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3a > Obs labour and delivery > Flashcards

Obs labour and delivery Flashcards

1
Q

Give 3 fetal obstetric emergencies

A
  • Fetal distress
  • Cord prolapse
  • Shoulder dystocia
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2
Q

What are rf for cord prolapse?

A
  • Premature rupture of membranes
  • Polyhydramnios
  • Long umbilical cord
  • Fetal malpresentation
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3
Q

What happens in shoulder dystocia?

A

The anterior shoulder fails to pass under the symphysis pubis after delivery of the fetal heads

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4
Q

What acronym is used for the management of shoulder dystocia?

A

HELPERR

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5
Q

What is the management of shoulder dystocia?

A

H - call for help
E - evaluate for episiotomy
L - legs in McRoberts
P - suprapubic pressure
E - enter pelvis
R - rotational manoeuvres
R - remove posterior arm

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6
Q

What are the neonatal risks of shoulder dystocia?

A
  • Hypoxia
  • Cerebral palsy
  • Injury to brachial plexus
  • Fits
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7
Q

What are risk factors for pre-term delivery?

A
  • Antepartum haemorrhage
  • Previous ptd
  • Genital infection
  • Cervical weakness
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8
Q

What is the aim of secondary prevention of pre-term delivery? What is involved?

A

Aim = identify women at increased risk by screening for preterm labour
- TVS US
- Qualitative fetal fibronectin test

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9
Q

What is the aim of tertiary prevention of pre-term delivery? What is involved?

A

Aim = reduce mobility/mortality
- Prompt dx
- Tocolytic drugs
- Antibiotics

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10
Q

What is required to diagnose preterm labour?

A

Persistent uterine activity AND change in cervical dilatation and/or poor effacement

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11
Q

How can the causes of ‘failure to progress’ be classified?

A

The 4 Ps:
- Power - strength of uterine contractions
- Passenger - size/position/presentation of fetus
- Passage - shape/size of pelvis
- Psyche - support and antenatal preparation for labour and delivery

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12
Q

In the first stage of labour, what indicates failure to progress?

A

If dilation is less than 2cm in 4 hours

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13
Q

In primiparous women, how much should the cervix dilate per hour?

A

1/2cm per hour

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14
Q

What does a partogram do?

A

It indicates how labour is progressing and wether care needs to be escalated to obstetric led

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15
Q

What is an amniotomy?

A

Artificial rupture of membranes

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16
Q

What is the management of failure to progress

A
  1. Amniotomy
  2. Oxytocin infusion
  3. Instrumental delivery
  4. CS
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17
Q

With an oxytocin infusion what is the aim for number of contractions/10 mins

A

4-5 contractions/10 mins

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18
Q

What are the 5 stages of labour?

A
  1. Latent stage
  2. First stage/established stage
  3. Second stage
  4. Third stage
  5. Fourth stage
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19
Q

How long can the latent stage of labour last?

A

2-3 days

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20
Q

How much does the cervix dilate in the latent phase of labour?

A

0 -> 4 cm

21
Q

When does the first stage of labour end?

A

When the cervix has dilated to 10cm

22
Q

When is the second stage of labour?

A

From full dilation to birth

23
Q

When is the third stage of labour?

A

From birth to explosion of the placenta

24
Q

What is the fourth stage of labour?

A

Skin to skin contact

25
Q

What happens to oestrogen levels at the onset of labour? Why?

A
  • They surge
  • To inhibit progesterone and prep smooth muscles for labour
26
Q

What is effacement?

A

The thinning and shortening of the cervix

27
Q

What 6 stages comprise the fetal journey in labour?

A
  1. Descent
  2. Flexion
  3. Internal rotation
  4. Extension
  5. External rotation
  6. Delivery of body
28
Q

What is the Bishop score used for?

A

To determine wether to induce labour

29
Q

What’s assessed as part of the Bishop score, what are they all scored out of?

A
  • Fetal station (0-3)
  • Cervical position (0-2)
  • Cervical dilatation (0-3)
  • Cervical effacement (0-3)
  • Cervical consistency (0-2)
30
Q

What Bishop score predicts spontaneous labour? What indicates labour is unlikely without induction?

A
  • 8/13
  • <5
31
Q

What are the options for indiction of labour?

A
  • Membrane sweep
  • Vaginal prostaglandin E2
  • Cervical ripening balloon
  • Artificial rupture of membranes with oxytocin infusion
32
Q

What is the main complication of induction of labour with prostaglandins?

A

Uterine hyperstimulation

33
Q

What are the criteria for uterine hyperstimulation?

A
  • Individual contractions lasting more than 2 minutes in duration
  • More than five contractions every 10 minutes
34
Q

What is the management of uterine hyperstimulation?

A
  • Removing vaginal prostaglandins/stopping the oxytocin infusion
  • Tocolysis with terbutaline
35
Q

What 2 lines are present on a partogram? What do they indicate?

A
  • Alert and action lines
  • Crossing the alert line -> amniotomy + repeat examination in 2 hours
  • Crossing the action line -> escalate to obstetric-led care
36
Q

What is plotted on a partogram?

A

The dilation of the cervix is plotted against the duration of labour (time)

37
Q

What is the stepwise management of failure to progress?

A
  • Amniotomy
  • Oxytocin infusion
  • Instrumental delivery
  • Caesarean section
38
Q

What would indicate uterine rupture?

A
  • Cessation of contractions
  • Disappearance of presenting part from pelvis
  • Sudden maternal shock
39
Q

What is a deceleration?

A

Drop in fetal HR of more than 15 bpm for more than 15 seconds

40
Q

What do decelerations indicate?

A

Insufficient blood flow to the uterus and placenta

41
Q

What are accelerations?

A

Increase in fetal HR of more than 15 bpm for more than 15 seconds

42
Q

How many and how often should accelerations occur?

A

2 accelerations every 15 minutes

43
Q

What are the two brachial plexus injuries associated with complicated delivery? Which nerve roots are affected?

A
  • Erb’s palsy - C5-C6
  • Klumpke’s palsy - C8-T1
44
Q

When is nifedipine used to slow labour?

A
  • Used from 24-33+6 weeks
  • When delivery is imminent
  • Used for 24 hrs to give steroids time to work/time to transfer mum to appropriate centre
45
Q

When is IV benzylpenicillin used in labour?

A
  • In woman with a temp >38
  • In woman with previous GBS infection in pregnancy
46
Q

What happens in the latent stage of labour?

A
  • Irregular contractions
  • Mucoid plug
  • Cervix begins to dilate
47
Q

What is the role skin to skin contact post delivery?

A
  • Triggers release of oxytocin in mum and baby
  • Helps with bonding
  • Helps regulate babies BP and HR
48
Q

What is the choice of prophylactic abx in preterm ROM? How long is it taken for?

A
  • PO erythromycin
  • Taken until in established labour
  • Can be taken for a max of 10 days

3a (34 decks)

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