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Reproductive System > Pregnancy and Labour > Flashcards

Pregnancy and Labour Flashcards

1
Q

how many stages are there in labour?

A

three

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2
Q

which two hormones are responsible for the initiation of labour?

A

oxytocin

prostaglandins

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3
Q

what is the average diameter of the cervix when fully dilated?

A

10cm

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4
Q

what is the physiological and active management of the third stage of labour?

A

physiological: maternal effort only
active: uterotonic drugs, cord clamping, cord traction

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5
Q

what are the physiological changes in the uterus that allow labour to start?

A
  • cervix thins and softens
  • myometrial tone changes to allow contractions
  • progesterone decreases and prostaglandins/oxytocin initiate contractions
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6
Q

what is the latent first stage of labour?

A

it is the period from the beginning of contractions until the cervix is dilated to 5cm

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7
Q

what is the established first stage of labour?

A

it is the period during which cervix is dilated from 5cm to full dilation of 10cm

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8
Q

when is the first stage of labour complete?

A

the cervix is fully dilated

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9
Q

what is the passive second stage of labour?

A

it is the period during which cervix is fully dilated before the start of expulsile contractions

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10
Q

what is the active second stage of labour?

A

it is the period during which expulsile contractions occur and maternal effort is used

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11
Q

when is the second stage of labour complete?

A

when the baby is delivered

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12
Q

what is the third stage of labour?

A

it is the period from the birth of the baby until placenta and membranes are expelled

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13
Q

during which stage of labour does the cervix start to soften and become thinner?

A

during the latent first stage of labour

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14
Q

when is a diagnosis of prolonged third stage of labour made?

A

if membranes haven’t been expelled:

  • within 30 mins with use of active management
  • within 60 mins with use of physiological management
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15
Q

name a few ways the progress of labour is monitored

A
  • maternal observation
  • abdominal examination
  • vaginal examination
  • liquor monitoring
  • auscultation of fetal heart
  • CTG
  • use of partogram
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16
Q

what is crowning?

A

it’s the point during delivery when the widest point of the baby’s vertex comes through the narrowest part of the pelvic inlet

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17
Q

what anatomical feature of baby is used to determine its position during delivery?

A

posterior fontanelle

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18
Q

name a few non-pharmaceutical ways to manage analgesia during labour

A
  • breathing exercises
  • aromatherapy
  • massages
  • water birth
  • TENS
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19
Q

name a few pharmacological ways to manage analgesia during labour

A
  • paracetamol
  • dihydrocodeine
  • entonox (nitrous oxide)
  • remifentanil
  • opioids
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20
Q

what are the 7 movements that make up the mechanism of labour?

A
  • engagement
  • descent
  • flexion
  • internal rotation
  • extension
  • external rotation
  • expulsion
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21
Q

which 9 diseases are currently screened for with a blood spot in newborns?

A
  • phenylketonuria (PKU)
  • sickle cell disorders
  • medium chain Acetyl-CoA Dehydrogenase deficiency (MCADD)
  • congenital hypothyroidism
  • cystic fibrosis
  • maple syrup urine disease
  • homocysteinuria
  • isovaleric acidaemia
  • gluratic aciduria type 1
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22
Q

what is a common condition in mum that might require induction of labour?

A

diabetes

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23
Q

what is the score used to assess how ripe a cervix is during labour?

A

Bishop’s score

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24
Q

what is the role of prostaglandins during labour?

A

they help the cervix to ripen

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25
Q

what is the role of oxytocin during labour?

A

it helps develop contractions

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26
Q

what is an amniotomy?

A

artificial breaking of the fetal membranes during labour

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27
Q

what is the ideal position for the baby’s head when it descends?

A

occipito-anterior

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28
Q

why might labour be abnormal because of problems with power?

A
  • underactive uterus
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29
Q

why might labour be abnormal because of problems with passage or passenger?

A
  • malpresentation
  • malposition
  • cephalopelvic disproportion
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30
Q

what does malpresentation mean in terms of abnormal labour?

A

baby is not presenting with vertex lie (ie transverse or breech)

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31
Q

what does malposition mean in terms of abnormal labour?

A

baby’s head is in incorrect position for labout (ie not occipito-anterior)

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32
Q

in terms of causes for abnormal labour, is malpresentation or malposition more common?

