Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3a > Obstetrics 1 - Labour and Delivery > Flashcards

Obstetrics 1 - Labour and Delivery Flashcards

1
Q

Define onset of labour

A

Regular uterine contractions, progressive cervical effacement and dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What occurs in the prelabour/latent phase?

A

Cervical ripening and softening
Irregular contractions
“show” - mucous plug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is engagement of the foetal head, and when does it occur?

A

Widest part of presenting part passes through the brim of the pelvis
2 weeks before delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the station when assessing a woman in labour?

A

The relationship between the lowest point of the presenting part and the ischial spines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the altitude when assessing a woman in labour?

A

Whether the presenting part is flexed or deflexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define the lie of the foetus

A

The relationship between the long axis of the foetus and the long axis of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How often should foetal heart rate (FHR) be monitored in labour?

A

every 15 minutes, or continuously with a CTG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How often should BP and temperature be monitored in labour

A

4-hourly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

At what position does the head enter the pelvis?

A

Occipto-lateral position

Delivers in the occipito-anterior position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When does the foetus internally rotate to the occipito-anterior position?

A

At the level of the ischial spines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is crowning?

A

Extension of the head and distension of the perineum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

At what level do the shoulders externally rotate?

A

Level of the ischial spines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does delivery of the anterior shoulder occur?

A

Lateral flexion of the trunk posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does delivery of the posterior shoulder occur?

A

Lateral flexion of the trunk anteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define the latent phase

A

Period taken for the cervix to completely efface and dilate to 3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define the active phase

A

Dilatation of the cervix from 3cm to 10cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are mild, irregular, non-progressive contractions that occur from 30 weeks gestation?

A

Braxton-Hicks contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is a delay in the active phase of labour identified?

A

Progress on the partogram falls to the right of the alert line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define failure to progress in the active phase of labour

A

Failure of cervix to dilate 1cm/hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the two types of delayed progression?

A

Primary - slow in early active phase

Secondary - slowing after previous adequate progress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 3Ps (causes of delayed progression)?

A

Power - inefficient uterine activity
Passenger - Malposition/presentation/large baby
Passage - Inadequate pelvic
Or a combination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is the second stage of labour?

A

Time from full cervical dilatation to delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why is there a delay in cord clamping?

A

Higher rates of haematocrit in the neonate to allow the baby to have a normal full blood volume and decreases the risk of placental complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How often after delivery is the condition of the baby assessed?

A

At 1, 5, and 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What score is used to assess the condition of the baby?

A

Apgar score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When would you suspect failure to progress in nulliparous women?

A

Delivery is not imminent after 1 hour of active pushing

VE, review by obstetrician, consider instrumental/CS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When would you diagnose failure to progress in multiparous women?

A

Delivery is not imminent after 1 hour of active pushing

Review by obstetrician, consider instrumental/CS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the third stage of labour?

A

The duration from delivery of the baby to delivery of the placenta and membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe physiological management of the third stage of labour

A

No uterotonics
Cord is allowed to stop pulsating before it is cut
Placenta delivered by maternal effort alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Describe active management of the third stage of labour

A

Uterotonics - IM Syntometrine
Early clamping and cutting of the cord
Controlled cord traction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the indications for Syntometrine?

A

Active management of the third stage of labour

Prevention of PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When should physiological management of the third stage of labour change to active management?

A

Haemorrhage
Failure to deliver placenta in one hour
Maternal desire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do you manage patients with an increased risk of PPH?

A

40IU oxytocin in 500mL saline for 3-4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What indicates placental separation (after delivery)?

A

Firm uterus, 20 week size
Cord lengthens
Separation bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When is intermittent auscultation of FHR appropriate?

A

No foetal or maternal risk factors
Perform for one minute after a contraction
Every 15 mins in first stage, every 5 mins in 2nd stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Give 3 maternal risk factors that indicate the need for electronic foetal monitoring (EFM)

A 
Previous CS
Cardiac problems
Pre-eclampsia
Post-term pregnancy
PROM
Induction of labour
Diabetes
APH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Give 3 foetal risk factors the indicate the need for EFM

A 
IUGR
Prematurity
Oligohydramnios
Multiple pregnancy
Meconium liqor
Breech presentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Give 3 intrapartum risk factors the indicate the need for EFM

A 
Oxytocin augmentation of labour
Epidural
Intrapartum bleeding
Prolonged labour
Abnormal FHR on intermittent auscultation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

10% of cerebral palsy is caused by what during labour?

