Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - O&G > O&G - Normal Labour & Delivery > Flashcards

O&G - Normal Labour & Delivery Flashcards

1
Q

What is the definition of Preterm?

A

Baby born < 37-weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Breech presentation?

A

Bottom first i.e.

When caudal end (bottom first) occupies the lower uterine segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How long do we say a normal pregnancy should last?

A

40-weeks

(from the 1st day of the LMP to estimated delivery date)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name some risk factors for Breech presentation.

A

Risk factors for Breech ppresentation:

  1. uterine malformations
  2. fibroids
  3. placenta praevia
  4. amniotic fluid abnormalities - polyhydramnios or oligohydramnios
  5. fetal abnormality (e.g. CNS malformation, chromosomal disorders)
  6. prematurity (~25% of pregnancies are breech at 28-weeks, this drops to ~3% at birth - thus in prematurity breech is more likely)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What serious complication of delivery is more common in Breech births?

A

Cord Prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is Breech presentation managed?

A
  1. if < 36-weeks –> many fetuses turn spontaneously
  2. if breech at 36-weeks –> external cephalic version (ECV)
    • ECV success rate = 60%
    • Offer ECV from 36-weeks in nulliparous women
    • Offer ECV from 37-weeks in multiparous women
  3. if breech after ECV –> plan delivery options include vaginal delivery OR planned C-section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What advise/info should be given to women when they are considering management of breech presentation after ECV?

A
  1. Choice of delivery method for breech-baby at term –> No long term impact on health of baby
  2. Planned C-section for breech has ↓ perinatal mortality & early neonatal morbidity compared with vaginal delivery for breech
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some contraindications to women being offered External Cephalic Version (ECV) at 36-weeks (or in general)?

A
  1. if C-section delivery is required
  2. antepartum haemorrhage in last 7-days
  3. abnormal cardiotocography (CTG)
  4. major uterine anomaly
  5. ruptured membranes
  6. multiple pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Cord Prolapse?

A

When the umbilical cord descends ahead of the fetus during delivery - if not managed can cause cord compression / cord spasm –> fetal hypoxia / irreversible dmg or death

  • 1 in 500 deliveries
  • Diagnosis:
    • fetal HR abnormal + palpable cord vaginally OR visible cord at vaginal entrance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some risk factors for Cord Prolapse?

A
  • prematurity
  • multiparity
  • twin pregnancy
  • polyhydramnios
  • cephalo-pelvic disproportion
  • abnormal presentations e.g. Breech or transverse lie
  • placenta praevia
  • long umbilical cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is Cord prolapse managed?

A
  1. Presenting part of fetus is pushed back into uterus
  2. Uterine relaxants (tocolytics) used
  3. If cord is past vaginal entrance –> keep warm + moist (do not push inside)
  4. Pt is put ‘on all fours’ unitil preparations for emergency C-section are made
  5. Emergency C-section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Beta-hCG:

  • Where is it produced?
  • When do it peak during pregnancy?
  • What is its effect?
A
  • B-hCG is produced by the placenta
  • B-hCG peaks at ~ 7-weeks gestation
  • B-hCG –> keep corpus luteum alive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where are Oestrogen and Progesterone released from during pregnancy?

A

Corpus luteum until 3rd trimester - then is mainly the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does Oestrogen do to the uterus during pregnancy?

A

↑ no. of Oxytocin receptors in uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does Progesterone do to the uterus during pregnancy?

A

Relaxes uterine smooth muscle - preventing pre-term labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the sequence of hormonal events causing labour in pregnancy?

A
  1. Fetal stress –> stims Adrenocorticotropic hormone (ACTH) release from anterior pituitary (fetal) –> stims cortisol release from fetal adrenal glands
  2. Fetal cortisol –> acts on placenta to:
    • ↓ Progesterone
    • ↓ Oestrogen
    • ↑ Prostaglandins –> stim uterine contraction
  3. Fetus pushes on cervix/uterus –> stims sensory nerve fibres –> stims oxytocin production by hypothalamus (which is then stored in and released from the posterior pituitary)
  4. Oxytocin –> stims uterine contraction + ↑ prostaglandins –> labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Labour?

A

Onset of regular and painful contractions associated with cervical dilation and descent of the presenting part of the fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the signs of labour?

A
  1. a ‘show’ i.e. shedding of mucous plug (clear mucoid discharge)
  2. regular + painful uterine contractions
  3. rupture of the membranes (not always) - due to uterine contractions causing rupture of amnitoic sac i.e. ‘water-breaking’
  4. shortening & dilation of the cervix
19
Q

What are the Stages of Labour?

A
  • Stage 1 - from the onset of true labour to when the cervix is fully dilated
  • Stage 2 - from full dilation to delivery of the fetus
  • Stage 3 - from delivery of fetus to when the placenta & membranes have been completely delivered
20
Q

What monitoring is done during labour?

A
  1. Fetal HR every 15-min for 1 min (or continuously via CTG)
  2. Contractions assessed every 30-min
  3. Maternal HR / pulse assessed every 60-min
  4. Maternal BP + temp checked every 4-hours
  5. Vaginal exam offered every 4-hours to check progression of labour
    • Offer hourly in 2nd stage of labour
  6. Maternal urine checked for ketones & protein every 4-hours
21
Q

What position does the head normally deliver in a cephalic delivery?

A

Occipito-anterior position

(fetus face down)

Fetal head enters the pelvis in the left/right occipito-lateral position then turns for delivery normally

22
Q

Stage 1 of labour is made of 2 phases - what are they?

