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Finals > O&G: Labour + delivery > Flashcards

O&G: Labour + delivery Flashcards

1
Q

Induction of labour

when is it offered

A
  • between 41-42w
  • prelabour rupture of membranes
  • FGR
  • pre-eclampsia
  • obstetric cholestasis
  • existing diabetes
  • intrauterine fetal death
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2
Q

Induction of labour

what is used to determine whether to induce labour.

A

the Bishop Score

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3
Q

Induction of labour

what is the Bishop score based on

A
  • fetal station
  • cervical position
  • cervical dilatation
  • cervical effacement
  • cervical consistency
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4
Q

Induction of labour

what bishop score predicts a successful induction of labour

A

8 or more (out of 13)

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5
Q

Induction of labour

what does a bishop score <8 suggest

A

cervical ripening may be required to prepare the cervix

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6
Q

Induction of labour

what are the 5 options

A
  • membrane sweep
  • vaginal prostaglandin E2 (dinoprostone)
  • cervical ripening balloon
  • artificial rupture of membranes with oxytocin infusion
  • PO mifepristone (anti-progesterone) + misoprostol
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7
Q

Induction of labour

what does Vaginal prostaglandin E2 (dinoprostone) involve

A

inserting a gel, tablet (Prostin) or pessary (Propess) into the vagina.

slowly release local prostaglandins

stimulates the cervix and uterus to cause the onset of labour.

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8
Q

Induction of labour

when is cervical ripening balloon used

A

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).
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9
Q

Induction of labour

when is Artificial rupture of membranes with an oxytocin infusion used

A

where there are reasons not to use vaginal prostaglandins.

It can be used to progress the induction of labour after vaginal prostaglandins have been used.

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10
Q

Induction of labour

when are Oral mifepristone (anti-progesterone) plus misoprostol used

A

used to induce labour where intrauterine fetal death has occurred.

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11
Q

Induction of labour

what are the 2 methods for monitoring during the induction of labour

A

CTG: fetal HR and uterine contractions

and bishop score: monitors progress

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12
Q

Induction of labour

options for when there is slow or no progress

A
  • further vaginal prostaglandins
  • artificial RoM + oxytocin infusion
  • cervical ripening balloon
  • elective caesarean section
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13
Q

Induction of labour

what is the main complication of induction of labour with vaginal prostaglandins

A

uterine hyperstimulation : contraction of the uterus is prolonged and frequent, causing fetal distress and compromise

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14
Q

Induction of labour

criteria for uterine hyperstimulation

A
  • individual uterine contractions lasting >2min

- >5 uterine contractions every 10 min

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15
Q

Induction of labour

what can uterine hyperstimulation lead to

A
  • fetal compromise, with hypoxia + acidosis
  • emergency caesarean section
  • uterine rupture
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16
Q

Induction of labour

mnx of uterine hyperstimulation

A
  • removing vaginal prostaglandins, or stopping the oxytocin infusion
  • tocolysis with terbutaline
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17
Q

Postpartum haemorrhage

To be classified as postpartum haemorrhage, there needs to be a loss of?

A

500ml after a vaginal delivery

or 1L after a caesarean section

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18
Q

Postpartum haemorrhage

what is a minor PPH

A

<1L blood loss

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19
Q

Postpartum haemorrhage

what is a major PPH

A

> 1L blood loss

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20
Q

Postpartum haemorrhage

what can a major PPH be further sub-classified as

A

moderate PPH: 1L-2L

severe PPH: >2L

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21
Q

Postpartum haemorrhage

what is a primary PPH

A

bleeding within 24h of birth

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22
Q

Postpartum haemorrhage

what is a secondary PPH

A

bleeding from 24h 12w after birth

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23
Q

Postpartum haemorrhage

causes (4)

A

Tone: uterine atony (most common)

Trauma: perineal tear

Tissue: retained placenta

Thrombin: bleeding disorder

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24
Q

Postpartum haemorrhage

RFs

A
  • previous PPH
  • multiple pregnancy
  • obesity
  • large baby
  • failure to progress in the 2nd stage of labour
  • prolonged 3rd stage
  • pre-eclampsia
  • placenta accreta
  • retained placenta
  • instrumental delivery
  • general anaesthesia
  • episiotomy of perineal tear
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25
Q

Postpartum haemorrhage

preventative measures

A
  • treating anaemia during the antenatal period
  • give birth with an empty bladder (a full one reduces uterine contraction)
  • active mnx of the 3rd stage (w/ IM oxytocin)
  • IV tranexamic acid can be used during c-section (in 3rd stage) in higher risk pts
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26
Q

