Obstetrics and Gynaecology Exam Flashcards
What are the layers cut during a episiotomy?
- Posterior vaginal wall
- Superficial and Deep transverse perineal muscles, bulbospongiosus and part of levator ani muscles
- Fascia covering these muscles
- Transverse perineal branches of pudendal vessels and nerves
- Subcutaneous tissue and skin
What are the types of episiotomy?
- Mediolateral
- Median
- Lateral
- ‘J’ shaped
True labor pain is characterized by:
- Painful uterine contractions at regular intervals,
- Frequency of contractions increase gradually,
- Intensity and duration of contractions increase progressively,
- Associated with ‘show’,
- Progressive effacement and dilatation of the cervix,
- Descent of the presenting part,
- Formation of the ‘bag of forewaters’ and
- Not relieved by enema or sedatives.
False labor pain is characterized by:
- Dull in nature,
- Confined to lower abdomen and groin,
- May be associated with hardening of the uterus,
- They have no other features of true labor pain as discussed above, and
- Usually relieved by analgesic.
The principal movements during labor?
- Engagement,
- Descent,
- Flexion,
- Internal Rotation,
- Crowning,
- Extension,
- Restitution,
- External Rotation
- Expulsion of the trunk.
What are the Indications for Induction of Labor (IOL)
- Pre-eclampsia, eclampsia
- Maternal medical complications
o Diabetes mellitus
o Chronic renal disease
o Cholestasis of pregnancy - Postmaturity
- Abruptio placentae
- Intrauterine Growth Restriction (IUGR)
- Rh-isoimmunization
- Premature rupture of membranes
- Fetus with a major congenital anomaly
- Intrauterine death of the fetus
- Oligohydramnios, polyhydramnios
- Unstable lie—after correction into longitudinal lie
- Maternal request
What is the active management of 1st stage of labor
» Initial assessment - history and vitals.
» Send laboratory tests (All routine)
» Perform abdominal examination - Fundal height, fetal lie, fetal position and presentation, duration and frequency of contractions, fetal heart rate
» Perform vaginal examination-Dilatation, effacement, consistency and position of cervix Presentation and station and Membrane status (for BISHOPS)
» Latent phase:
» Active Phase: 4cm till 10cm -> Start partogtram
ELABORATE ON VITALS SPECIFICALLY.
What is the active management of 2nd stage of labor
- Patient kept in Modified Lithotomy Position
- Oxytocin infusion
- Episiotomy
- Delivery
What is the active management of 3rd stage of labor
- Record vitals and assess her general condition
- Injection of Oxytocin IM to maternal ant. thigh (10 units)
- Cord Clamping
- Controlled cord traction
- Check bleeding and uterine contractions
- Manage if postpartum haemorrhage, a retained placenta or maternal collapse, or any otherconcerns about the woman’s wellbeing
What are the 4 causes of PPH
- Tone - Uterine Atony
- Tissue - Retained products
- Trauma - Vaginal Tears and Lacerations
- Thrombosis - Coagulation disorders
What are the two types of PPH?
Primary and Secondary PPH
What are the two types of PPH?
Primary and Secondary PPH
Define PPH
**Primary PPH **is defined as blood loss of 500mL or more from the genital tract occurring within 24h of delivery or more than 1000mL during a cesarean section.
Secondary PPH is defined as ‘excessive’ loss occurring between 24h and 6wks after delivery.
What is the management of PPH
- Call for help
- ABCD
- Massage uterus to stimulate contractions
- 1 helper at HEAD
- Helper 2 and 3 at ARMS
- Empty bladder with folley’s catheter
- If atony permits - Apply bimanual compression
- Review other causes (4Ts - Tone, Trauma, Tissue, Thrombin)
- Move to OT if bleeding persists
How to do controlled Cord Traction?
- Give IM oxytocin following delivery of anterior shoulder to maternal anterior thigh (10 Units) to cause uterus to contract
- Watch for contraction
- Clamp the cord near the vulva
- Once contraction felt- move LEFT hand suprapubically (elevated fundus by placing palm to mother)
- RIGHT hand grasp cord & exert steady traction
- Once membrane out- peel off membrane with twisting motion
What is Preterm Labor
Onset of labour < 37 completed weeks of pregnancy (after 20weeks)
* With cervical effacement and soft ( at least 80%)
* Cervical is dilated ( 2 cm or more)
* Present of uterine contractions 2 in 10 minutes
How do you manage Preterm Labor
Admit for frequent monitoring
* Monitor vital signs closely
* Hydrate patient
* Keep patient nil by mouth
* Put patient on CTG to confirm uterine activity and for fetal monitoring
* Assess cervical status , progress of labour and presenting part
* Vaginal swab for bacteria vaginosis and Group B streptococcus
* Advice patient for complete bed rest
* Counsel the couple on the current diagnosis and treatment given
* Arrange for neonatal ventilator support
Tocolytic Therapy
- Nifedipine
- Magnesium Sulphate
Must be given to inhibit contractions, to delay delivery by 24-48 hours for lung maturation induction or to transport for higher tertiary centre.
Corticosteroids for Lung Maturity (24-34 WOG)
IM Dexamethasone 12mg, given 12 hourly apart for 2 doses
IM Betamethasone 24mg, given 12 hourly apart for 4 doses
Contraindicated : in mothers who are having chorioamnionitis or any other active infections
Define (Preterm, Pre labor rupture of membranes - PPROM?
The spontaneous rupture of membrane in absence of uterine activity (prior onset of labour) Happened before 37 completed weeks
Define Prelabor Rupture of Membranes (PROM)
The spontaneous rupture of membrane in absence of uterine activity (prior onset of labour)
*Happened before 37 completed weeks
What is the Management of Prelabor Rupture of Membranes (PROM)
Wait for 24 hours for spontaneous labor. if no labor–> go for IOL
Define Chronic Hypertension
Persistent BP elevation (˃140/90 mmHg) on two occasions more than 24 hours apart
- Occurs before 20th weeks and persist after 6 weeks post-partum
Define Pregnancy Induced Hypertension
Persistent BP elevation (˃140/90 mmHg) on two occasions of 6 hours apart with:
- No proteinuria
- Occur after 20th weeks and return within 6 weeks post- partum
Define Pre Eclampsia
HPTN (˃140/90 mmHg) on 2 occasions of 4 hours apart
- Proteinuria ˃300mg protein in a 24 hour urine collection (in absence of UTI)
- Occur after 20th weeks and return within 6 weeks post-partum
Define Eclampsia
- Pre-eclampsia with fit and/or coma, or
- Development of fit and/or unexplained coma during pregnancy in patients with signs & symptoms of pre-eclampsia
- Occur more at more than 20th week of gestation or less than 48H post-partum
Name some pregnancy same Antihypertensives
- Nifedipine
- Labetolol
- Methyldopa
- Hydralazine
How do you manage Pre Eclampsia
- Establish diagnosis
- Assess and Monitor Maternal and Fetal conditions
- Consider therapy
- Antihypertensive 1st line: Labetolol // Nifedipine // (IV/PO)
- BP Still not controlled: Hydralazine // Labetalol (IV)
- Steroid: 24-36 weeks) - Consider delivery at 38 weeks
- Monitor fluid status by passing foleys catheter and Documenting I/O
Management of Eclampsia
- Delivery (The only cure // Definitive Treatment)
- First Stabilize the patient.
- ABC
- Control convulsions: Mag sulf.- Overdose: RS depression // Cardiac Arrest // Hyporeflex
- Antidote: Calcium Gluconate
- Control BP: Labetolol // Nifedipine
- Monitor Pregnancy
- Plan for delivery
- IOL + Instrumental to shorten 2nd stage of labor
- LSCS
