OBS AND GYNAE LECTURES Flashcards
What is a normal birth:
One that is spontaneous in onset, low risk at the start of labour and remaining so throughout the labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 weeks of pregnancy. After birth, both mother and infant are well.
What are the 3 stages of birth:
Latent
Effacement
Engagement
What is involved in the latent phase?
- Consists of irregular contractions
- The period lasts between 6 hours to 2-3 days.
- The Cervix effaces in this period and thins. This shows a mucoid plug
- In this phase women are told to stay at home: rest, keep hydrated and have paracetamol.
What is involved in the effacement phase?
- This process starts in the fundus (pacemaker) and involves the retraction and shortening of the muscle fibres.
- This builds an amplitude for labour
- The foetus is eventually forced down and puts pressure on the cervix
- After full effacement the cervix undergoes dilation originally at 5cm and eventually 10cm.
What is involved in engagement of the foetus?
- The head is mobile above the symphysis pubis
- The head accommodates a full width of fiver fingers above the symphysis pubis
- Head is 2/5 above symphysis pubis
Head accommodates two fingers above the symphysis pubis
What is presentation?
Presentation: the anatomical part of the foetus that presents its self first through the birth canal. You want the head to flexed and at its narrowest par of the head.
What is a lie?
Lie: relationship between the long axis of the foetus and the long axis of the uterus
What is attitude?
Attitude: whether the baby is presenting as flexed or deflexed
What is engagement?
Engagement: widest part of the presenting part passed through the brim of the pelvis.
What is station?
Station: relationship between the lowest presenting part and the ischial spines.
What is active labour deemed as?
4cm dilation with regular frequent contractions
The process is progressive
What are 4 methods used for pain relief?
- Psychological methods: - - Psychological methods: imagery, relaxation and hypnobirthing
- Sensory methods: hydrotherapy and TENS
- Birth environment
- Complementary: massage, acupuncture and reflexology etc.
- Water birth: reduces pain and the use of regional analgesia.
What are 3 commonly used medications in pregnancy?
Entonox
Opiates
Epidural
What are the 8 factors of mechanisms of labour
Mechanism of labour:
- Descent - Flexion - Internal rotation - Crowning - Extension - Reitution - Internal restitution of shoulders - Lateral flexion
What is competency?
Legal term use to indicate that a person has the ability to make and be held accountable for their decision
What are some RF for developing HTN in pregnancy?
- Young females
- Black population
- Multifetal pregnancy
- Hypertension
- Renal
- Collagen Vascular diseas
When is it classed as gestational Hypertension
After 20 weeks
When is it pre-eclampsia?
after 20 weeks
What are 3 of the clinical test criteria for Pre-Eclampsia?
- Imparied liver function tests
- Thrombocytopenia <100,000
- Intrauterine growth restriction
Oligohydramnios
What is the treatment of acute severe hypertension in pregnancy?
- Systolic >160 mm Hg or diastolic >105 mm Hg
- Parenteral hydralazine
Oral nifedipine use with caution
- Parenteral hydralazine
What are some tests for menorrhagia?
FBC
TV ultrasound
Endometrial biopsy if older than 45 yrs
Hysteroscopy
What is climacteric?
- Climacteric: years before menopause associated with menopause symptoms but still menstruating
When in early pregnancy how do you measure the gestation of a baby?
foetal crown to rump.
What is classed as a small for date baby?
Less than 2.5 kg
What is classed as a large for date baby?
More than 5 kg
What is the biggest cause of post natal death?
Being Premature i.e.
Being born before 37 weeks
What are 4 consequences f being born prematurely?
- Developmental Delay
- Visual Impairment
- Chronic Lung Disease
Cerebral palsy
What are some RF to being born early?
- Previous Pre term Birth
- Maternal Infection
- Multiple Gestations
- Race (higher in BME)
- Smoker
- Low age
- Low SE
What are some primary, secondary and tertiary prevention for pre-term babies?
- Primary prevention: reducing population risk, smoking and STD prevention, prevention of multiple pregnancies, planned pregnancy and physical/sexual activity advice.
- Secondary prevention: screening via transvaginal cervical ultrasound (to look at cervical length) and qualitative foetal fibronectin test. This allows screening of asymptomatic high risk women or manage to with a cervix <3cm
Tertiary prevention: treatment after diagnosis. Aim is to reduce morbidity and mortality. From having prompt diagnosis and referral, giving antibiotics and corticosteroids is necessary
What two screening methods can you use on pre term labour?
TV cervical US
Fibronectin test
What is the treatment for pre term delivery?
Progesterone injection
Pessary
What does progesterone do to the endometrium and uterus?
- Proliferation, Vascularisation and Differentiation of endometrium
- Increases maternal ventilation
Promotes glucose deposition in fat store
- Increases maternal ventilation
What does failed endovascular invasion lead to?
- Pre-eclampsia
- Premature Birth
- Foetal Growth Restriction
- Placental Abruption
- Recurrent Miscarriage
Why is a foetus not rejected by the host?
Syncitiotropblast
MHC-negative)
Does not induce any systemic maternal T- or B-cell response
What is the balance of TH1 to TH2 in a non pregnant lady
What is it like in pregnancy?
What is it like in IUGR or pre-eclampsia
Balanced
TH2 bias
Balanced
What antibody does breast milk include?
Ig A
What is the principle nutrient for a foetus?
Glucose
What are the post prandial glucose levels like in early pregnancy?
Early pregnancy – lower; maternal glycogen synthesis, fat deposition
What are the post pradial plasma glucose levels like in late pregnancy
Late pregnancy – higher; maternal insulin resistance – glucose sparing for fetus?
What can induce pregnancy? Decrease of what hormone?
Progesterone
How does oxytocin induce pregancy?
By elevating Ca2+
