Obstetrics and Maternity Flashcards
The calculation of the duration of pregnancy is based on __________
the first day of the last menstrual period
What are the weeks involved in each trimester of pregnancy?
- trimester 1: weeks 1 - 12
- trimester 2: weeks 13 - 28
- trimester 3: weeks 29 - 40+
What are the three stages of labour?
- 1st stage:
- Dilation of cervix by regular and painful contractions; this stage may last up to 12 hours
- 2nd stage:
- Birth of the infant; this stage may last between 2 and 3 hours, but can also be much shorter in subsequent deliveries
- 3rd stage:
- Delivery of the placenta; this stage may last up to 1 hour
When a midwife is present the responsibility for maternal resuscitation falls upon ________
paramedics!
What is the definition of “term” with reference to pregnancy
37-40 weeks gestation
What is the definition of “pre-term” with reference to pregnancy
24-36 weeks gestation
pregnancies at <24 weeks gestation are not considered viable, and the concept of term/pre-term does not apply
The vaginal discharge of mucus and blood during labour is known as:
Show or “Bloody Show”
What is the clinical term and significance of “water breaking”.
- Spontaneous rupture of membranes
- Outpouring of normally clear or pinkish fluid; can occur from prior to onset of labour until baby is born
- Does not herald imminent delivery in isolation
Greenish or brown stained amniotic fluid visible in ruptured membranes is indicative of:
Meconium-stained amniotic fluid, a sign of fetal distress and risk for aspiration
What are indicators of imminent birth? (up to 6 signs)
- active pushing or grunting
- rectal pressure (e.g., urge to use bowels or bladder)
- anal pouting or bulging perineum
- strong unstoppable urge to push
- presenting part on view or crowning
- patients stating, “I’m going to have the baby,” or “It’s coming now”
What is the definition and significance of precipitous birth?
- unusually rapid labour, less than four hours long with extremely quick birth
- the rapid change in pressure from intrauterine life may cause cerebral irritation
What are normal changes to cardiovascular physiology in pregnancy?
- Blood pressure experiences minimal changes, though there is an initial decrease in the first and second trimesters with a return to baseline in the third; systolic blood pressures above 160 mmHg and diastolic pressures greater than 110 mmHg are considered significant
- Heart rate elevates by 15-20 beats per minute; normal heart rate in pregnancy is 80-110 beats per minute
- Cardiac output increases by 30-40% to a normal volume of 6-7 L per minute during pregnancy
- Non-specific ST segment changes are sometimes seen on ECG, along with Q waves in leads III and aVF and atrial and ventricular ectopic beats
- Systemic vascular resistance often decreases due to the effects of progesterone
True or False; hypertension is a normal finding in pregnancy
Blood pressure experiences minimal changes, though there is an initial decrease in the first and second trimesters with a return to baseline in the third; systolic blood pressures above 160 mmHg and diastolic pressures greater than 110 mmHg are considered significant
What does the acronym GTPAL stand for?
G - Gravida: number of previous pregnancies
T - Term: number of deliveries between 37 and 40 weeks gestation
P - Pre-term: number of deliveries before 37 weeks gestation
A - Abortions: number of abortions (spontaneous or therapeutic)
L - Living: number of living children
multiparity (twins, triplets, etc.) are listed as single deliveries
A 41-year-old person is 36 + 4 pregnant with twins. They have triplets that were born at 33 weeks, a 12-year old born at 41 weeks, and had a spontaneous abortion 15 years ago.
Describe their gestational history in GTPAL format
G4 T1 P1 A1 L4
- twins/triplets are counted as single deliveries, but multiple living children
A 27 year old person is 33 + 5 pregnant and has a 3-year old child born at 38 weeks. They have had two previous medical abortions at 8 and 15 weeks.
Describe their gestational history in GTPAL format
G4T1P0L1
A 35 year old person is 26 + 4 pregnant, has a 6 year old daughter born at 37 weeks and a 3 year old son born at 35 weeks. They also delivered a baby without signs of life (i.e. stillbirth) at 29 weeks.
Describe their gestational history in GTPAL format
G4T1P2A0L2
- Babies born without signs of life after week 24 are considered pre-term, not spontaneous abortion
List up to 10 important questions about the current pregnancy when assessing a pregnant patient
- Current gestational age?
- Multiple births expected?
- Membranes ruptured or intact? If ruptured, colour of amniotic fluid?
- Is the patient currently having contractions? Assess duration, intensity, and frequency.
- Does the patient have an uncontrollable urge to push?
- Has the patient felt fetal movements? If so, when were the last?
- What hospital interventions, if any, have been performed?
- Are there any anticipated problems or complications?
- Has the patient had any prenatal care?
- Any current complaints? Vaginal bleeding, hypertension, pain, trauma, etc.
List up to 4 important questions about previous pregnancies when assessing the pregnant patient
- Any/number of previous pregnancies?
- Prior caesarean sections/interventions?
- Complications/problems with previous pregnancies?
- Length of previous labours?
What is “crowning” and what is its clinical significance?
- when the head, buttocks, or legs, of the baby become visible at the vaginal opening between contractions
- signals that delivery will occur within minutes.
Should cord clamping be delayed after delivery, and if so, by how much?
Yes! Best practice is to wait at least 2 minutes. Waiting longer confers no additional benefit.
Under what conditions should a patient in labour NOT be conveyed to hospital?
- Delivery is imminent
- The primary care provider (often midwife) advises otherwise
What is Sims’ position?
- left lateral with right leg extended, left leg flexed
Where should the umbilical cord be clamped prior to cutting?
- once at 10cm from baby and again at 5cm from the first clamp. Cut between the two clamps
What are the components and ratings of the APGAR score?
- A (Activity/Muscle Tone)
- +2 Active
- +1 Some extremity flexion
- +0 Limp
- P (Pulse)
- +2 >100
- +1 <100
- +0 absent
- G (Grimace)
- +2 Sneeze/cough
- +1 Grimace
- +0 None
- A (Appearance/colour)
- +2 pink all over
- +1 acrocyanosis
- +0 blue all over
- R (Respirations)
- +2 Good/crying
- +1 Irregular/slow
- +0 None
When is an APGAR score calculated?
At 1 and 5 minutes post birth
You have just delivered a baby with the following characteristics;
They weakly flex their extremities, they grimace and whine, they have a HR of 140, respirations are mostly quiet and irregular, and they are peripherally and centrally cyanotic
assign an APGAR score
- A1
- P2
- G1
- A0
- R1
APGAR = 4
What are target pre-ductal SpO2 values at 1, 5, and 10 minutes after birth?
- 1 minute: 60-65%
- 5 minutes: 80-85%
- 10 minutes: 85-95%
Delivery of placenta should usually occur within _______ minutes
30-60 minutes
A normal amount of blood loss in childbirth is:
400-500mL
TXA is/is not indicated for post-partum hemmhorage
is!