A
  • latent phase = 0-3 cm dilation (normally takes ~ 6-hours)
  • active phase = 3-10 cm dilation (normally 1 cm/hr)
23
Q

How long does the stage 2 of labour last on avg?

A
  • Nulliparous - birth in ~ 3-hours from start of active 2nd stage
    • Diagnose delay if active 2nd stage > 2-hours
  • Multiparous - birth in ~ 2-hours from start of active 2nd stage
    • Diagnose delay if active 2nd stage > 1-hours

If delay is diagnosed –> operative vaginal birth (instrumental)

24
Q

What causes amniotic fluid during rupture of membranes to be green / smelly?

A

Presence of Meconium in amniotic fluid

  • Danger - fetus can aspirate the meconium as it floats in the amniotic fluid
25
Q

What are some contraindications to artificial rupture of membranes?

(this is normally done to induce/accelerate labour)

A
  1. Breech-position
  2. Placenta Previa
26
Q

What is Failure to Progress?

A

Failure of to progress through labour (can occur in any stage)

27
Q

What qualifies at ‘Failure to Progress’ in stage 1 of labour?

A

Failure to Progress (Stage 1)

Nulliparous

  • Initial phase = > 20-hrs
  • Active phase = ~ < 1.2 cm/hr

Multiparous:

  • Initial phase = > 14-hrs
  • Active phase = ~ < 1.5 cm/hr
28
Q

What are some indications for Forceps delivery?

A
  1. fetal distress in stage 2 of labour
  2. maternal distress in stage 2 of labour
  3. failure to progress in stage 2 of labour
  4. control of head in breech deliver
29
Q

At what times is the APGAR score done after birth?

A

1 min & 5 mins after birth

(repeat if < 7)

30
Q

During what period can intrapartum haemorrhage occur?

A

Haemorrhage occuring between onset of labour - end of stage 2 of labour

31
Q

What is Uterine Rupture?

A

When the muscular wall of the uterus tears during pregnancy or childbirth

  • incomplete = peritoneum is intact
  • complete = contents of uterus spill into peritoneal cavity
32
Q

What are some risk factors for uterine rupture?

A
  1. Uterine scar from previous C-section (commonest risk factor)
  2. Uterine scars from other surgeries e.g. myomectomy
  3. Labour augmentation by oxytocin or prostaglandins (↑ uterine contractions)
  4. Factors that ↑ force applied to uterine muscle:
    • Shoulder dystocia
    • Breech extraction
    • Placenta accreta
33
Q

What are the features of Uterine rupture?

A
  • Acute onset significant CTG changes (70% cases)
  • Maternal tachycardia
  • PV bleeding
  • Abdo pain
  • CTG abnormalities
  • Easily palpable fetal parts via abdomen
  • Hypovolaemic shock
34
Q

How is Uterine Rupture managed?

A

Emergency - All help!!

ABCDE / resuscitation

Emergency laparotomy (with repair of defect) - hysterectomy may be required

35
Q

What is the prognosis of complete uterine rupture?

A

75% perinatal mortality

36
Q

When is haemorrhage classified as post-partum?

A

Haemorrhage occuring from stage 3 of labour until the end of the peurperium

  • peurperium = period of 6-weeks post-childbirth when mother’s reproductive organs return to normal
37
Q

What are some indications for Emergency C-section?

A
  1. Cord prolapse
  2. Failure to progress
  3. Fetal distress in Stage 1
  4. Antepartum haemorrhage
  5. Transverse lie in labour
38
Q

What are some of the ‘frequent’ risks of C-section?

A

Maternal:

  • persistent wound
  • abdominal discomfort in the 1st few months post-op
  • ↑ risk of future C-section when vaginal delivery attempted in subsequent pregnancies
  • readmission to hospital
  • haemorrhage
  • infection (wound, endometritis, UTI)

Fetal:

  • lacerations (1 or 2 in 100)
39
Q

What are the ‘serious’ risks of C-section?

A

Maternal:

  • emergency hysterectomy
  • may need further surgery at a later date e.g. curettage (retained placental tissue)
  • subfertility (due to adhesions)
  • admission to ICU
  • thromboembolic disease (X8 compared to vaginal birth)
  • bladder injury
  • ureteric injury
  • death (1 in 12,000)

Fetal:

  • ↑ risk of uterine rupture in subsequent deliveries
  • ↑ risk of antepartum stillbirth
  • ↑ risk of placenta praevia & placenta acreeta in future pregnancies
40
Q

What are the classifications of perineal tears?

A
  • 1st degree = superficial damage with no muscle involvement
  • 2nd degree = injury to the perineal muscle, but not involving the anal sphincter
  • 3rd degree = injury to perineum involving the anal sphincter complex - which is composed of external anal sphincter (EAS) and internal anal sphincter (IAS)
    • 3a = < 50% of EAS thickness
    • 3b = > 50% of EAS thickness
    • 3c = IAS torn
  • 4th degree = injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa
41
Q

What are some risk factors for perineal tears?

A
  1. primigravida
  2. large babies
  3. precipitant labour (unusually rapid)
  4. shoulder dystocia
  5. forceps delivery
42
Q

Stage 2 of labour is split into 2 phases - what are they?

A

Stage 2 of Labour:

  • Passive second stage - full dilation + absence of involuntary expulsive contractions
  • Active second stage - full dilation + expulsive contrations
43
Q

What positions should we encourage birthing women to avoid?

A

Supine or semi-supine

Year 4 - O&G (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions