PBL 1 Flashcards
what are 2 potential signs that labour is going to begin?
rupturing of the amniotic sac- water breaks
plug of mucus/blood may fall out of the opening to the cervix - the blood show
what is the first stage of labour?
its from the onset of contractions until they become more regular and intense
there are 2 stages to this, latent phase and active stage
what is the latent phase of labour?
the dilation of the cervix begins and the cervix becomes softer
there will be mild, irregular contractions lasting 30 seconds each
what is the active stage of the first stage of labour?
contractions are much more regular and intense (every 3 mins lasting 1 min each)
dilation of cervix reaches 10cm when there should be crowning
the cervix should be 100% effaced
when does the amniotic sac rupture if it did not rupture before labour?
in the active stage of labour due to increased intrauterine pressure caused by contractions
what does it mean if amniotic fluid comes out smelly and green?
then there eis probably meconium in amniotic fluid -this is worrying because the foetus can swallow this and meconium aspiration can cause respiratory problems
what is an amniotomy?
artificial rupturing of the amniotic membranes
what is failure to progress?
when labor slows and delays delivery of the baby.
at what cervical dilation is labour established?
4cm
how long can the latent stage of labour last?
hours to days
what is the 2nd stage of labour?
when the cervix is fully dilated until the birth of the baby
where does the power for pushing the baby out come from?
levator ani muscles
why is the baby propelled downwards into the vagina?
because the uterus is only fixed onto the cervix so the contractions will lower the fundus
if you are nulliparous, how long should it take to push the baby out?
no more than 3 hours
if you are multiparous how long should it take to push the baby out?
2 hours
why do women experience Braxton hicks?
They tone the muscles in your uterus and may also help prepare the cervix for birth.
how many contractions should you be having in 10 minutes?
3-4
why do you still experience contractions after giving birth?
as the uterus contracts to shrink back down to its original size and your body is also working to compress blood vessels in the uterus to prevent too much bleeding
why is it important that human skulls are made up on fontanelles?
as they allow for movement/overlapping to reduce the diameter of the skull as the baby moves through the birth canal
what should foetal attitude be when giving birth?
fully flexed- head to chest and limbs tucked in
what’s the most ideal foetal lie for giving birth?
longitudina;
what are the 3 types of foetal presentation
cephalic
breech
shoulder
when do babies tend to get into the cephalic position/engage?
at about 32-36 weeks
what position for babies is the best to engage in?
occiput anterior position
head down facing the back
what are the 7 cardinal movement of labour?
engagement descent flexion internal rotation extension external rotation expulsion
what is engagement?
when th widest part of the foetuses head has passed the pelvic inlet
what is descent?
he movement of your
baby’s head through the bony part of the pelvis and reaches the depth
of the pelvic cavity.
what is flexion?
when the foetal chin presses against its chest due to resistance from the pelvic floor
what is internal rotation?
foetal shoulder internally rotate 45 degrees so the widest part of the shoulders are aligned with the widest part of the pelvic inlet
what is extension?
the head passes through the pelvis
at the nape of the neck, a rest occurs as the neck is under the pubic arch
what is external rotation?
After the head of your baby is born, there is a slight pause in the action of labor. During this pause, your baby will rotate from face-down to 90 degrees to face towards one of your thighs.
what is expulsion?
Your baby’s body follows the rotation of the head and this allows the top
and then bottom shoulders to be born
why does the baby have to rotate during brith?
as in the pelvic inlet, the anteroposterior diameter is smaller than the transverse diameter but at the pelvic outlet the anteroposterior diameter is larger
why should the woman not push as the baby’s head comes out?
so the baby’s head can be born slowly, giving time for the perineum to stretch and preventing ripping
what is an episiotomy?
a small cut in the perineum to make your vaginal opening larger for childbirth.
what is the 3rd stage of labour?
after your baby is born, when your womb contracts and the placenta comes out through your vagina.
what are the 2 ways that the third stage of labour can be carried out?
active or physiological
what is active delivery of the placenta?