A

Intrapartum hypoxia during uterine contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the four components of CTG assessment?

A

Baseline rate, baseline variability, acceleration, deceleration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are accelerations/decelerations as seen on the CTG?

A

transient rise/reduction in FHR by at least 15 beats over baseline, lasting >15s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How is foetal hypoxia or heart block indicated on the CTG?

A

Decreased variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Which drugs can cause decreased variability on the CTG?

A

Methyldopa, narcotic analgesia, MgSO4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How is foetal sleep cycle shown on the CTG?

A

Decreased variability for less than 40 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Define baseline foetal bradycardia

A

Baseline FHR <110BPM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Define baseline foetal tachycardia

A

Baseline FHR >160BPM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the difference between early and late decelerations on the CTG?

A

Early - uniform in appearance and timing with contraction

Late - >15s time lag in relation to contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Variable decelerations are associated with what complication of labour?

A

Cord compression/prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the two types of variable decelerations?

A

Typical - U or V shaped, quick to recover (less sinister)

Atypical - last >60 seconds, slow recovery (more sinister - associated with distress)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What does a sinusoidal pattern with little variability on the CTG indicate?

A

Significant foetal anaemia

Short spells - foetal physiological behaviour such as thumb sucking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the most common indication for induction of labour?

A

Prolonged pregnancy

Then, utero-placental insufficiency, pre-eclampsia, PROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What total Bishop score is strongly predictive of spontaneous labour?

A

> 8

53
Q

What are the stages of induction of labour?

A

Cervical ripening
Artificial rupture of membranes
Cervical dilatation

54
Q

In induction of labour, how is cervical ripening brought about?

A

Vaginal PGE2

55
Q

Amniotomy is used as an adjunct to the vaginal PGE2, and releases local PGs to commence cervical ripening and myometrial contractions. What is the next step if there are no painful contractions 2 hours post amniotomy?

A

Oxytocin infusion

56
Q

What are five complications of inducing labour?

A 
Uterine hyperstimulation and rupture
Caesarian section
Atonic PPH
Intrauterine infection
Perineal damage from rapid/uncontrolled delivery
57
Q

What is a side effect of oxytocin administration?

A

Uterine hyperstimulation

58
Q

What are the consequences of uterine hyperstimulation?

A

Decreased uterine blood flow leads to foetal asphyxia

Uterine tetany = continuous contraction.

59
Q

What is a risk factor of uterine rupture?

A

Grand multipara

60
Q

Why is it necessary to decrease the rate of oxytocin infusion as the rate of (induced) labour progresses?

A

Myometrium gets increasingly sensitive to oxytocin

Risk of uterine hyperstimulation

61
Q

When is labour premature?

A

Delivery from 24+0 weeks to 36+6 weeks

62
Q

What are the causes of premature labour?

A

PROM
Idiopathic
Other - poor social conditions, APH, infection, severe maternal illness, extremes of maternal age

63
Q

How does genital tract infection cause premature labour?

A

Promotes myometrial activity
Causes PROM from chorioamnioitis
Can penetrate the mucous plug, produce proteases, and destroy tissue

64
Q

How can you assess risk of premature labour?

A

Presence of foetal fibronectin on the cervix - 20% women deliver

65
Q

What factors are used to decide if tocolysis should be used in premature labour?

A 
Age of gestation
Absence of infection/bleeding
Whether membranes are intact
Whether cervix is dilated
Availability of neonatal care
66
Q

What is the first line tocolytic drug in premature labour?

A 
Nifedipine
If CI (PPROM), then atosiban
67
Q

Why do you give corticosteroids, and magnesium sulphate to a woman in premature labour?

A

Steroids: matures the foetal lung so decreases the risk of respiratory disease due to lack of surfactant.
MgSO4: neuroprotection: decreases risk of cerebral palsy

68
Q

What are the signs of preterm prelabour rupture of membranes?

