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Specialities > Obstetrics Labour > Flashcards

Obstetrics Labour Flashcards

1
Q

What is the criteria for Hyperemesis Gravidarum?

A

> 5% loss in Pregnant weight
Electrolyte disturbance
Ketosis

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2
Q

What is the scoring system used in Hyperemesis Gravidarum, and what is considered severe?

A

Pregnancy- Unique Quantification of Emesis

> 12 is severe

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3
Q

How is Hyperemesis Gravidarum managed?

A

Midl:

  • Home
  • anti emetics (cyclizine) + oral rehydration

Moderate:

  • Day cases
  • IV fluid
  • IV anti-emetics (metaclopramide)
  • IV thiamine

Severe:

  • admitted
  • IV anti-emetics (ondansetron - carries risk) or really severe: Steroids (Dexamethasone)
  • IV fluids
  • Pabrinex/ thiamine
  • VTE prophylaxis (enoxaparin + stockings)

**note that severe you try antiemetic first then use steroids

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4
Q

What is the criteria for pre-eclampsia?

A

HTN: >140/>90

Proteinuria: >30 P:C ratio

> 20 weeks gestation

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5
Q

What are the stages of labour?

A

Stage 1:

  • latent stage:
  • 3-4cm dilated:
  • active stage:
  • Regular painful contractions
  • Full dilation of cervix >10cm
  • Effacement of cervix
  • Crowning of baby

Stage 2:
From full cervix dilation to delivery of the head of the baby
*propulsive - head reaches pelvic floor
*Expulsive - mother wants to push

Stage 3:
- From delivery of baby to Delivery of placenta

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6
Q

What are the cardinal movements of the labour?

A

Prelabour stage:
- occipital lateral position

Engagement

  • anterior occipital
  • station

Extension of head

Restitution
- turning transverse so shoulders sit antro-posterior

Expulsion

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7
Q

What are the pro-labour hormones?

A

Oxytocin

  • increases for of contractions
  • Receptors increase via fetal adrenocorticotrophin hormone

Prostaglandins

  • Increase ripening of cervix
  • increase uterine contractions

Inflammatory mediators
- promote membrane rupture by collagenases

Oestrogens

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8
Q

What score can be used to assess how “ripe” the cervix is, and when is it used?

A

Bishops Score
< 3 - not ripe
> 7 ready to deliver

Used when thinking about induction of labour.
If induction was to commenced on a low Bishop score there would be increased risk of:
- prolonged labour
- fetal distress

Takes into account:

  • Dilation
  • length of cervix
  • Consistency (firmness)
  • Engagement
  • Position of fetus
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9
Q

What is the criteria for labour?

A

Regular painful contractions

Effacement of cervix

Dilation of cervix

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10
Q

What can be used to assess the maternal and fetal condition during labour?

A

Partogram
- gives a graphical representation including:

Maternal HR, BP
Fetal HR
Descent
Frequency of contractions

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11
Q

What instrument can be used to assess fetal heart sounds?

A

Pinard
or
Doppler

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12
Q

How often should the vagina be examined during labour?

A

Every 4 hours

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13
Q

What is meant by Caput?

A

Refers to oedema of the scalp during labour owing to pressure of the head against the pelvic rim.
denoted by +, ++, +++

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14
Q

What is meant by Moulding:

A

Refers to the compression of the head of the fetus during labour, where the individual cranial bones move.
+: bones opposed
++: bones overlap but are reducible
+++: Overlapped and cannot be reduced

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15
Q

What are the clinical progress times of labour?

A

Stage 1:
Prim - 8- 18hours
Multi - 5.5 - 12 hours
*dilation should continue at 0.5-1cm for prim and >1cm for multi

Stage 2:
Prim - 3 hours
Multi - 2 hours

Stage 3:
30 - 1 hour

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16
Q

What is it called when stages 1 and 2 of labour occur in <2-3 hours, and why is it dangerous?

A

Precipitate delivery

Can cause fetal distress

17
Q

What is considered unacceptable dilation rates causing prolonging of labour/ failure to progress?

A

<2cm in 4 hours

or

<0.5cm per hour

18
Q

What is the indication for induction of labour?

A

When the risk of induces labour outweighs continuing pregnancy
- 20% of pregnancy will have this occur

potential causes:

  • Failure to progress
  • Maternal diabetes
  • Twins
  • Pre-labour rupture of membranes
  • Pre-eclampsia
  • Maternal request
19
Q

What would be some contraindications to induction of labour?

A

Anything that contraindicates a vaginal birth

  • Placenta Previa
  • transverse lie
  • breech presentation
  • cord prolapse
  • genital herpes

Caution with:
- previous C section - risk of scar rupture

20
Q

Why is Continual cardiotocography monitoring required when inducing labour?

A

Induction can cause uterine contractility reducing blood flow, compromising fetus

21
Q

What are the methods used for inducing labour?

A

Bishop score <6:

  • Prostaglandins (intra-vaginally).
  • repeat if needed
  • when >6 move to:

Bishop Score >6:
- artificial rupture of membranes
+
- Syntocinon (Oxytocin)

22
Q

What is the inhaled analgesia used during labour?

A

Entonox

- 50:50 of oxygen and nitrogen

23
Q

What opioid should be used in pregnancy and when should it be avoided?

A

Diamorphine

Avoid if possible within 4 hours of delivery

24
Q

When is the APGAR score done?

A

1, 5, 10 minutes after birth

25
Q

When is clamping of the umbilical cord?

A

1 minute

26
Q

What is the discharge called following post-partum?

A

Lochia

  • mucus
  • blood
  • uterine tissue

Lochia rubra
- blood stained for first few days

Lochia serosa
- watery discharge for few weeks

Lochia alba
- Yellowish discharge

27
Q

What are the 7 B’s of post partum care?

A

Breastfeeding
- aid in assistance

Bladder
- many women may have incontinence following birth

Bowel

  • damage from tears
  • use of opioids

Bleeding

  • Clots
  • volume

Blues
- Post partum depression

Bottom
- Damage/ pain

Birth control

28
Q

When does post partum depression usually begin?

A

2-4 months following birth

29
Q

What is the time line for postpartum psychosis and what are some symptoms and risk factors?

A

<2 weeks post partum
*can occur within hours

Signs of psychosis and mania:

  • rapid mood changes
  • grandiose delusions
  • paranoid delusions -especially towards baby
  • hallucinations
  • confusion

Risk factors:

  • previous psychosis
  • Psychotic illness prior to illness
  • stopping medication for pregnancy of a mental health
  • poor social or relationship networks
30
Q

What are the options for monitoring the fetus during labour:

A

CTG
- sensitive to distress but not specific

Fetal electrocardiogram
- more specific, identifying acidosis and need/ not need for delivery

Fetal blood sample
- used in conjunction with CTG

31
Q

What actions should be taken during labour following abnormal CTG?

A

Suspicious results:

  • correct any underlying causes (maternal hypotension, uterine hyperstimulation)
  • change syntocinon infusion

Clearly pathological:

  • exclude uterine rupture, cord prolapse
  • stop infusions if needed
  • Gain fetal blood sample
  • consider delivery
32
Q

Define what caput means?

A

refers to the change in shape of the skull as the fetus passes through the birth canal

33
Q

List some reasons for C-section:

A

Pre-labour:

  • placenta previa
  • placenta abruption
  • severe growth restriction
  • pre-eclampsia
  • breech presentation
  • maternal request

Labour:

  • Emergancy
  • non-dilating
34
Q

List some of the pre-operative preparations done for elective C-section:

A
  • IV access
  • Group and save / cross match (if large amount of blood loss anticipated)
  • Ranitidine + sodium alginate (to prevent aspiration from stomach content)
  • VTE prophylaxis (this was a large killer before)
  • Antibiotic prophylaxis
  • Epidural/ spinal/ GA
  • Bladder catherization
35
Q

What are the complications of a C section:

A

Short term:

  • PPH
  • Pain
  • Prolonged hospital stay
  • Damage to internal organs

Long term:

  • reduced chance of vaginal birth
  • uterine rupture in future
  • placenta previa
  • reduced conception
36
Q

What must be in place prior to an instrumental delivery and name some common causes of a instrumental delivery:

A

Criteria:

  • consent
  • fully dilated
  • head fully engaged
  • position of head known
  • bladder empty
  • analgesia onboard

Indications:

  • fetal compromise (CTG, Fetal cardiograph)
  • 2nd stage delay
37
Q

In Scotland there are certain times abortion is allowed before a referral is needed to England, what are these times?

A

Medical: 18 weeks

Surgical 13 weeks

referral via PBAS

38
Q

What are the non-pharmacological things that can be done to reduce PPH?

A

Early suckling
- stimulates oxytocin release

Rubbing the uterine contraction
- stimulate fundus to contract

39
Q

What is your immediate management of a new-born?

A

Clamp cord and cut

Dry baby and wrap warm towel

Record APGAR - 1, 5, 10

Inspect for gross abnormalities

Vitamin K

Hand back to bother for early skin to skin and suckling

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