Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics > Pregnancy/Parturition > Flashcards

Pregnancy/Parturition Flashcards

1
Q

How would you define Labour?

A

Painful uterine contractions accompany dilation & effacement of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the 1st stage of labour?

A

cervix opens to full dilation — allows the head to pass through

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the 2nd stage of labour?

A

full dilation until delivery of the fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the 3rd stage of labour?

A

delivery of the fetus till the delivery of the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 3 mechanical factors that influence labour?

A

POWERS - force expelling fetus

PASSAGE - demensions of the pelvis and resistance of soft tissues

PASSENGER - diameters of the fetal head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What problem to do with POWER normally effects nulliparous women?

A

Poor uterine activity is more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are ischial spines used as landmarks to assess descent of the head? What are the stations?

A

Station 0 - head level with spines

Station +2 - head is 2cm below

Station -2 - head is 2cm above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the anterior fontanelle known as?

A

bregma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the posterior fontanelle known as?

A

occiput

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is presentation? What are the different ways a fetus can present?

A

Part of the fetus that occupies lower segment or pelvis?

Cephalic (head)

Breech (buttocks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the variations of cephalic presentations? What are these known as?

A

Vertex (full flexion)

Brow (poor flexion)

Face (full extension)

known as attitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is position? What are the different positions?

A

Describes the rotation of the fetus

occipito - transverse

occipito - posterior

occipito - anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are Braxton- Hicks contractions?

A

Involuntary contractions of uterine smooth muscle felt throughout 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do prostaglandins help the initiation of labour?

A

decreases cervical resistance

increase release of oxytocin from posterior pituitary - which aids stimulation of contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is effacement? What is normally accompanied by?

A

When the normally tubular cervix is drawn up into lower segment until it is flat

normally accompanied by -

i) ‘show’ - pink/white mucus plug
ii) rupture of membranes - release of liquor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What occurs during the latent phase of the 1st stage of labour?

A

Cervix usually dilates slowly for first 3cm, takes several hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What occurs during the active phase of the 1st stage of labour?

A

Average cervical delation is at the rate of

1cm/h in nulliparous women
2cm/h in multiparous women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How long should the 1st stage of labour normally last?

A

12hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the passive phase of the second stage of labour?

A

Full dilation until the head reaches the pelvic floor

women experiences desire to push

should last few mins, can be longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the active phase of the second stage of labour?

A

mother pushing

comfortable position, but not supine

fetus normally delivered in 40 mins (nulliparous), 20 mins (multiparous)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

After how long during the active phase of labour does the likelihood of spontaneous delivery decreasE?

A

> 1hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What happens during the 3rd stage of labour?

A

delivery of fetus —- delivery of placenta

lasts around 15 mins and blood loss of 500ml

uterine muscles contract, which compresses blood vessels formerly supplying the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the stages of perineal trauma? How are they defined?

A

1st degree - minor damage to fourchette

2nd degree - involves the perineal muscle

3rd degree - involves the anal sphincter

4th degree - involves the anal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the stages of headmovement during labour?

A

Every Decent Female I Crown Rules Lovingly

engagement

descent

flexion

internal rotation

crown

restitution

lateral flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What position is the head in at engagement? What position does it rotate to ?

A

occipito-transverse

rotates 90 degrees to occipito-anterior

in 5% rotates to occipito-posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

During restitution, what position does the head rotate to?

A

back to transverse before the shoulders are delivered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why the supine position not good for labour?

A

aortocaval compression : hypotension and fetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What measures should be taken into account for the physical well-being of a labouring mother?

A

Hydration - encourage drinking, IV fluid if epidural used or labour prolonged

Eating discouraged - ranitidine often given

Pyrexia in labour - >37.5 increases risk of neonatal illness, culture of vagina, urine and blood
antipyretics
IV abx is >38 degrees

Encourage urinating, if epidural used, catether may be needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is associated with inefficient uterine contractions?

A

Nulliparous Women

Induced Labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How would you manage inefficient uterine action?

A

Support

Mobility Encouraged

Amniotomy and then Oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What can hyperactive uterine action cause?

A

Fetal Distress

Labour very rapid

Risk of placental abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What medications causes the hyperactive uterine action and as a result increased risk of placental abruption?

A

Oxytocin

Prostglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How would you treat hyperactive uterine action?

A

Salbutamol IV or SC

C-Section normally indicated due to fetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How would you manage a nulliparous women who is having a slow first stage of labour?

