Obs - Labour Flashcards
what is the bishops score?
used to assess cervix and determine outcome of labour
what are the bishops scores used as boundaries?
≥9 will start without induction
5≤ will require induction
what is the first line method of inducing labour? how long does it take to work?
membrane sweep
48hrs
what medications can be used to induce labour? contraindications?
vaginal prostaglandin pessary
Hx of uterine scarring
do misoprotol/mifepristone have a role in labour induction?
only where fetal death has occurred
what infusion can be given to induce labour?
syntocinon infusion (often alongside artifical membrane rupture)
what would be indications for induction?
macrosomia
pre eclampsia
premature ROM
reduced fetal movements
when is an artifical rupture of membranes done?
cervix 2cm dilated
head engaged
what does syntocinon do?
induce labour + contractions
what does ergometrine do?
contractions
what does syntometrine do?
induce labour + contractions
what do vaginal prostaglandins do?
induce labour
what anaesthetic options do women have during labour?
entonox
epidural
pudendal (ischial spines for op vaginal)
spinal (not commonly)
what non pharmacological anaesthetic options do women have during labour?
TENS
water immersion
what are the layers of the spinal cord? where does an epidural go?
dura (below this)
arachnoid
pia
what are complications of an epidural?
headache back pain atonic bladder hypotension abnormal fetal HR inhibit stage 2
what is failure to progress in the 1st stage classified as?
<2cm in 4hrs
what is failure to progress in the 2nd stage classified as?
> 3hrs with anaesthetic/>2 without
>2hrs ‘’, >1 (multi)
what is the maximum length of time for the 1st stage?
12 in nulparous
10 in primi
when is doppler of fetal heart done during 1st/2nd stage of labour?
1st - every contraction, every 15 mins
2nd - every contraction, every 5 mins
when is the 3rd stage of labour delayed?
> 30mins active
>60 mins physiological
options for active management of the 3rd stage?
synometrine
oxytocin
bladder catheter
cord clamping
when is an operative delivery indicated?
delay in stage 2 fetal distress pre/eclampsia haemorrhage maternal CVS umbilical cord prolapse
whats better, ventouse or forceps?
forceps
when is a c section indicated?
previae abruption pre eclampsia fetal distress cord prolapse vasa previae failure to progress
what are the 4 classifications of c section?
1 - immediate threat to life (30 mins)
2 - maternal/fetal compromise (30-75mins)
3 - no compromise
4 - timed to suit women
what Abx are given with a c section?
co amox (+amox if BMI >30)