Your midwife will give you an injection of oxytocin into your thigh as you give birth, or soon after. This makes your womb contract.
Once the placenta has come away from your womb, your midwife pulls the cord – which is attached to the placenta – and pulls the placenta out through your vagina.
what’s the benefit of active delivery of the placenta?
speeds up the delivery of the placenta and lowers your risk of postpartum haemorrhage, but it increases the chance of you feeling/being sick. It can also make afterpains worse.
what is physiological management of delivering the placenta?
No oxytocin injection is given
and the cord is not cut until it has stopped pulsing. (around 2 to 4 minutes.)
Once the placenta has come away from your womb, you should feel some pressure in your bottom and you’ll need to push the placenta out.
what is controlled cord traction?
traction applied to the umbilical cord once the woman’s uterus has contracted after the birth of her baby, and her placenta is felt to have separated from the uterine wall, whilst counter-pressure is applied to her uterus beneath her pubic bone until her placenta delivers.
what will you be given to encourage uterine contractions and minimise haemorrhage chance?
syntometrine- causes contraction of muscles of the womb
what is Gillick competence?
Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment.
what are the Fraser guidelines?
- the young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).
- the young person understands the advice being given.
- the young person’s physical or mental health or both are likely to suffer unless they receive the advice or treatment.
- it is in the young person’s best interests to receive the advice, treatment or both without their parents’ or carers’ consent.
- the young person is very likely to continue having sex with or without contraceptive treatment.
when is pre-eclampsia most likely to happen?
after 20/40 and up to 6 weeks after delivery
what are the signs/symptoms of pre-eclampsia?
hypterension, epigastric pain, peripheral oedema, dyspnea, oliguria, proteinuria, severe headache, altered mental state, visual disturbances, hyper-reflexia, sudden rapid weight gain and general oedema
why does pre-eclampsia cause hypertension?
hypo perfused placenta release pro-inflammatory proteins which enter circulation and cause endothelial cell dysfunction = vasoconstruction
why does pre-eclampsia cause proteinuria?
glomerular damage
why does pre-eclampsia cause oedema?
increased vascular permeability
what are some risk factors for pre-eclampsia?
nulliparous, previous pre-eclampsia, increased BMI, multiple gestations, mothers >35, hypertension, diabetes, family history of it
what cause pre-eclampsia?
the placenta not developing properly due to a problem with the blood vessels supplying it.
what can a poorly perfused placenta lead to?
IUGR, premature birth, foetal death
why does pre-eclampsia tend to occur after 20/40?
as hypo perfusion worsens s gestational age progresses
what can bp be in severe pre-eclampsia?
> 160 >110
what are some complications for pre-eclampsia?
haemorrhage stroke placental aburption cerebral oedema hepatic or renal failure HELP syndrome eclampsia death
what is HELP syndrome?
haemolysis, elevated liver enzymes, low platelets
why can pre-eclampsia cause HELP syndrome?
endothelial damage can lead to the formation of lots of thrombi
why can you get blurred vision in pre-eclampsia?
reduced blood flow to the retina
how do you treat pre-eclampsa?
delivery of foetus and placenta
what can you give a mother in preparation for a premature birth?
steroids
if the onset of pre-eclampsia is after birth then how do you treat it?
manage symptoms with oxygen and medications to manage seizures/other complications e.g. magnesium sulphate
how do you diagnose pre-eclampsua?
pulse oximetry, foetal ultrasund, placental ultrasound, umbilical artery doppler ultrasound, ECG, urinalysis, blood test, peripheral blood smear
what are some reasons for being induced?
being 42/40
if waters break and labour doesnt start within 24 hours
if you/baby have health problems
what are some reasons for being induced?
being 42/40
if waters break and labour doesnt start within 24 hours
if you/baby have health problems
what is a membrane sweep?
doctor sweeps their finger around your cervix during an internal examination. This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases prostaglandins, which may start your labour.
what are 2 medical ways that labour can be induced?
inserting a pessary (propess) for 24 hours or pristine (a gel) into the vagina
what is a pessary?
a tablet of a drug called propess which contains prostaglandins
it is inserted into the vagina and causes it to soften
how does prostin work?
a drug containing prostaglandins that is inserted into the vagina and causes cervical ripening
what are dilapan rods?
rods made of synthetic gel that absorb fluid from surrounding tissues and expand, softening the cervix
at what point do you artificially rupture the membranes?
when the cervix has started to dilate and the baby’s head is firmly engaged
how are the membranes artificially ruptured?
amniotomy - amnihook breaks membranes
why does artificially rupturing the membranes help with labour?
it speeds up and strengthens contractions
what drug might you be given to speed up labour?
IV Pitocin (synthetic oxytocin)
what are some issues with inducing labour?
it can be extra long, more painful, not always successful and so can result in C-sections
what is intrauterine growth restriction?
when the baby does not grow as expected and is <10th percentile of brith weight for its gestational age
at what weight do we define it as ‘low birth weight’?
2.5kg
what is symmetrical IUGR?
where all foetal biometric parameters tend to be less than expected for the given gestational age. Both length and weight parameters are reduced.
what is assymetrical IUGR?
where some fetal biometric parameters are disproportionately lower than others, as well as falling under the 10th percentile. The parameter classically affected is the abdominal circumference - head sparing
what decides if IUGR is symmetrical or asymmetrical?
if a risk factor happens early in pregnancy when growth is predominantly hyperplasia then it will be symmetrical
if the risk factor occurs later when growth is driven by hypertrophy then it will tend to be asymmetrical
what weeks is hyperplasia the predominant growth type and what week is it more commonly hypertrophy?
0-20 weeks = hyperplasia
28-term = hypertrophy
what are some maternal risk factors for IUGR?
smoking, alcohol, anaemia, medical diseases like hypertension and CVD, poor nutritional status, lowe pre-pregnancy weight, poor weight gain during pregnancy, pollution exposure
what are some foetal risk factors for IUGR?
structural abnormalities, chromosomal abnormalities, multiple gestations (nutrient competition), inutero infections (TORCHS)
what are TORCHS infections?
toxoplasmosis others rubella cytomegalovirus herpes syphilis
what are some placental risk factors for IUGR?
abruptio placenta placenta praaevia thrombosis infarction cord abnormalities
what is placenta previ?
the placenta lies very low in the uterus and covers all or part of the cervix.
what are some uterine risk factors for IUGR?
decreased uterine blood flow
pre-eclampsia
structural anomalies e.g. single umbilical arteries
atherosclerosis of uterine spiral arteries
what are some signs/symptoms of IUGR?
baby is small or malbourished
thin, pale, loose and dry skin
umbilical cord is thin and often stained with meconium
how do you diagnose IUGR?
measuring the uterine fundal height
foetal ultrasound to estimate weight
doppler ultrasound to check blood flow to placenta through umbilical cord
what’s the treatment for IUGR?
observation with doppler US once a week and give steroids to prep baby’s lungs for pre-term delivery
arrange safe delivery of baby once over 34 weeks (C-section is doppler shows poor blood flow through placenta and induction if normal doppler)
what are some complications of IUGR?
perinatal asphyxia, meconium aspiration, persistent pulmonary hypertension, hypothermia, hypoglycemia, hyperglycemia, hypocalcemia, polycythemia, jaundice, feeding difficulties, feed intolerance, necrotizing enterocolitis, late-onset sepsis, pulmonary hemorrhage
more susceptible to cardiovascular and renal diseases, metabolic disorders including nonalcoholic fatty liver disease, metabolic syndrome and type 2 diabetes and chronic lung disease at adulthood
