointments?
- Nulliparous women attend __ appointments
- Multiparous women attend __ appointments
- If the pregnancy is complicated i.e. Pre – existing medical conditions are present, then more appointments, especially with the Obstetrician.
10
7
What happens in a booking appointment?
This can be many women’s first contact with a healthcare professional and so information should be given:
- Folic acid supplementation 400 micrograms per day until 12 weeks/ Vitamin Diu • Lifestyle advice
- Antenatal screening information
- How the baby develops during pregnancy
- It is important to identify women who may need extra care and to plan the pattern of care for their pregnancy
- Check blood group and Rhesus D status
- Offer screening for Anaemia, Hep B, HIV, Rubella and Syphilis, Asymptomatic bacteriuria, Down’s Syndrome
• Calculate BMI, measure blood pressure and test urine
• Ultrasound scan to determine gestational age using:
- Crown rump measurement between 10 weeks and 13 weeks 6 days
- Head circumference if crown rump length is above 84 millimeters
How do you test for down syndrome?
- Combined test at 11 weeks 0 to 13 weeks 6 days
- Serum screening test at 15 weeks 0 days to 20 weeks 0 days
• Ultrasound screening for structural anomalies between __ weeks 0 days and ___ weeks 6 days
18
20
What happens in a 16 week appointment?
- Review and discuss the results of any screening tests.
- Investigate a haemoglobin level before 11g/100ml and consider iron supplementation
- Measure blood pressure and test urine for proteinuria
- Give information about the routine anomaly scan; offer verbal information supported by antenatal classes and written handouts
What happens between 18 and 20 weeks:
- An ultrasound scan should be performed to detect any structural anomalies’
- If a placenta is found to extend across the internal cervical OS at the time of the scan another scan at 32 weeks should be offered
What happens between 25 and 28 week Appointments
25 week appointment offered to all nulliparous women. At this appointment it is important to:
- Measure and plot the symphysis – fundal height (SFH)
- Offer support, opportunity for women to bring up concerns or ask about antenatal classes etc
28 week appointment is offered to all women.
- Second screening for Anaemia, offer iron supplementation
- Offer anti D prophylaxis to Rhesus negative women
- Measure SFH, BP and Urine
- Again, encourage any concerns to be voiced
Nulliparous women are offered an appointment at ___ weeks to measure __, urine and ___ as well as discuss any screening results
Nulliparous women are offered an appointment at 31 weeks to measure BP, urine and SFH as well as discuss any screening results
From which week is women seen every two weeks?
34/36
What to look out for 34 weeks?
- Preparation for labour and birth should be made, a birthing plan is created
- Recognition and discussion of active labour
- A second dose an anti D is given to rhesus negative women
- Measure BP, urine and SFH, and discuss any further screening tests that occurred at 28 weeks if not done so at the 31 week appointment.
What to look out for 36 weeks?
- Information should be given regarding breastfeeding, care of the new baby, Vitamin K prophylaxis, new born screening tests and postnatal self care.
- Measure BP, urine and SFH.
- Check the position of the baby and if breech presentation, offer external cephalic version
When is women classed as full term
37 weeks
This means that although these appointments are booked in with the midwifes, they may not be attended.
What happens in 38 weeks?
- BP and urine are measured – screening for late onset pre – eclampsia ‘
- Measurement of SFH
- Information is given about prolonged pregnancy
What are women offered at 41 weeks
- A membrane sweep is offered
- Induction of labour is offered
- SFH, BP and urine is also measured for the final time.
What is the combined test commonly used to screen for?
a) Fetal macrosomia
b) Down’s Syndrome
c) Rhesus D status
d) Anaemia
b) Down’s Syndrome
Offered as a serum blood test and a scan to measure nuchal translucency
What is a Nuchal translucency test?
a) A blood test
b) Measurement of amniotic fluid level
c) Measurement of fluid behind baby’s neck
d) Amniotic fluid sample taken
c) Measurement of fluid behind baby’s neck
Part of the combined screening test for Down’s
When is anti D prophylaxis given?
a) 34 and 36 weeks
b) 24 and 28 weeks
c) 28 and 36 weeks
d) 28 and 34 weeks
d) 28 and 34 weeks