A

Sudden gush of fluid/constant leaking of fluid from the vagina

69
Q

What are the causes of PPROM?

A

Infection
Polyhydramnios
Multiple pregnancy
Idiopathic

70
Q

What is the management of PPROM?

A

Refer to hospital and admit for first 48h
Decide delivery or expectant management
Swab vaginal fluid and monitor for sepsis, prophylactic erythromycin 250mg QDS, corticosteroids
If evidence of infection - induce labour
No sex
Report any change in foetal movements and discharge

71
Q

What percentage of women with PROM labour within 24 hours?

A

60%, but most women deliver spontaneously within 48 hours

72
Q

What is the management of women with PPROM and Group B strep isolation?

A

Penicillin or clindamycin

73
Q

What is prolonged pregnancy?

A

Any pregnancy that exceeds 42 weeks gestation from the first day of LMP in a woman with regular 28 day cycles

74
Q

What are the foetal risks of prolonged pregnancy?

A

Meconium aspiration
Oligohydramnios
Macrosomia and shoulder dystocia
Cephalohaematoma

75
Q

What are the maternal risks of prolonged pregnancy?

A

Increased risk of intervention (induction, use of instruments etc)
Increased risk of genital tract trauma

76
Q

What is the management of prolonged pregnancy?

A

Stretch and sweep at 41 weeks
Induce labour 41-42 weeks
Daily CTGs after 42 weeks
Report any change in foetal movements

77
Q

What causes the symptoms of foetal post-maturity syndrome?

A

Intrauterine malnutrition

78
Q

What are the signs of foetal post maturity syndrome?

A

Scaphoid abdomen, peeling skin, little SC fat on body or limbs, overgrown nails, alert, anxious look, skin stained with meconium

79
Q

What are the four categories of Caesarian section?

A

Elective, scheduled, urgent, immediate

80
Q

How is a CS carried out?

A

Transverse incision in the lower uterine segment

81
Q

What are the complications of CS?

A

Blood loss, infection, bladder/ureteral/bowel injury, endometritis, UTI, pulmonary atelectasis

82
Q

What are the risks of vaginal birth after CS?

A

Uterine rupture

Intrapartum death

83
Q

What are the indications for instrumental delivery?

A

Maternal exhaustion
Prolonged 2nd stage/failure to progress
Foetal compromise

84
Q

What are the adverse effects of use of forceps?

A

Maternal genital tract trauma

Foetal injuries more rare - facial nerve palsy, skull fractures, ICH

85
Q

What are the adverse effects of ventouse use?

A

Scalp lacerations and convulsions
Retinal/subgleal haemorrhage
ICH

86
Q

When do you abandon instrumental delivery for CS?

A

No progressive descent with each pull (usually 3 pulls)

87
Q

What are the indications for episiotomy?

A

Complicated vaginal delivery e.g. breech, shoulder dystocia
Extensive lower genital tract scarring
Foetal distress
Indication that there will be perineal trauma - button holing

88
Q

What are the complications of episiotomy?

A

Bleeding, pain, scarring, infection, dyspareunia, fistula

89
Q

What do third and fourth degree tears involve?

A

3rd - anal sphincter complex

4th - anal/rectal epithelium

90
Q

What is the management of perineal tears?

A

Rapid repair
Broad spectrum antibiotics
Stool softeners
Refer if >6 weeks incontinence

91
Q

What are the side effects of Entonox (NO and O2)?

A

Nausea, vomiting, feeling faint

92
Q

Give one advantage and one disadvantage of epidurals

A

Adv - decreased maternal secretion of catecholamines, can be topped up
Disadv - Decreased maternal mobility, patchy block, nerve damage risk

93
Q

Give three other methods of pain relief in labour (other than epidurals)

A

Pethidine - neonatal resp depression - nalaxone
Diamorphine - neonatal resp depression - naloxone
Meptazinol
Nitrous oxide
Spinal/CSE

94
Q

What anaesthetic technique is most commonly used in CS?

A

Spinal

95
Q

What anaesthetic is used in a spinal?

A

Hyperbaric bupivacaine usually with fentanyl

96
Q

Where is the spinal anaesthetic injected?

A

Sub arachnoid space

97
Q

What is the main advantage of a combined spinal and epidural anaesthesia (CSE)?

A

Spinal - rapid onset of a predictable block

Epidural - can be topped up

98
Q

Why may hypotension occur with a spinal anaesthetic and how is this combatted?

A

Sympathetic blockade

IV fluids and ephedrine (vasopressor)

99
Q

What’s the best way of estimating the gestational age of a pregnancy?

A

First trimester ultrasound at 12/40, crown-rump-length (CRL)

100
Q

What are the risks of footling breech presentation?

A

Chorioamnioitis

Cord prolapse

101
Q

At what gestational age is Anti-D prophylaxis given if the mother is Rhesus negative?

A

28 and 34 weeks

102
Q

At what gestational age is an OGTT undertaken?

A

24-28 weeks

103
Q

What uterine relaxants are given before ECV?

A

Terbutaline, salbutamol

104
Q

What are the three stages of induction of labour?

A

Cervical ripening
Artificial rupture of membranes
Cervical dilatation

105
Q

What are the risks of breech presentation?

A

Cord prolapse
Difficulty delivering head
Foetal hypoxia

106
Q

What does the quadruple test test for?

A

hCG
AFP
Unconjugated oestriol
Inhibin A

107
Q

What does the combined screening test test for?

A

Bloods - hCG and pregnancy-associated protein A (PAPP-A)

Nuchal translucency

108
Q

What are the contraindications to ECV?

A

Under 37 weeks preterm
Previous CS
Multiple pregnancy
PP

109
Q

What are the four main indications for induction of labour?

A

Post-dates
Pre-labour rupture of membranes
Pre-eclampsia
Plus diabetes

110
Q

What is the first sign of scar dehiscence in VBAC?

A

Abnormal CTG

111
Q

What gives the best chance of VBAC?

A

Natural labour

112
Q

What medication is used in uterine hyperstimulation?

A

Terbutaline

113
Q

Detail the management of IUGR

A

Confirm dates
Ultrasound - symmetry and amniotic fluid volume
Doppler studies for placental function

114
Q

What is a risk factor for pre-term labour?

A

Multiple pregnancy - stretch of myometrium and membranes

Ascending infection

115
Q

How is pre-term labour prevented in those with a history?

A

Cervical stitch

Progesterone

116
Q

What is bleeding at <24 weeks known as?

A

Threatened miscarriage

117
Q

What are three uterine causes of APH?

A

Placenta abruption
Placenta praevia/vasa praevia
Marginal bleed (bleed from placental edge)

118
Q

What are three cervical causes of APH?

A

Show - loss of mucous plug
Cervical cancer
Cervical polyp or ectropion

119
Q

What causes the woody hard uterus in placental abruption?

A

Infiltration of blood into myometrium

120
Q

What is placental migration?

A

Growth of the lower segment of the uterus after 20 weeks causes movement upwards of a placenta praevia at 32w

121
Q

When is CS advised in major placenta praevias?

A

38 weeks

122
Q

What is vasa praevia?

A

Placental vessels run over cervical os in the membranes

123
Q

What are the consequences of vasa praevia?

A

Labour or ROM may result in catastrophic foetal exsanguination

124
Q

What antibiotics are used for GBS prophylaxis and treatment of sepsis in the neonate?

A

Benzylpenicillin

Penicillin and clindamycin

125
Q

What is the Bishop’s score?

A

Pre-labour scoring score in predicting whether induction of labour will be required

126
Q

What are the components of Bishop score?

A 
Cervical dilatation (cm)
Cervical effacement (%)
Cervical consistency
Cervical position
Foetal station
127
Q

What indicates amniotic fluid embolism?

A

Sudden collapse after ARM
Hypotension, tachycardia, MI
Shivering, sweating

128
Q

What are the doses of corticosteroids and magnesium in premature labour?

A

24mg betamethasone/dexamethasone IM over 24-48h

4g IV MgSO4 bolus followed by infusion of 1g/hour over 24h

129
Q

What are the indications for emergency cervical cerclage?

A

Women between 16+0 and 34+0 weeks who have a dilated cervix and exposed unruptured foetal membranes.

Phase 3a (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions