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Year 2 Medicine > Pregnancy and Birth > Flashcards

Pregnancy and Birth Flashcards

1
Q

Initiation of Labour

  • Remains uncertain
  • Multifactorial in origin
    • h…
    • m…
  • Fetal … is triggered
  • Maternal post pituitary releases …
  • Decidua releases p…
A
  • Remains uncertain
  • Multifactorial in origin
    • hormonal
    • mechanical
  • Fetal hypothalamus is triggered
  • Maternal post pituitary releases oxytocin
  • Decidua releases prostaglandins
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2
Q

Initiation of Labour (2)

  • ↑ in … pro-labour hormone
  • ↓ in … pro-pregnancy hormone
  • Release of … by the mother’s posterior pituitary gland
  • P… from the decidua
  • Together creating … contractions
  • … stimulation of the uterus and cervix caused by … and pressure from the pp
A
  • ↑ in oestrogen pro-labour hormone
  • ↓ in progesterone pro-pregnancy hormone
  • Release of oxytocin by the mother’s posterior pituitary gland
  • Prostaglandins from the decidua
  • Together creating uterine contractions
  • Mechanical stimulation of the uterus and cervix caused by overstretching and pressure from the pp
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3
Q

Stages of labour

  • First - (Latent phase)
  • Then how many stages of labour?
A
  • First - (Latent phase)
  • 1st stage of labour
  • 2nd stage of labour
  • 3rd Stage of labour.
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4
Q

Latent phase of labour

  • … of cervix
  • C…
  • … varies
A
  • Effacement of cervix
  • Contractions
  • Intensity varies
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5
Q

Effacement of the cervix

  • Effacement means that the cervix stretches and gets thinner.
A

Effacement means that the cervix stretches and gets thinner.

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6
Q

Diagnosis of Active Labour Requires:

  • … … contractions
  • Cervical …
  • Dilatation of the cervix of … or more
    *
A
  • Painful regular contractions
  • Cervical effacement
  • Dilatation of the cervix of 4cms or more
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7
Q

Active Labour/First Stage of Labour

  • Established labour to full cervical …
  • … examinations
  • Average is …cm/hour
A
  • Established labour to full cervical dilatation
  • Vaginal examinations
  • Average is 0.5cm/hour
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8
Q

Descent of the fetal head in relation to the ischial spines

  • Progress measured by cervical … and descent of the fetal head (in relation to the … … and the ischial spines depicted by the arrow)
A
  • Progress measured by cervical dilatation and descent of the fetal head (in relation to the pelvic brim and the ischial spines depicted by the arrow)
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9
Q

Second Stage of Labour

  • This is from … of the cervix to the … of the baby.
A
  • This is from full dilatation of the cervix to the delivery of the baby.
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10
Q

Pelvic Inlet

  • The brim is … except where the … projects
  • The anteroposterior diameter is …cm
A
  • The brim is oval except where the promontory projects
  • The anteroposterior diameter is 12cm
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11
Q

Pelvic Outlet

  • The outlet is … shaped
  • Its three diameters are:
    • a… (as the coccyx is deflected backwards this is the space available during birth)
    • o…
    • t…
A
  • The outlet is diamond shaped
  • Its three diameters are:
    • anteroposterior (as the coccyx is deflected backwards this is the space available during birth)
    • oblique
    • transverse
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12
Q

What is this image showing?

A

Lateral view of the fetal skull

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13
Q

What is this image showing?

A

Superior view of the fetal skull

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14
Q

Fontanelles

  • … fontanelle (bregma)
    • diamond shaped intersection of … sutures
    • 2x3 cms
    • closes at … months
  • … fontanelle
    • Y shaped intersection of … sutures
    • closes at …-… weeks
A
  • Anterior fontanelle (bregma)
    • diamond shaped intersection of 4
    • sutures
    • 2x3 cms
    • closes at 18 months
  • Posterior fontanelle
    • Y shaped intersection of 3 sutures
    • closes at 6-8 weeks
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15
Q

Diameters of the fetal skull

  • Suboccipitobregmatic (…cms) = OA position
  • Occitopitofrontal (…cms) = OP position
  • Supraoccipitomental (… cms) = brow
  • Submentalbregmatic (… cms) = face
A
  • Suboccipitobregmatic (9.5cms) = OA position
  • Occitopitofrontal (11cms) = OP position
  • Supraoccipitomental (13.5 cms) = brow
  • Submentalbregmatic (9.5cms) = face
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16
Q