A

malposition is more common

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33
Q

name a few ways fetal well-being can be monitored during induced labour

A
  • auscultation
  • cardiotocography (CTG)
  • fetal blood sampling
  • fetal ECG
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34
Q

when is a fetal blood sample taken during labour?

A

it’s done when CTG is abnormal

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35
Q

what are some of the main indications not to undergo labour?

A
  • placenta praevia
  • masses or other obstruction
  • malpresentation
  • previous labour complications
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36
Q

when are ventouse or forceps deliveries of babies carried out?

A

when the baby’s head is in malposition

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37
Q

what is the management of a retained placenta?

A

oxytocin to induce contractions or manual removal of placenta

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38
Q

what are the main complications in the third stage of labour?

A
  • retained placenta
  • tears
  • post partum haemorrhage
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39
Q

what are the four major causes of primary post partum haemorrhage?

A

Trauma
Tissue
Tone
Thrombin

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40
Q

what is the definition of primary post partum haemorrhage?

A

loss of >500ml blood within first 24 hours of delivery

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41
Q

what is the definition of secondary post partum haemorrhage?

A

loss of >500ml blood between 24 hours and 6 weeks after delivery

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42
Q

why are swollen legs or SoB in pregnancy or postpartum worrying?

A

because they might indicate a VTE (DVT or PE)

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43
Q

name a few serious conditions to be aware of in postpartum women

A
  • post partum haemorrhage
  • venous thromboembolism
  • sepsis
  • puerperal depression/psychosis
  • pre-eclampsia/eclampsia
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44
Q

how does pregnancy affect the cardiovascular system?

A
  • increased blood volume/flow
  • increased cardiac output
  • increased stroke volume
  • increased heart rate
  • decreased total peripheral resistance
  • blood pressure drop
  • lung/peripheral oedema
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45
Q

why is there a decrease in total peripheral vascular resistance in pregnancy?

A

because progesterone causes vasodilation

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46
Q

apart from mechanical strain from the fetus weight and resulting posture, what is another reason for joint and back pain in pregnancy?

A

progesterone loosens ligaments which can result in pain

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47
Q

how does pregnancy affect the blood components?

A
  • increase of red cell count by half
  • increased requirement of folate and iron
  • increased plasma volume
  • decreased haematocrit, haemoglobin
  • decreased platelets
  • increased WBC
  • increased coagulation factors 8, 9 and 10
  • protein loss
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48
Q

what causes pregnancy to be a hypercoagulable state and why is that beneficial?

A

because there is an increase in coagulation factors 8, 9 and 10
it minimises the risk of bleeding during delivery

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49
Q

how does pregnancy affect the renal system?

A
  • massive increase in size of collecting system
  • increase in kidney size (hydronephrosis)
  • increase in ureter diameter (hydroureter)
  • increase in GFR and creatinine clearance
  • reduced urea and creatinine
  • increased urate
  • proteinuria/microscopic haematuria
  • increased renal plasma flow -> urinary frequency
  • urinary stasis –> increased risk of infections
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50
Q

what causes urinary frequency in pregnancy?

A
  • massive increase in renal plasma flow

- decrease in bladder volume due to compression by uterus

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51
Q

why is there a higher risk of UTIs in pregnant women?

A

because there is urinary stasis as a result of the increase in plasma volume and enlarged kidneys/ureter

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52
Q

what characterises shortness of breath in pregnancy?

A

it occurs at rest and gets better on movement

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53
Q

why does blood volume almost double during labour and delivery?

A

because each contraction results in more blood being squeezed into the circulation (up to 500ml per contraction)

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54
Q

how should a pregnant woman NOT be examined and why?

A

NEVER examine a pregnant women flat on her back, because the weight of the baby will compress her IVC

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55
Q

what is colostrum and what does it contain?

A

it’s the first milk secreted from the mum’s breast during pregnancy
it contains a high number of calories and IgA to be passed onto the baby

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56
Q

what causes the linea nigra to appear and the nipples to become darker in colour?

A

increased melanocyte production by anterior pituitary

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57
Q

what promotes colostrum production?

A

prolactin release from anterior pituitary

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58
Q

where is oxytocin produced?

A

posterior pituitary

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59
Q

which liver enzyme is massively increased during pregnancy and why?

A

Alkaline phosphatase (ALP) - secreted by placenta

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60
Q

what is a common finding on a urine dipstick in pregnancy?

A

glycosuria

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61
Q

how is the thyroid affected during pregnancy?

A

can become hypoactive

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62
Q

name a few common GI changes during pregnancy?

