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Clinical Care > Obstetrics and neonates > Flashcards

Obstetrics and neonates Flashcards

1
Q

What do dark green stains/streaks mean in a pregnant person’s broken water?

A

Meconium in the amniotic fluid

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2
Q

What are the dangers of meconium in the amniotic fluid?

A

The neonate can aspirate on it if stressed and gasping whilst still in the womb

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3
Q

What questions are important to ask with labour patients?

A

Has she got notes to hand?
Gestation
Parity/gravida
Any risk factors?
Complications with pregnancy so far?
Multiple pregnancy (Twins,triplets etc.)?
Spontaneous rupture of membranes (SROM)? -Were they stained?
Contractions - frequency, duration?
Bleeding?
Pain?
Foetal movement?

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4
Q

What is gravida?

A

Number of times a woman has been pregnant, including current pregnancy and regardless of any past outcomes (miscarriage, stillbirth, termination etc.)

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5
Q

What is parity?

A

Number of live childbirths a woman has had

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6
Q

What are the 3 stages of labour?

A

Stage 1: Regular uterine contractions increasing in length and frequency causing cervical effacement and dilation from 0cm-10cm

Stage 2: Delivery of the baby

Stage 3: Placenta delivery

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7
Q

What are Braxton Hicks?

A

False labour pains when the womb contracts and relaxes, usualling during the second and third trimester, uncomfortable but not usually painful. Braxton Hicks do not cause the cervix to dilate.

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8
Q

What are you looking for upon inspection during labour?

A

Bleeding
Head or breech presentation
Prolapsed loop of cord
Perineum bulge with each contraction
Environment

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9
Q

What is the second stage of labour and its signs?

A

Full dilation to delivery of baby:
Contractions become more expulsive in nature
Women may have a strong urge to push
The vertex (head) may be visible at the introitus
Dilation of the anus due to the engagement of the baby’s head
Head, body then full delivery of baby

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10
Q

How should you prepare the birth environment?

A

Clean towels/incontenance pads
WARMTH - close windows, heating, warm blankets etc.

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11
Q

What should you recomend during head delivery?

A

Panting over pushing hard

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12
Q

Why should you usually delay umbilical cord cutting?

A

Leaving the umbilical cord intact until it has ceased pulsating will help the baby gradually adapt to extrauterine life and ensure it has optimum blood volume for full lung expansion

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13
Q

Why do neonates lose heat easily?

A

A high surface area to volume ratio and a metabolic response to cooling that involves chemical (non shivering) thermogenesis.

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14
Q

What is the physiology of the neonate thermogenesis response?

A

Norepinephrine is discharged into brown fat in the nape of the neck, between the scapulae, and around the kidneys and adrenals.
There is lipolysis and oxidation. This produces heat locally, that is then circulated.

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15
Q

What is the danger of the neonate thermogenesis response?

A

It is a diversion of calories to produce heat which can impair growth.
Metabolic rate and oxygen consumption is increased 2-3x.
May also result in tissue hypoxia and neurologic damage in neonates with respiratory issues.
Activation of glycogen stores can cause transient hyperglycemia. Persistent hypothermia can result in hypoglycaemia and metabolic acidosis and increases the risk of late-onset sepsis and mortality.

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16
Q

What are the increased mortality rates associated with neonate hypothermia?

A

For each 1 degree decrease in temperature below 36.5 degress there is an associated increase in mortality of 28% in an otherwise healthy baby

17
Q

What maneuvre can you use to maintain body heat in premature neonates?

A

Place the baby wet in a polyethene bag along with blankets and hat

18
Q

What are the benefits of skin to skin?

A

Regulates baby’s heart rate, breathing and temperature
Stimulates release of hormones – oxytocin
Helps provide protection against infection

19
Q

What is the AGPAR assessment for neonates?

A

Appearance
Grimace
Pulse
Activity
Respiration

20
Q

How can you assess neonate heart rate in very noisy or cold environments?

A

Palpating the umbilical cord (if HR >100)

21
Q

When is the AGPAR assessment performed with neonates?

A

At one minute after birth then five minute intervals

22
Q

When might you not delay cord clamping?

A

Problems with mother: e.g. Bleeding, placenta issues (abruption, praevia etc.)

Problems with the cord e.g. bleeding so blood not reaching baby anyway.

Problems with baby e.g. resus needed

23
Q

What is placental abruption?

A

A serious condition in which the placenta separates from the wall of the uterus before birth

24
Q

What is placenta praevia?

A

When the placenta lies very low in the uterus, covering all or part of the cervix.

25
Q

How far away from the baby should you cut the cord?

A

15cm

26
Q

How long can placenta delivery last without active management?

A

Up to one hour

27
Q

What are the signs of impending placenta delivery?

A

Contractions return
Cord lengthens
Urge to push
Sometimes small gush of blood

28
Q

Why is it important to keep the placenta?

A

It must be examined by a midwife

29
Q

What are the risks associated with placenta praevia?

A

Cervix dilation can cause placenta rupture and massive bleeding and damage. Almost all patients require C-section.

30
Q

What are the benefits of immediate breastfeeding after birth?

A

It can encourage delivery of the placenta
It induces oxytocin release
It helps bonding with mother and baby
It is a great source of energy for the newborn - promotes adequate thermogenesis

31
Q

What is placenta accreta?

A

A serious condition in which the placenta grows too deeply into the uterine wall, causing difficulty separating and likely to cause haemorrhage

32
Q

What is the difference between placenta accreta, placenta increta and placenta percreta?

A

Placenta accreta – The placenta attaches itself too deeply and too firmly into the uterus

Placenta increta – The placenta attaches itself even more deeply into the muscle wall of the uterus.

Placenta percreta – The placenta attaches itself and grows through the uterus, sometimes extending to nearby organs, such as the bladder.

33
Q

What is vasa praevia?

A

Unprotected blood vessels from the umbilical cord travelling across the opening of the cervix

34
Q

What is the time frame for post-partum haemorrhage?

A

24 hours

35
Q

What is a massive obstetric haemorrhage?

A

Obstetric haemorrhage is classified as antepartum (APH) or postpartum (PPH) of more than 1.5L of blood loss

36
Q

What is the difference between primary and secondary post-partum haemorrhage?

A

Primary is within 24 hours of birth, secondary is after 24 hours and up to 6 weeks after birth

37
Q

What is the first stage of labour broken down into and what are the qualities of each?

A

Clinical Care (15 decks)

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