Postpartum haemorrhage

mnx

A
  • ABCDE
  • lie woman flat, keep warm, communicate with her
  • insert 2 large-bore cannulas
  • Bloods: FBC, U&E, clotting screen
  • Group and cross match 4units
  • warmed IV fluid + blood resus as required
  • O2 (regardless of sats)
  • FFP: where there are clotting abnormalities or after 4U of blood
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27
Q

Postpartum haemorrhage

in severe cases, what do you activate

A

the major haemorrhage protocol:

- rapid access to 4U of crossmatched or O negative blood

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28
Q

Postpartum haemorrhage

mechanical trx to stop the bleeding

A
  • rubbing the uterus

- catheterisation

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29
Q

Postpartum haemorrhage

medical trx to stop the bleeding

A
  • IV Oxytocin 40U in 500ml
  • ergometrine
  • carboprost
  • misoprostol
  • tranexamic acid
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30
Q

Postpartum haemorrhage

medical trx: what does ergometrine do

A

stimulates smooth muscle contraction (contraindicated in hypertension)

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31
Q

Postpartum haemorrhage

medical trx: what does Carboprost do

A

IM
prostaglandin analogue and stimulates uterine contraction

(caution in asthma)

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32
Q

Postpartum haemorrhage

medical trx: what does Misoprostol do

A

sublingual

prostaglandin analogue stimulates uterine contraction

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33
Q

Postpartum haemorrhage

medical trx: what does Tranexamic acid do

A

IV

an antifibrinolytic that reduces bleeding

34
Q

Postpartum haemorrhage

surgical trx options to stop the bleeding

A
  • Intrauterine balloon tamponade
  • B-Lynch suture
  • Uterine artery ligation
  • Hysterectomy (last resort)
35
Q

Postpartum haemorrhage

surgical trx: what is a B-lynch suture

A

putting a suture around the uterus to compress it

36
Q

Postpartum haemorrhage

surgical trx: what is Uterine artery ligation

A

ligation of one or more of the arteries supplying the uterus to reduce the blood flow

37
Q

Postpartum haemorrhage

what is a secondary PPH more likely be due to

A

retained products of conception (RPOC) or infection (i.e. endometritis).

38
Q

Postpartum haemorrhage

inx of a secondary PPH

A
  • US: for retained products of conception

- endocervical + high vaginal swabs for infection

39
Q

Postpartum haemorrhage

mnx for retained products of conception

A

surgical evacuation

40
Q

Postpartum haemorrhage

mnx for infection

A

abx

41
Q

Amniotic Fluid Embolism

what is it

A

the amniotic fluid passes into the mother’s blood

usually around labour

42
Q

Amniotic Fluid Embolism

why is there an immune reaction

A

The amniotic fluid contains fetal tissue

immune reaction to cells from the foetus leads to a systemic illness

43
Q

Amniotic Fluid Embolism

RFs (4)

A
  • Increasing maternal age
  • Induction of labour
  • Caesarean section
  • Multiple pregnancy
44
Q

Amniotic Fluid Embolism

presentation

A

It can present similarly to sepsis, PE or anaphylaxis:

  • SOB
  • hypoxia
  • hypotension
  • coagulopathy
  • haemorrhage
  • tachycardia
  • confusion
  • seizures
  • cardiac arrest
45
Q

Amniotic Fluid Embolism

mnx

A

supportive, ABCDE

46
Q

Onset of Labour

when does labour and delivery normally occur

A

37 - 42w gestation

47
Q

Onset of Labour

when is the 1st stage of labour

A

from the onset of labour (true contractions) until 10cm cervical dilatation

48
Q

Onset of Labour

when is the 2nd stage of labour

A

from 10cm cervical dilatation until delivery of the baby

49
Q

Onset of Labour

when is the 3rd stage of labour

A

from delivery of the baby until delivery of the placenta

50
Q

Onset of Labour

what does the ‘show’ refer to

A

the mucus plug in the cervix, which prevents bacteria from entering the uterus during pregnancy

it falls out and creates space for baby to pass through

51
Q

Onset of Labour

what are the 3 phases in the 1st stage of labour

A

latent

active

transition

52
Q

Onset of Labour

1st stage: what is the latent phase

A
  • from 0 to 3cm dilation of the cervix
  • progresses at 0.5cm/hr
  • irregular contractions
53
Q

Onset of Labour

1st stage: what is the active phase

A
  • from 3cm to 7cm dilation of the cervix
  • progresses at 1cm/hr
  • regular contractions
54
Q

Onset of Labour

1st stage: what is the transition phase

A
  • from 7cm to 10cm dilation of the cervix
  • progresses at 1cm/hr
  • strong regular contractions
55
Q

Onset of Labour

what are Braxton-Hicks contractions

A

irregular contractions of the uterus

usually felt at the 2nd and 3rd trimester

not true contractions, and they do not indicate the onset of labour.

