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RCPSC > Obs: Labour/Delivery > Flashcards

Obs: Labour/Delivery Flashcards

1
Q

EMCS or ELCS abx prophylaxis

A

Cefazolin 1-2g IV single stat dose, 15-60 min pre skin incision

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2
Q

EMCS or ELCS abx prophylaxis if pen allergic

A

Clindamycin 600mg IV, or
Erythromycin 500mg

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3
Q

OASIS: abx prophylaxis

A

Cefotetan or Cefoxitin 1g IV

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4
Q

two factors influencing duration of first stage

A

mat age >35
and BMI >=30

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5
Q

rate of adequate progress for low risk nullip

A

> =0.5cm/h

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6
Q

single most important factor in labour management

A

diagnosis of ACTIVE phase of labour

regular, painful uterine contractions resulting in progressive cervical effacement and dilation

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7
Q

> 90% of women with NVD progressed at what rate?

A

> =1cm/hr after 5cm

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8
Q

maternal factors affecting labour

A
  1. power (contractions + effort)
  2. passage (bony structure + soft tissue)
  3. psyche (pain + anxiety)
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9
Q

Fetal factors affecting labour

A

passenger:
1) position
2) attitude
3) size
4) abnormalities

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10
Q

how to calculate MVU

A

sum of pressure above baseline multiplied by # of contractions

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11
Q

features of good contractions

A
  • 50-60mmHG above baseline
    or
  • > =200 MVU
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12
Q

every 5y delay in mat age after 35, increases duration of labour by

A

0.5h

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13
Q

mechanism/interaction of excessive pain on contractions

A

pain increases catecholamines, which reduced uterine contractility, which can increase anxiety, which further increases catecholamines

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14
Q

key points for management of active first stage

A

1) partogram
2) ambulation, position changes
3) choice to E/D
4) continuous labour support
5) ARM
6) analgesia

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15
Q

analgesia options for first stage of albour

A

1) TENS
2) water immersion
3) sterile water injections
4) entonox
5) opioids
6) local blocks
7) epidural

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16
Q

effect of TENS in labour

A

reduced pain reporting but no difference in pain scores

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17
Q

effect of water immersion in labour

A

significant reduced use of regional, and reduced duration of first stage

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18
Q

effect of sterile water injections in labour

A

reduced pain and CS rate but minimal evidence;

not effective for low back pain

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19
Q

preferred opioids for labour analgesia

A

morphine and fentanyl

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20
Q

lidocaine dose

A

4-5mg/kg (max 300)
or 7mg/kg with epinephrine (max 500)

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21
Q

bupivicaine dose

A

2.5mg/kg (max 175)
or 3mg/kg with epinephrine (max 225)

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22
Q

epidural increases risks of

A
  • AVB
  • hypotension
  • motor blockade
  • pyrexia
  • urinary retention
  • prolonged second stage
  • oxytocin administation
  • C/S fetal distress
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23
Q

Dystocia diagnosis first stage

A

<0.5cm/hr/4h
or
no change/2h

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24
Q

dystocia diagnosis second stage

A

> =1h active pushing without descent

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25
Q

preferred position for second stage

A

upright&raquo_space; recumbent

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26
Q

delayed pushing for up to

A

maximum of 2h

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27
Q

second stage assessment

(When and what)

A

hourly reassessment of progress in descent and rotation

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28
Q

valsalva decreases second stage by

A

9-19min

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29
Q

candidates for high dose synt protocols

A
  • parous IOL or augmentation
  • nullip IOL
  • nullip with epidural
30
Q

candidates for high dose synt protocols

A
  • parous IOL or augmentation
  • nullip IOL
  • nullip with epidural
31
Q

successful IOL achieved within

A

24-48h

32
Q

high priority IOL indications

A
  • PET >=37/40
  • significant maternal disease
  • not responding to Rx
  • significant but stable APH
  • chorio
  • suspected fetal compromise
  • term PROM w/GBS
33
Q

if declines postdates IOL, what monitoring?

