RCSI LECTURES Flashcards
Complications of molar pregnancy
- severe hyperemesis
- thyrotoxicosis
- early onset preeclampsia
- hemorrhage
- persistant trophoblasict disease
- choriocarcinoma
Labour diagnosis
Progressive effacement and dilatation of the cervix in the presence of uterine contractions
First stage of labour
From establishment of labour until full dilatation
Second stage of labour
Full dilatation to delivery of the fetus
Third stage of labour
Delivery of the placenta
What are the standard procedures in labour assessment?
- general examination
- assessment of uterine contractions and fetabl wellbeing
- FBC, blood type and Rh status
- Partogram
- Minimal vaginal examinations following initial assessment
What are the fetal assessments in labour?
- Amniotic fluid (volume and colour)
- Maternal assessment - BP, HR and temp charting - uterine contractions
Average rate of cervical dilatation in a primigravida?
1cm per hour
When is the fetal head considered engaged?
When 2/5ths or less are palpable
When does the second stage of labour begin?
-with full dilatation
What are the two phase of the second stage of labour?
Passive phase: from full dilatation until the head reaches the pelvic floor
Active phase: when the fetal head reaches pelvic floor - usually associated with strong desire to push
First degree tear?
Injury to the vaginal epithelium and vulval skin only
Second degree tear?
Injury to the perineal muscles but not the anal sphinctor
Third degree tear?
Injury to the perineum involving the anal sphinctor
Fourth degree tear?
Injury involving the anal sphincter and rectal mucosa
Signs of placental separation
- lengethening of the umbilical cord
- gush of blood
- Rising up of the fundus
what is the latent phase of labour?
up to 3cm dilation
how long may the latent phase of labour take?
up to 6 hours
what is the active phase of labour?
3cm to 10cm dilation
at what rate should dilation occur?
1cm per hour in primi, 1-2cm per hour in multi
what are EFFICIENT uterine contractions?
Regular contractions, lasting 60-80 seconds with a frequency of up to 7 in 15 min
Most common cause of failure to progress in primigravid women?
Inefficient uterine action
Management of inefficient uterine action?
Oxytocin via IV infusion - start low and increase
Aim to acheive 7 contractions in 15 min
Must monitor fetal heart while using oxytocin
A multigravid woman is likely to have inefficient uterine action T OR F
FALSE - unlikely - caution when using oxytocin, failure to progress could be from malpresentation
Diagnosis of prolonged labour?
- certainty about onste of labour?
- review history
- assess contractions
- review the CTG
- perform abdominal and vaginal exams before making any decisions
Management of prolonged labour?
IF maternal and fetal wellbeing are satisfactory - alllow labour to continue
IF suspected fetal compromise, arrest in cervical dilation despite adequate contractions, or cephalic disproportion -> C-section
What is malpresentation?
When any non-vertex part presents - arm/face/feet/brow etc
Risk factors for oblique/transverse lie?
- preterm labour
- placenta previa
- abnormal uterus
- polyhydramnios
why does transverse lie occur in women with high parity?
laxity of the abdominal wall
Management of a non-reassuring CTG ?
Fetal blood sampling OR delivery via C section/instrumental delivery
normal pH on fetal blood sampling?
7.25 and up
Borderline ph and procedure for borderline ph?
7.2-7.25 = repeat in 30 min or deliver if rapid fall since last sample
What is an abnormal pH on fetal blood sampling?
<7.20 -> delivery (based on cervical dilation)
Indicators of down syndrome on a first trimester screening?
- nuchal translucency
- decreased PAPP-A and elevated b-hcg
What are the definitive tests for down syndrome in uteruo?
Chorionic villus sampling - performed at 11-14 weeks gestation
Amniocentesis - greater than 15 weeks gestation
what is the risk of chorionic villus sampling?
1% risk of miscarriage
Risk of amniocentesis?
<0.1% chance of miscarriage
trisomy 18 =
edwards syndrome
ultrasound features of a fetus with edwards syndrome?
IUGR, strawberry shaped head, choroid plexus cysts, hydrocephalus, micrognathia, nuchal edema, heart defects, neural tube defects
trsimoy 13 =
patau syndrome
ultrasound features of a fetus with patau syndrome?
IUGR, holoprosencephaly, facial abnormalities, microcephaly, heart defects
when should the neural tube close?
26-28 days
when should a woman commence folic acid?
3 months prior to conception - 0.4mg OR 5mg if high risk
what is the role of the first trimester scan?
- to confirm viability of the pregnancy
- to confirm that its an intrauterine pregnancy
- to confirm or exclude multiple gestation
- if multiple gestation - confirm chorionicity
- confirm dates by measuring crown rump length
What is the role of the second trimester scan?
18-22 weeks - fetal anomoly scan
- confirm pregnancy dating with biophysical measurements
- placental location (especially in women with bleeding)