56
Q

Onset of Labour

how to help reduce Braxton-Hicks contractions

A

hydration and relaxing

57
Q

Onset of Labour

what are the 4 signs of labour

A
  1. show
  2. rupture of membranes
  3. regular, painful contractions
  4. dilating cervix on examination
58
Q

Onset of Labour

NICE dx of latent 1st stage

A

both of:

  • painful contractions
  • changes to cervix, with effacement and dilation up to 4cm
59
Q

Onset of Labour

NICE dx of established 1st stage of labour

A

both of:

  • regular, painful contractions
  • dilatation of cervix from 4cm onwards
60
Q

Active Management of the Third Stage

what are the 2 options for the 3rd stage

A

physiological

active

61
Q

Active Management of the Third Stage

what is physiological mnx

A

where the placenta is delivered by maternal effort without medications or cord traction.

62
Q

Active Management of the Third Stage

what is active mnx

A
  • IM 10U oxytocin

- traction to umbilical cord

63
Q

Active Management of the Third Stage

benefits of active mnx

A

shortens the third stage and reduces the risk of bleeding

64
Q

Active Management of the Third Stage

disadvantages of active mnx

A

associated with nausea and vomiting.

65
Q

Active Management of the Third Stage

when is it offered

A
  • routinely offered to all women to reduce the risk of postpartum haemorrhage
  • Haemorrhage
  • More than a 60-minute delay in delivery of the placenta (prolonged third stage)
66
Q

Uterine Rupture

what is it

A

a complication of labour

the muscle layer of the uterus (myometrium) ruptures.

67
Q

Uterine Rupture

what is incomplete rupture (aka uterine dehiscence)

A

the uterine serosa (perimetrium) surrounding the uterus remains intact.

68
Q

Uterine Rupture

what is complete rupture

A

the serosa (perimetrium) ruptures along with the myometrium

and the contents of the uterus are released into the peritoneal cavity.

69
Q

Uterine Rupture

what is the main RF

A

a previous caesarean section

the scar on the uterus becomes a point of weakness and may rupture with excessive pressure (e.g. excessive stimulation by oxytocin)

70
Q

Uterine Rupture

RFs

A
  • Vaginal birth after caesarean (VBAC)
  • Previous uterine surgery
  • Increased BMI
  • High parity
  • Increased age
  • Induction of labour
  • Use of oxytocin to stimulate contractions
71
Q

Uterine Rupture

presentation

A
  • acutely unwell moth
  • abnormal CTF
  • ceasing of uterine contractions
  • abdo pain
  • vaginal bleeding
  • Hypotension
  • Tachycardia
  • Collapse
72
Q

Uterine Rupture

mnx

A

emergency

  • resus + transfusion
  • emergency c-section is necessary to remove baby, stop any bleeding and repair or remove the uterus (hysterectomy).
73
Q

Uterine Inversion

what is it

A

a rare complication of birth

the fundus of the uterus drops down through the uterine cavity and cervix

74
Q

Uterine Inversion

what is incomplete uterine inversion (partial inversion)

A

the fundus descends inside the uterus or vagina, but not as far as the introitus (opening of the vagina)

75
Q

Uterine Inversion

what is complete inversion

A

the uterus descends through the vagina to the introitus.

76
Q

Uterine Inversion

what is a possible cause

A

pulling too hard on the umbilical cord during active management of the third stage of labour

77
Q

Uterine Inversion

presentation

A
  • large post partum haemorrhage

- maternal shocl or collapse

78
Q

Uterine Inversion

examination findings of incomplete uterine inversion

A

may be felt with manual vaginal examination

79
Q

Uterine Inversion

examination findings of complete uterine inversion

A

the uterus may be seen at the introitus of the vagina

80
Q

Uterine Inversion

3 options for trx

A
  1. Johnson manoeuvre
  2. Hydrostatic methods
  3. Surgery
81
Q

Uterine Inversion

initial mnx and what is it

A

Johnson manoeuvre

using a hand to push the fundus back up into the abdomen and the correct position

oxytocin used to a create a uterine contraction

ligaments and uterus need to generate enough tension to remain in place

82
Q

Uterine Inversion

mnx: what does the hydrostatic method involve

A

filling the vagina with fluid to “inflate” the uterus back to the normal position

tight seal required at entrance of vagina

Finals (47 decks)

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