A

AFV and NST or BPP twice weekly after 41/40

34
Q

unacceptable IOL indications

A
  • care provider or pt preference
  • fetal macrosomia
35
Q

Contraindications to IOL

A
  • placenta/vasa previa
  • cord presentation
  • abnormal fetal lie/presentation
  • prior classical or T incision
  • significant prior uterine surgery
  • active genital herpes
  • pelvic structure deformaties
  • invasive cervical carcinoma
  • previous uterine rupture
36
Q

most important 3 factors of bishop score

A

1) dilation
2) effacement
3) station

37
Q

contraindications to foley balloon IOL

A
  • APH, LLP
  • ROM, Infection
38
Q

size of foley and water insertion

A

18G + 30-60ml H20

Leave for 24h or until falls out spontaneously

39
Q

foley IOL outcomes

A

increases need for synt but reduces tachysystole

CS rate same as for PG

40
Q

prostaglandin E2

A

DINOPROSTONE

  1. controlled release gel 10mg (cervidil)
  2. prostin 1mg and 2mg gel
  3. intracervical 0.5mg prepidil
41
Q

prostaglandin E2 outcomes for IOL

A

reduces CS rates with unfavourable BS and increases maternal satisfaction,
but
increases maternal infections and tachysystole

42
Q

prostaglandin E1

A

MISOPROSTOL

  1. 50mcg PO or 25mcg PV
  2. Repeat q4h as long as contractions absent
  3. oxytocin 4h after last dose
43
Q

when should EFM be performed for misoprostol IOL

A

1) 30 min after administration
2) 60 min after tachysystole

44
Q

misoprostol IOL outcomes

A

more effective than PGE2 to achieve NVD and reduced epidural use
but, increases uterine tachysystole

45
Q

amniotomy alone as IOL

A

results in reduced vaginal delivery than with oxytocin

46
Q

half-life of oxytocin

A

5-12 minutes

47
Q

time to steady state for oxytocin

A

40 minutes

48
Q

gestational age for IOL for mat age

A

39/40, if 40y or more

49
Q

PPH occurs in what proportion of deliveries

A

5%

50
Q

PPH thresholds

A

> 500ml NVD
1000 ml C/S

51
Q

mild shock - what % blood loss

A

20%
usually 1000-1500ml

52
Q

mild shock - what signs/symptoms

A

diaphoresis, cool extremities
Inc cap refill
Anxiety

53
Q

moderate shock - what % blood loss

A

20-40%
usually 1500-2000ml

54
Q

moderate shock - what signs/symptoms

A

increased HR and RR
Dec BP (postural)
Mild decrease SBP (80-100)
Oliguria

+ diaphoresis, cool extremities, inc cap refill, anxiety

55
Q

severe shock - what % blood loss

A

> 40%
Usually >2L

56
Q

severe shock - what signs/symptoms

A
  • Dec BP
  • Agitation/Confusion
  • Hemodynamic instablity
57
Q

Signs symptoms of hemodynamic instability

A
  1. reflexive tachycardia
  2. peripheral vasoconstriction
  3. Increased myocardial contractility
58
Q

active 3rd stage reduces which outcomes

A
  • mild PPH
  • severe PPH
  • low HB <9
  • need for RBC Tx
  • need for additional uterotonics
59
Q

Active management of 3rd stage does not affect which outcomes

A

incidence of retained placenta or need for MROP

60
Q

placental delivery - usually successful in what proportion

A

50% within 5 minutes
90% within 15 minutes

61
Q

MROP required if placenta not delivered within

A

30-45 minutes

62
Q

intraumbilical vein injection for retained placenta

drugs and doses

A
  1. misoprostol 800 mcg, or
  2. oxytocin 10-30iu

wait 30 mins after injection

63
Q

preferred medication for PPH prevention in low risk NVD

A

oxytocin 10 units IM

oxytocin 20-40 units/1000mL @ 150ml/hr is acceptable alternative

64
Q

oxytocin dose for established PPH

A

10 units IM

5iu IV or 20-40u infusion in 250ml @ 500-1000ml/hr

65
Q

carboprost dose for established PPH

A

250mcg IM
q15min
max 8 doses (2mg)

asthma is relative CI

66
Q

carbetocin dose for PPH prevention

A

100mcg IM or IV /1minute

better for CS than NVD

67
Q

misoprostol dose for PPH management

A

400-1000mcg PO/SL/PR

off label use

68
Q

ergonovine dose for PPH management

A

0.25mg IM or IV
q2h

CI in women with HTN and if taking PI/HIV

69
Q

balloon tamponade for PPH - how long to keep in?

A

8-48h, with gradual deflation
+ continued oxytocin infusion
+ prophylactic abx

70
Q

new stages for PPH classifications

A

Stage 1 >500 NVD, >1000 CS (mild)

Stage 2 1000-1500 (moderate)

Stage 3 >1500 (severe)

RCPSC (17 decks)

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