Obs Flashcards
What is normal labour?
When diagnosed?
Process where foetus and placenta are expelled from uterus
Painful uterine contractions + dilation/effacement of cervix
Mechanical factors in labour?
power
passage
passenger
Braxton-Hicks contractions?
painless uterine contractions from 30/40
can be palpated
who has poor uterine activity?
nulip
induced labour
where is the ‘pacemaker’ of the uterus?
junction of fallopian tube and uterus
physiological changes due to contractions?
permanent shortening of muscle fibres –> distension
what causes pain in contractions?
ischaemia in myometrial fibres
RFs for abnormal lie?
polyhydramnios
multip
fetal/uterine abnormalities
preterm
what position in extended breech?
buttocks present; legs extended by head
what is presentation?
part of fetus occupying the lower segment of uterus
how common is abnormal lie?
1/200
3 main parts of passage?
bony pelvis -inlet, mid cavity, outlet
ishial spine - used to assess descent
soft tissues - cervical dilation, vagina and perineum
what does station 0 mean?
head level with ischial spines
+ve = below
-ve = above
which presentation is best?
Vertex (narrowest diameter)
occipito-anterior normal deliver
3 stages of labour
1 - initiation to full cervical dilatation
- -> Latent - slow dilation up to 3cm
- -> Active - about 1cm/hr
2 - full cervical dilation to delivery of fetus
- -> passive - til head reaches pelvic floor (desire to push)
- -> active - mother pushing
3 - delivery of foetus to delivery of placenta
- -> normall 15 mins
- -> expectant or active management
how to epidurals affect labour?
remove desire to push
so labour is longer
expectant management of 3rd stage?
active?
light massage of uterus through abdo
IM - syntocinon
normal blood loss in delivery?
VD?
CS?
VD = 500ml CS = 1000ml
Identifying abnormal labour?
partogram
most common cause of slow progress in primip?
inefficient uterine action
what is the worry in multip with slow progress in labour?
malposition –> uterine rupture is more likely
when do you use tocolysis?
iatrogenic uterine hyperactivity eg prostaglandin
why is eating discourage in labour?
whats this called?
aspiration of stomach contents
under anaesthetic = Mendelson’s syndrome
general care points in labour?
physical - obs, mobility, delivery positions
mental - environment, control, partner
what to do in persistent inefficient uterine action?
augmentation (ARM)
Hyperactive uterine action can lead to…?
placental abruption
mx of hyperactive uterine action?
if no evidence of abruption –> tocolytic eg salbutamol
usually LSCS
what is augmentation? egs?
artificial strengthening of contractions in established labour
ARM, amniotomy, artificial oxytocin
nulip with slow 1st stage?
poor descent in passive 2nd stage?
longer than 1h in active second stage?
augementation –> if no full dilation by 16h –> LSCS
P2nd - oxytocin infusion
A2nd -> episiotomy, ventouse
how frequent do you auscultate fetal heart?
1st stage - /15mins
2nd - /5mins
intrapartum fetal problems?
meconium aspiration
fetal blood loss
trauma
infection (GBS)
what is fetal destress?
signs?
hypoxia that could lead to fetal damage / death
colour of meconium, auscultate fetal heart, CTG, fetal blood sampling (scalp)
CTG mnemoic
DR C BRAVADO (normal values) Define risk Contractions / 10mins (<5) Base rate (110-160) Variability (>5) Accelerations (with movement/contractions) Deceleration Overall assessment
What might fetal tachycardia indicate?
Fetal bradycardia?
fever, infection, hypoxia
sustained deterioration –> distress due to hypoxia
what do early, variable and late deceleration suggest?
early - synchronous with contraction = normal
variable - cord compression causing hypoxia
late - persist after contraction = hypoxia
what to do with sustained fetal brady?
deliver urgently!
pain relief in labour?
non-pharma –> warm towel / massage
pharma –> entonox, opiates (+antiemetic), epidural
perineal trauma degrees?
mx?
1 - skin only
2 - perianal muscles but not sphincter
3 - involving anal sphincter
4 - anal sphincter + epithelium
1/2 - suture under LA
3/4 - epidural + physio
how frequently do you USS in multiple pregnancy?
monthly from 20/40
gestration for an elective CS?
37/40
comps of multiple pregnancy?
prem
twin-twin transfusion?
when is it concerning?
arterial blood flow from donor through placenta to vein of recipient
if >30% discordance
comps of twin-twin transfusion?
donor - IUGR, oligohydramnios, hypovolaemia, hypotension, anaemia
recipient - poyhydramnios, hypertension, polycythaemia, oedema, kernicterus, CHF
mx of twin-twin transfusion?
doppler analysis
therapeutic amniocentesis to decrease polyhydramnios of recipient
+/- intra-uterine blood transfusion
RFs for shoulder dystocia?
high birth weight, maternal DM, induced labour, prev shoulder dystocia, oxytocin, abnormal lie
what is shoulder dystocia?
failure of the shoulder to deliver
comps of shoulder dystocia?
cord compression
asphyxiation
Erb’s palsy
mx of shoulder dystocia
HELPERR "Help!" Episiotomy Legs (McRoberts) Pressure (suprapubic) Enter (rotational manouevers) Remove posterior arm Roll patient onto hands + knees
last resort in shoulder dystocia?
deliberate clavicular fracture
Zavanelli’s (push head back in + CS)
abdo surgery with hysterectomy
RFs for cord prolapse?
preterm breech abnorm lie multiples **AMNIOTOMY**
mx of cord prolapse
elevate presenting part to prevent cord comp
tocolytics (nifedipine, terbutaline)
CS
Pres of amniotic fluid embolus?
sudden dyspnoea, hypoxia, hypotension
can occur at any time in pregnancy
–> ARDS
mech of amniotic fluid embolus?
liquor enters maternal circulation –> anaphylaxis +/- seizures and cardiac arrest
mx of amniotic fluid embolus?
O2, fluids
bloods
blood transfusion + FFP
ICU
RFs for uterine rupture?
labour with scared uterus
CS / prev
obstructed labour
sx of uterine rupture
fetal heart rate abnomalities constant abdo pain VB cessation of contractions maternal collapse
comps of uterine rupture
fetal hypoxia
massive internal haemorrhage
high recurrence rate
mx of uterine rupture
maternal resus
urgent laparotomy for delivery
uterine inversion?
pres?
fundus inverts into uterine cavity PPH lower abdo pain vaginal mass CV collapse
mx of uterine inversion
GA fluid replacement 1 - manually push back 2 - fill with warm saline 3 - laparotomy
mx of epileptiform seizures?
clear airway, O2
diazepam if epilepsy
MgSO4 if eclampsia
induction vs augmentation?
induction = artificial initiation of labour augmentation = promotes contractions when spont contractions are inadequate
what is a ripe cervix? how can you ripen it?
soft, short, think, anterior cervix with open os
prostaglandin
CIs for induction of labour?
fetal distress
cord presentation
pelvic tumour
praevia