Obs labour and delivery Flashcards
Give 3 fetal obstetric emergencies
- Fetal distress
- Cord prolapse
- Shoulder dystocia
What are rf for cord prolapse?
- Premature rupture of membranes
- Polyhydramnios
- Long umbilical cord
- Fetal malpresentation
What happens in shoulder dystocia?
The anterior shoulder fails to pass under the symphysis pubis after delivery of the fetal heads
What acronym is used for the management of shoulder dystocia?
HELPERR
What is the management of shoulder dystocia?
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
What are the neonatal risks of shoulder dystocia?
- Hypoxia
- Cerebral palsy
- Injury to brachial plexus
- Fits
What are risk factors for pre-term delivery?
- Antepartum haemorrhage
- Previous ptd
- Genital infection
- Cervical weakness
What is the aim of secondary prevention of pre-term delivery? What is involved?
Aim = identify women at increased risk by screening for preterm labour
- TVS US
- Qualitative fetal fibronectin test
What is the aim of tertiary prevention of pre-term delivery? What is involved?
Aim = reduce mobility/mortality
- Prompt dx
- Tocolytic drugs
- Antibiotics
What is required to diagnose preterm labour?
Persistent uterine activity AND change in cervical dilatation and/or poor effacement
How can the causes of ‘failure to progress’ be classified?
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
In the first stage of labour, what indicates failure to progress?
If dilation is less than 2cm in 4 hours
In primiparous women, how much should the cervix dilate per hour?
1/2cm per hour
What does a partogram do?
It indicates how labour is progressing and wether care needs to be escalated to obstetric led
What is an amniotomy?
Artificial rupture of membranes
What is the management of failure to progress
- Amniotomy
- Oxytocin infusion
- Instrumental delivery
- CS
With an oxytocin infusion what is the aim for number of contractions/10 mins
4-5 contractions/10 mins
What are the 5 stages of labour?
- Latent stage
- First stage/established stage
- Second stage
- Third stage
- Fourth stage
How long can the latent stage of labour last?
2-3 days
How much does the cervix dilate in the latent phase of labour?
0 -> 4 cm
When does the first stage of labour end?
When the cervix has dilated to 10cm
When is the second stage of labour?
From full dilation to birth
When is the third stage of labour?
From birth to explosion of the placenta
What is the fourth stage of labour?
Skin to skin contact
What happens to oestrogen levels at the onset of labour? Why?
- They surge
- To inhibit progesterone and prep smooth muscles for labour
What is effacement?
The thinning and shortening of the cervix
What 6 stages comprise the fetal journey in labour?
- Descent
- Flexion
- Internal rotation
- Extension
- External rotation
- Delivery of body
What is the Bishop score used for?
To determine wether to induce labour
What’s assessed as part of the Bishop score, what are they all scored out of?
- Fetal station (0-3)
- Cervical position (0-2)
- Cervical dilatation (0-3)
- Cervical effacement (0-3)
- Cervical consistency (0-2)
What Bishop score predicts spontaneous labour? What indicates labour is unlikely without induction?
- 8/13
- <5
What are the options for indiction of labour?
- Membrane sweep
- Vaginal prostaglandin E2
- Cervical ripening balloon
- Artificial rupture of membranes with oxytocin infusion
What is the main complication of induction of labour with prostaglandins?
Uterine hyperstimulation
What are the criteria for uterine hyperstimulation?
- Individual contractions lasting more than 2 minutes in duration
- More than five contractions every 10 minutes
What is the management of uterine hyperstimulation?
- Removing vaginal prostaglandins/stopping the oxytocin infusion
- Tocolysis with terbutaline
What 2 lines are present on a partogram? What do they indicate?
- Alert and action lines
- Crossing the alert line -> amniotomy + repeat examination in 2 hours
- Crossing the action line -> escalate to obstetric-led care
What is plotted on a partogram?
The dilation of the cervix is plotted against the duration of labour (time)
What is the stepwise management of failure to progress?
- Amniotomy
- Oxytocin infusion
- Instrumental delivery
- Caesarean section
What would indicate uterine rupture?
- Cessation of contractions
- Disappearance of presenting part from pelvis
- Sudden maternal shock
What is a deceleration?
Drop in fetal HR of more than 15 bpm for more than 15 seconds
What do decelerations indicate?
Insufficient blood flow to the uterus and placenta
What are accelerations?
Increase in fetal HR of more than 15 bpm for more than 15 seconds
How many and how often should accelerations occur?
2 accelerations every 15 minutes
What are the two brachial plexus injuries associated with complicated delivery? Which nerve roots are affected?
- Erb’s palsy - C5-C6
- Klumpke’s palsy - C8-T1
When is nifedipine used to slow labour?
- 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
When is IV benzylpenicillin used in labour?
- In woman with a temp >38
- In woman with previous GBS infection in pregnancy
What happens in the latent stage of labour?
- Irregular contractions
- Mucoid plug
- Cervix begins to dilate
What is the role skin to skin contact post delivery?
- Triggers release of oxytocin in mum and baby
- Helps with bonding
- Helps regulate babies BP and HR
What is the choice of prophylactic abx in preterm ROM? How long is it taken for?
- PO erythromycin
- Taken until in established labour
- Can be taken for a max of 10 days