A

cardiac sphincter relaxes
gastric emptying slows down
GI motility reduced –> heartburn/reflux

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63
Q

where do ectopic pregnancies most commonly occur?

A

in fallopian tube

64
Q

what is a molar pregnancy?

A

it’s the fertilisation of an empty ovum by a sperm, causing the implantation of a non-viable egg

65
Q

what is the pathophysiology of a molar pregnancy?

A

methylated genes from the dad are not balanced with the methylated genes from the mum as the ovum is empty.
this causes abnormal proliferation of trophoblast cells and placenta

66
Q

what is the role of trophoblast cells and decidual cells during egg implantation in the uterus?

A
  • trophoblast cells invade the decidua and guide chorionic villi into the tissue
  • decidual cells act as pro-coagulants to stop bleeding caused by trophoblast cells invading the tissue
67
Q

what medical treatment can be given for an ectopic pregnancy?

A

methotrexate

68
Q

what do trophoblast cells secrete?

A

beta HCG

69
Q

which test can be carried out in utero to diagnose Trisomy 21?

A

amniocentesis

70
Q

feature of babies born from mums with poorly controlled diabetes?

A

very large babies, broad shoulders

“diabetic cherub”

71
Q

what is a common cause of cerebral palsy in newborns?

A

infection during labour

72
Q

what is the main concern for fetus in placental abruption?

A

hypoxia

73
Q

name a few causes of placental abruption

A 
smoking
old maternal age
hypertension
cocaine use
trauma
74
Q

what is the pathophysiology of hypertension due to pregnancy?

A
  • trophoblast cells damage blood vessels in placenta, causing vaconstriction
  • vasoconstriction causes a drop in oxygen supply to placenta,
  • placental hypoxia triggers an increase in blood pressure to overcome the vasoconstriction and deliver oxygen to placenta
75
Q

what is the definition of a miscarriage?

A

intrauterine death of fetus before 24 weeks of gestation

76
Q

what are the six types of sponatenous miscarriage?

A
  • threatened
  • inevitable
  • incomplete
  • complete
  • septic
  • missed
77
Q

define a threatened miscarriage

A

bleeding from uterus before 24 weeks, with cervix closed

78
Q

define an inevitable miscarriage

A

loss of fetus due to dilated cervix before 24 weeks

79
Q

define an incomplete miscarriage

A

loss of fetus but placenta and membranes have not been expelled

80
Q

define a complete miscarriage

A

all products of conception are expelled and cervix closed again

81
Q

define a septic miscarriage

A

infection in uterus/pelvis following an incomplete miscarriage

82
Q

define a missed miscarriage

A

death of fetus but no expulsion

83
Q

name a few possible causes of spontaneous miscarriage

A
  • fetal abnormalities
  • uterine abnormalities
  • maternal disease/hormonal imbalance
  • cervical incompetence
  • idiopathic
84
Q

management of miscarriage?

A

removal of leftover conceptus in uterus (either medically or surgically)

85
Q

define an ectopic pregnancy

A

implantation of embryo outside of uterus

86
Q

name a few risk factors for ectopic pregnancies

A
  • previous infections
  • previous pelvic surgery
  • previous ectopic
87
Q

why are infections and previous fallopian tube surgery a risk factor for ectopic pregnancy?

A

because scarring can cause narrowing of the fallopian tube and obstruct passage of embryo

88
Q

how is an ectopic pregnancy identified?

A
  • USS scan
  • beta HCG levels
  • progesterone levels
89
Q

in an ectopic pregnancy, how do beta HCG and progesterone levels compare to normal pregnancy levels?

A
  • beta HCG increases rapidly in pregnancy. in ectopics it doesn’t
  • progesterone is lower in ectopic pregnancy than in normal pregnancy
90
Q

how are ectopic pregnancies managed?

A
  • conservatively (on mum’s request)
  • methotrexate
  • salpingotomy/salpingectomy
91
Q

what is the difference in medical treatment between ectopic pregnancies and miscarriages?

A

ectopic pregnancy - methotrexate to shrink conceptus

miscarriage - misoprostol (prostaglandins) to induce expulsion of conceptus

92
Q

what is misoprostol?

A

a synthetic prostaglandin used to induce labour/uterine contractions

93
Q

define antepartum haemorrhage

A

bleeding from uterus after 24 weeks of gestation but before delivery

94
Q

name a few causes of antepartum haemorrhage

A
  • placenta praevia
  • placental abruption
  • idiopathic
  • localised trauma
95
Q

how many grades of placenta praevia are there? give a brief description of each

A

1 - placenta near os
2 - placenta on edge of os
3 - placenta covers os
4 - placenta central over os

96
Q

what are the three ways placental abruption can present?

A

concealed - haematoma behind placenta
revealed - placenta comes away from the edge
mixed - concealed and revealed

97
Q

how does a placenta praevia present?

A
  • can be found incidentally
  • PAINLESS bleeding
  • malpresentation of baby
98
Q

how is placenta praevia identified?

A

by ultrasound scan

99
Q

what examination should not be done in mums with placenta praevia, and why?

A

vaginal examination - because it may result in more bleeding

100
Q

what are the two main clinical differences between placenta praevia and placental abruption?

A
  • placenta praevia is PAINLESS, abruption is painful
  • clinical presentation much more severe in placental abruption, whereas in placenta praevia mum is well unless there is severe bleeding
101
Q

what complication can occur in placenta praevia and why?

A

post partum haemorrhage, because lower part of uterus doesn’t contract as well as upper part, preventing vasosonctriction of placental blood vessels

102
Q

how is post partum haemorrhage treated?

A
  • with uterotonics (oxytocin, ergometrine)
  • with a balloon tamponade
  • with surgery
103
Q

name a few risk factors for placental abruption

A
  • previous abruption
  • pre-eclampsia/hypertension
  • polyhydramnios
  • smoking
  • increasing age
  • multiparity
  • cocaine use
104
Q

which type of placental abruption is most common?

A

mixed concealed and revealed

105
Q

how does placental abruption present?

A

PAINFUL bleeding

106
Q

in which type of placental abruption is there normally no PV bleeding?

A

in concealed placental abruption

107
Q

how is placental abruption managed?

A

managed depending on gestation, maternal/fetal wellbeing and amount of bleeding
options include waiting, induction of labour, cesarean

108
Q

name a few complications of placental abruption

A
  • postpartum haemorrhage
  • circulatory shock
  • fetal death
  • DIC
109
Q

when is labour classed as preterm?

A

when it occurs before 37 completed weeks of gestation

110
Q

how is pre-term labour managed?

A
  • tocolysis to slow down labour
  • steroids to help preterm baby to develop quicker
  • prepare for vaginal delivery
111
Q

what are the main signs of pre-eclampsia?

A
  • onset of hypertension after 20 weeks of gestation up to 6 weeks post delivery
  • proteinuria
112
Q

name a few symptoms associated with pre-eclampsia

A
  • headaches
  • blurred vision
  • RUQ pain
  • oedema
  • vomiting
  • clonus
  • hyperreflexia
113
Q

what are the HELLP signs in severe pre-eclampsia?

A

haemolysis
elevated liver enzymes
low platelets

114
Q

what investigation are done to diagnose pre-eclampsia?

A
  • blood pressure readings
  • urine dipstick
  • FBC (RBC, platelets)
  • liver function tests
  • kidney function tests
  • neuro exam for clonus and hyperreflexia
115
Q

why is it important to monitor women post-pregnancy for pre-eclampsia?

A

because over 40% of eclamptic seizures occur during the 6 weeks post-partum

116
Q

what is the medical treatment for women having an eclamptic fit?

A

magnesium sulphate

117
Q

what is the management of pre-eclampsia?

A

delivery of baby

118
Q

name a few potential complications of pre-eclampsia

A 
stroke
renal failure
liver failure
seizures
pulmonary oedema
DIC
heart failure
119
Q

what is gestational hypertension?

A

hypertension that starts after 20 weeks of pregnancy but stops after delivery

120
Q

what is the difference between gestational hypertension and pre-eclampsia?

A

presence of proteinuria in pre-eclampsia, not present in gestational hypertension

121
Q

name a few risk factors for developing pre-eclampsia

A
  • first pregnancy or long interval since last pregnancy
  • obesity
  • hypertension
  • renal failure
  • diabetes
  • previous pre-eclampsia
  • family history of pre-eclampsia
122
Q

why can women with pre-eclampsia present with hyperreflexia and clonus?

A

because vasoconstriction and oedema can cause increased intracranial pressure and cerebral irritation

123
Q

how can you screen for gestational diabetes?

A

monitor HbA1C

oral glucose tolerance test

124
Q

what is the prophylactic VTE management in pregnant women?

A

compression stockings

advice on mobility and hydration

125
Q

at which stage of gestation is a heart beat present?

A

6 weeks

126
Q

when is the dating scan carried out?

A

between weeks 11 and 14

127
Q

what information can be obtained from the dating scan?

A
  • due date
  • multiple pregnancies
  • molar/ectopic pregnancy
  • miscarriage
  • anencephaly
  • chromosomal abnormalities
  • neural tube defects
128
Q

when can the fetus be tested for Down’s Syndrome?

A

between weeks 11-14

129
Q

what are the tests done to identify the fetus’ risk of having Down’s Syndrome?

A

Combined Ultrasound and Biochemical screen (CUBS):

  • Ultrasound: Nuchal Translucency test
  • Biochemical test: hCG, PAPP-A
130
Q

when is the anomaly scan carried out in pregnancy?

A

week 20

131
Q

what can the anomaly scan identify?

A

structural abnormalities

132
Q

name a few abnormalities the anomaly scan can identify during pregnancy

A 
duodenal atresia
cleft lip
spina bifida
renal agenesis
diaphragmatic hernia
exomphalos
gastroschisis
133
Q

what is the first sign of pregnancy visible on ultrasound?

A

thickening of endometrium

134
Q

how is the gestation of a fetus measured during the first trimester scan?

A

crown-rump length of fetus is measured, which roughly coincides with gestation length

135
Q

if mum comes for a pregnancy scan between weeks 15 and 20, what can she be offered to identify risk of neural tube defects and Down’s syndrome?

A

blood test for alpha-fetoprotein, hCG, inhibin and unconjugated oestriol

136
Q

what should the crown rump length of baby be for a nuchal translucency test?

A

45-84mm

137
Q

is there a routine ultrasound scan done during the third trimester?

A

no

138
Q

what is the purpose of an ultrasound scan during the third trimester?

A

monitoring babies who are too small or too large for their gestation time, or for other potential problems

139
Q

how can fetal growth be measured during a third trimester scan?

A

head circumference
femur length
abdominal length

140
Q

what does the baby’s head look like if there is a neural tube defect?

A
  • frontal bossing

- lemon shaped head

141
Q

which neural tube defect can be detected during the first trimester?

A

anencephaly

142
Q

what is the first trimester ultrasound scan called?

A

dating scan

143
Q

what is the second trimester ultrasound scan called?

A

detailed anomaly scan

144
Q

what is the rate of detection of fetuses with Down’s syndrome using the CUBS tests?

A

85%

145
Q

what is the rate of neural tube defect detection during the second trimester scan?

A

90%

146
Q

which protein is raised in mum’s blood if the fetus has a neural tube defect?

A

alpha fetoprotein

147
Q

if a CUBS test shows a fetus is at high risk of having Down’s syndrome, what other more invasive tests can be carried out and when?

A

chorionic villus sampling - week 10-14

amniocentesis - after week 15

148
Q

name a few aims of pre-pregnancy counselling

A
  • optimise physical/psychiatric health
  • optimise BMI/diet
  • reduce alcohol consuption
  • smoking cessation
  • review medications
  • address pre-existing conditions
149
Q

if mum had a DVT during previous pregnancy, what action is taken to prevent risk in new pregnancy?

A

thromboprophylaxis - LMWH

150
Q

if mum had pre-eclampsia during previous pregnancy, what action is taken to prevent risk in new pregnancy?

A

blood pressure monitoring

low dose aspirin

151
Q

what pregnancy complication can be identified from a MSSU?

A
  • bacteriuria (UTI)
  • proteinuria (pre-eclampsia)
  • glycosuria (diabetes)
  • alpha feto protein (neural tube defect)
152
Q

after which week of pregnancy is it sometimes necessary to discuss termination of pregnancy due to severe fetal abnormalities?

A

after week 20 (anomaly scan)

153
Q

which infections are screened for as part of the antenatal examination?

A
  • rubella
  • HIV
  • syphilis
  • hepatitis B
  • UTI
154
Q

what is the main contributing risk factor that to the chance of fetus having Trisomy 21?

A

maternal older age

155
Q

what type of maternal death is most common in the UK?

A

indirect death - caused by comorbidities exacerbated by pregnancy

156
Q

what type of maternal death is the most common worldwide?

A

direct death - caused by complications of pregnancy/labour

Reproductive System (7 decks)

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