Mechanism of Birth

  • Head at pelvic brim … (OT) position
  • … of neck (Suboccipitobregmatic)
  • Head … and …
  • Head reaches pelvic floor- rotates to Occipital …
  • Head delivers by …
  • Head “…” (comes in line with the shoulders)
  • Shoulders rotate into anterior/posterior … of pelvis
  • Anterior shoulder delivered by … … from downward pressure on baby’s head
  • Posterior shoulder by upward … flexion
A
  • Head at pelvic brim Occipital transverse (OT) position
  • Flexion of neck (Suboccipitobregmatic)
  • Head descends and engages
  • Head reaches pelvic floor- rotates to Occipital Anterior
  • Head delivers by extension
  • Head “restitutes” (comes in line with the shoulders)
  • Shoulders rotate into anterior/posterior diameter of pelvis
  • Anterior shoulder delivered by lateral flexion from downward pressure on baby’s head
  • Posterior shoulder by upward lateral flexion
17
Q

Third Stage of Labour

  • Delivery of …
  • Normal Estimated Blood loss …-…mls
  • Inspection of … to ensure …
A
  • Delivery of placenta
  • Normal Estimated Blood loss 300-500mls
  • Inspection of placenta to ensure completion
18
Q

Third Stage of labour - Placenta delivery, either:

  • Active management (CCT)
    • … i.m. given into maternal …
    • Causes sustained … contraction
    • Aids delivery of the placenta & contraction of the placental bed
    • Decreases risk of … (PPH)

OR

  • …:
    • Mother naturally expels the placenta and membranes with contractions
A
  • Active management (CCT)
    • Oxytocin i.m. given into maternal thigh
    • Causes sustained uterine contraction
    • Aids delivery of the placenta & contraction of the placental bed
    • Decreases risk of Post Partum Haemorrhage (PPH)

OR

  • Physiological:
    • Mother naturally expels the placenta and membranes with contractions
19
Q

Fetal Monitoring in Labour

  • Why do we do this?
    • to detect fetal … and deliver baby if needed
  • How?
    • Screening the fetal … rate by:
      • Intermittent … by
      • P… or Sonicaid
      • CTG (…)
      • FBS (…)
A
  • Why do we do this?
    • to detect fetal hypoxia and deliver baby if needed
  • How?
    • Screening the fetal heart rate by:
      • Intermittent auscultation by
      • Pinard or Sonicaid
      • CTG (cardiotocograph)
      • FBS (fetal blood sample)
20
Q

Intermittent Auscultation

  • Every … mins before and after a contraction during the first stage
  • Every … minutes in the second stage
    • Any … heard would lead to the use of the …
A
  • Every 15 mins before and after a contraction during the first stage
  • Every 5 minutes in the second stage
  • Any abnormality heard would lead to the use of the CTG
21
Q

Cardiotocograph

  • Continuous print out of fetal heart rate and contractions
    • By abdominal …-detects cardiac … and hence heart rate
  • OR
    • A clip applied to the fetal … (FSE)-detects the R-R wave of the fetal …
  • Most usual is the …
A
  • Continuous print out of fetal heart rate and contractions
    • By abdominal ultrasound-detects cardiac movements and hence heart rate
  • OR
    • A clip applied to the fetal scalp (FSE)-detects the R-R wave of the fetal ECG
  • Most usual is the abdominal ultrasound
22
Q

What is this a sample of?

A

A normal CTG monitoring

23
Q

Fetal Blood Sampling

  • Why?
    • A CTG is … … e.g. if normal, baby is OK
    • But … …, for example if abnormal only a few babies are hypoxic
    • Use of CTG leads to a … fold increase in Caesareans Sections for fetal heart …
  • Therefore
  • Need to check the CTG findings with FBS
A
  • Why?
    • A CTG is highly sensitive e.g. if normal, baby is OK
    • But poorly specific, for example if abnormal only a few babies are hypoxic
    • Use of CTG leads to a 4 fold increase in Caesareans Sections for fetal heart irregularities
  • Therefore
  • Need to check the CTG findings with FBS
24
Q

Fetal Blood Sampling

  • This is a … on the fetal scalp
  • Blood is then collected via a … …
  • pH and base excess results
  • Contraindications:
    • Infection such as … and … …
    • Fetal … disorder
    • Prematurity less than … weeks
A
  • This is a stab on the fetal scalp
  • Blood is then collected via a glass pipette
  • pH and base excess results
  • Contraindications:
  • Infection such as HIV and Hepatitis B
  • Fetal Bleeding disorder
  • Prematurity less than 32 weeks

Year 2 Medicine (162 decks)

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