A

artificial membrane rupture

if fails - IV oxytocin

if full dilation not imminent within 12-16 hrs - C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How would a occipito-posterior position during labour present?

A

labour longer

pain

backache

early desire to push

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How would you manage a occipito-posterior position?

A

many fetuses auto-rotate to OA or deliver OP

If labour slow, use augmentation

delivery can be done by flexion rather than extension

If fails - C-section

*if in active second stage - ventouse or manual rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How would you manage a Occipito-transverse position?

A

If no delivery after an hour

use ventouse rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How could you diagnose cephalo-pelvic disproportion?

A

inability to deliver despite

i) presence of adequate uterine delivery
ii) absence of malposition or malpresentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are some causes of fetal damage during labour?

A

Fetal hypoxia and distress

Infection/Inflammation

Meconium Aspiration

Trauma

Fetal Blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How would you define fetal distress?

A

pH <7.2 in fetal scalp sample

*however average tends to be 7.22, in reality below 7 is when there is neuro damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Causes of fetal distress?

A

decrease due to compression

longer labours

placental abruption

hypertonic uterine states

maternal hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are some signs of fetal distress?

A

Colour of liquor : meconium (pea-soup)

FHR

CTG

Fetal blood scalp sampling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Acronym for using CTG to assess fetal distress?

A

DR C BRAVADO

DR - define risk - e.g. meconium, fever, IUGR

C - contractions - >5/10mins = hyperstimulation

BR - baseline rate - should be 110-160 bpm

V - Variability - should be >5 beats/minute - if prolonged suggests hypoxia

Accelerations - accelerations of fetal heart with movements.contractions are reassurring

Decelerations - ‘variable’ - vary in timing = cord
compression = hypoxia
‘late’ - suggestive of fetal hypoxia

Overall Assess - false positive is high, hypoxia confirmed by blood sample

44
Q

What is the protocol for fetal distress?

A

Intermittent auscultation of FHR (if abnormal, meconium, long/high risk labour)&raquo_space;»>

Continuous CTG (if sustained bradycardia > deliver)
(if abnormal and simple measures fail > fetal blood sampling

If abnormal > deliver by quickest route

  • oxytocin stopped and contractions stopped with beta-2 agonists
  • vaginal exam to exclude cord prolapse
45
Q

What groups are risk for fetal infection?

A

maternal fever during labour

prolonged rupture of membranes

46
Q

What are complications of meconium aspirate? How would you treat it?

A

Severe pneumonitis

treat with amniofusion of saline into the uterus

47
Q

What is an inhaled form of pain relief during labour? What are it’s side effects?

A

Entonox - rapid onset

Can cause light-headedness, nausea and hyperventilation

48
Q

What are systemic opiates that can be used during labour? What are some side effects?

A

Pethidine or Meptid (IM)

Analgesic effect cause small patients to become sedated and confused

Can cause respiratory depression in newborn - can be reversed with naloxone

49
Q

What can spinal anaesthesia be used for? What are some complications associated?

A

C-section or Instrumental Vaginal Delivery

Hypotension and respiratory paralysis

50
Q

What is epidural anaesthetic? What are it’s effects?

A

Local anaesthetic w or w/o opiates via an epidural space (L3/L4)

Complete sensory and partial motor blockade from upper abdomen downwards

51
Q

What are the disadvantages to epidural anaesthesia?

A

Increased supervision to check BP and HR

Women bed bound (bed sores)

Decreased bladder sensation - urinary retention

maternal fever more common

Instrumental delivery more likely

transient fetal bradycardia

52
Q

What are the contraindications to epidural analgesia?

A

Sepsis

Coagulopathy

Active neurological disease

Spinal Abnormal

Hypovolaemia

53
Q

When should a women admit herself for labour?

A

Painful contractions at 5-10 minute intervals

Membranes have ruptured

54
Q

What is done when a women is admitted for labour?

A

Hx

Temp

BP

HR

Urinalysis

Presentation checked and vaginal exam performed checked effacement and dilation

Degree of descent assessed

Colour of liquor noted

Every 15 mins check FHR for 1 min

Birth plans and wishes read

55
Q

What is done during the first stage of labour?

A

Analgesia? - if epidural, catheterization is needed

Fetal liquour colour observed
FHR after a contraction
CTG if high risk
Oxygen, IV Fluid and Left Lateral Position

Oxytocin Stopped

If abnormal HR persists - fetal scalp blood is taken
If there is fetal distress - C-section

Progress assessed 2-4 hourly via vaginal exam
Descent measured by ischial spines and dilation

56
Q

What should be done if there is slow dilation after laten phase?

A

Artificial Rupture of Membrane

if still slow - oxytocin in nulliparous women

*in multiparous women malpresentation or malposition must be excluded first

If cervix not full dilated by 12 hrs - c-section

57
Q

During the second stage of labour what is instructed to the mother if NO epidural?

A

‘non-directed’ pushing - when mother has desire to push

58
Q

During second stage of labour, what is instructed to the mother if there IS epidural?

A

normal to wait one hour before pushing

‘directed pushing’ - push 3 times for 10 seconds

59
Q

During the second stage of labour when is an instrumental delivery indicated?

A

Delivery not imminent after 1hr of pushing

If fetal distress

60
Q

In the 3rd stage of labour what is normally given to the mother? What is it’s use?

A

Syntometrine (ergometrine + oxytocin)

Helps uterus contract once the shoulders are delivered

61
Q

How would you define retained placenta?

A

When the 3rd stage of labour lasts for more than 30 mins

62
Q

What is the management for retained placenta?

A

If there is partial separation = bleeding w/o external signs, oxytocin infusion is started

In the absence of bleeding =

  1. one hour left for natural expression
  2. placenta manually removed if not delivered naturally after an hour
63
Q

What are the advantages and disadvantages to the active management (syntometrine) of the 3rd stage of labour?

A

Disadv - causes maternal vomiting, can be unecessary

Adv - reduces the risk for postpartum haemorrhage

64
Q

What is are the degrees of perineal tear?

A

1st degree - injury to skin only

2nd degree - involving perineal muscle but not anal sphincter

3rd degree - involving anal sphincter complex

4th degree - anal sphincter and anal epithelium

65
Q

How would you manage the different degrees of perineal tear?

A

1st and 2nd - sutured under local

3rd and 4th - sphincter repaired under epidural/spinal in operation theatre
abx and laxatives given + analgesia

physio assessment and anal manometry

66
Q

What some risk factors for a 3rd or 4th degree perineal tear?

A

Forceps

Large Baby

Nullparity

Use of midline episiotomy

67
Q

How would pregnancy be induced using Prostaglandins?

A

Prostaglandin E2 gel inserted into posterior vaginal fornix

If one does doesn’t increase ripeness, another is given 6hrs later

May be more effective if administered in the evening

68
Q

How does an amniotomy work?

A

Rupture water with amnihook

then oxytocin infusion started within 2h if labour hasn’t started

69
Q

What are some fetal indications for induction?

A

prolonged pregnancy

IUGR

Antepartum Haemorrhage

Poor Obstetrics History

Prelabour rupture of membranes

70
Q

What are some maternal indications for induction?

A

Pre-eclampsia

Diabetes

Social reasons

In Utero death

71
Q

What are some absolute contra-indications for induction?

A

abnormal lie
placenta praevia
pelvic obstruction
after 2 or more c-sections

72
Q

What are some relative contra-indications for induction?

A

One c section

prematurity

73
Q

After administration of PGE , what other steps should you be taken?

A

CTG for an hour

Oxytocin commonly required in labour

74
Q

What does a ventouse delivery allow?

A

Traction during maternal pushing

Allows rotation of head to occipito-anterior position

can be used for most instrumental deliveries

75
Q

What can a Simpson’s or Neville-Barnes’ forceps do? What is a disadvantage of this kind of forcep?

A

Grips head at whatever position and allows traction

disadvant - only suitable for occiput anterior position

Otherwise use rotational forceps such as Kieland’s

76
Q

What are some disadvantages of Ventouse?

A

More likely to fail

Chignon

Scalp Lacerations

Cephalhaematomata

Neonatal Jaundice

77
Q

What are some disadvantages of Forceps?

A

Increased risk of maternal complication

need for analgesia is higher

facial bruising

facial nerve damage

skull and neck fractures

78
Q

What is the disadvantage of changing instruments? When is it indicated?

A

Increase fetal trauma

Only indicated when ventouse achieved descent but then comes off head

79
Q

What are some general disadvantages of instrumental deliveries?

A

Vaginal Laceration

Blood Loss

3rd Degree tear

80
Q

What are indications for instrumental vaginal delivery?

A

Prolonged Second Stage (1hr of pushing has failed)

Fetal Distress

Prophylactic use (women who can’t push, cardiac disease etc)

Breech Delivery

81
Q

What increases the risk of instrumental delivery?

A

Epidural Analgesia

Induction

82
Q

When would you choose forceps or ventouse?

A

Forceps appropriate unless rotation is needed

83
Q

What are some pre-requisites for instrumental delivery?

A

head MUST NOT be palpable abdominally

must be at or below ischial spines

cervix must be full dilated

position of head must be known

adequate analgesia

bladder empty

84
Q

What is the common type of C-section? Why would you not do that type of C-section? What is the alternative?

A

Lower Segment C-Section

If extreme prematurity, Multiple Fibroids and Fetus transverse

Uterus incised vertically - Classical C-section

85
Q

What are indications for C-section?

A

Prolonged 1st stage (full dilation not imminent by 12 h)

Fetal Distress

86
Q

When is an Elective C-section done? Why?

A

39 weeks

to reduce risk of neonatal lung immaturity

87
Q

What are some absolute indications for Elective C-Section?

A

placenta praevia

severe antenatal fetal compromise

uncorrectable abnormal lie

previous vertical c-section

gross pelvic deformity

88
Q

What are some relative indications for Elective C-Section?

A

breech

severe IUGR

twins

diabetes

previous c-section

older nulliparous patients

89
Q

If less than 34 weeks gestation and delivery needed (severe pre-eclampsia, severe IUGR) which is more appropriate? C -sec or Induction?

A

C -section

90
Q

What are some maternal and fetal complications assoc. with c-section?

A

Haemorrhage

Infection of uterus or wound

Visceral, Bladder or Bowel damage

VTE

Increased risk of fetal respiratory morbidity

Fetal lacerations

Bonding and breast-feeding affected

91
Q

How does a c-section affect subsequent pregnancies?

A

They become increasingly difficult

placenta praevia more common

placenta may implant more deeply

92
Q

Risk factors for Shoulder Dystocia?

A

large baby

previous shoulder dystocia

high maternal bmi

labour induction

low height

maternal diabetes

instrumental delivery

93
Q

How would you manage shoulder dystocia?

A

McRobert’s manoeurve - hyperextension of mothers legs

Episiotomy

Wood’s screw manoeurve

Symphisiotomy

Zavanelli manoeurve - replacement of fetal head and c section

94
Q

What is the risk with untreated cord prolapse?

A

baby becomes hypoxic

95
Q

Risk factors for cord prolapse?

A

pre term labour

breech

polyhydramnios

abnormal lie

twin

artificial amniotomy

96
Q

How is diagnosis of cord prolapse made?

A

FHR becomes abnormal

Cord is palpated vaginally

97
Q

Management for cord prolapse?

A

presenting part pushed up

tococlytics 0 terbutaline

if cord is out of introitus - keep warm and moist

patient asked to go on all fours

then c-sections

98
Q

What is an amniotic fluid embolism?

A

When liquor enters maternal circulation

causes anaphylaxis with dyspnoea, hypoxia, hypotension, seizures and cardiac arrest

If woman survives develops - DIC, Pulm Oedema and ARDS

99
Q

What are risk factors for Amniotic fluid embolism?

A

When membranes rupture

Labour

C-sec

termination

strong contractions in presence of polyhydramnios

100
Q

What is management of amniotic fluid embolism?

A

Resus and supportive

O2 and fluid IV

FBC, U&E and cross-match taken

patient to ICU

101
Q

What are complications of uterine rupture?

A

acute fetal hypoxia

massive internal maternal haemorrhage

102
Q

What are risk factors for uterine rupture?

A

labours with a scarred uterus

classical c-section

deep myomectomy

congenital uterine abnormality

103
Q

How to avoid uterine rupture?

A

avoid induction

caution using oxytocin on women with previous c -section

104
Q

How would you manage uterine rupture?

A

Maternal resus - IV fluid and blood

Laparotomy

105
Q

Components of Bishops score?

A 
Cervical position
Posterior
Intermediate
Anterior
-
Cervical consistency
Firm
Intermediate
Soft
-
Cervical effacement
0-30%
40-50%
60-70%
80%
Cervical dilation
<1 cm
1-2 cm
3-4 cm
>5 cm
Fetal station
-3
-2
-1, 0
\+1,+2

Obstetrics (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions