Brainscape's Knowledge GenomeTM

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


See full index

A3 ME3034 REPRO > W03: Normal Labour; Abn Labour > Flashcards

W03: Normal Labour; Abn Labour Flashcards

1
Q

Describe the physiological process of labour and birth

A
  • cervix softens, myometrial changes allowing coord contractions
  • ⇧oxytocin + prostaglandins; ⇩progesterone = INITIATE LABOUR
  • ⇧cervical dilatation

STAGE 1:
latent phase = irregular contractions, dilat. up to 4cm

active first stage = 8-12hrs, regular painful contractions, dilat 4-10cm

transition = physical changes: shaking, vomit, poo

STAGE 2
full dilatation to birth
passive followed by active

STAGE 3
birth until expulsion of placenta and membranes; physio. mgmt.,
active mgmt.

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

Describe methods of assessing progress in labour

A

Abdo examination can elucidate the position and possible presentation

  • cephalic
  • right or left transverse
  • oblique (left/right)

+ obs
+ vaginal examination
+ liquor monitoring
+ palpation. of contractions
+ rhomboid of michaelis & anal cleft line

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

What is normal labour

A

expulsion of the fetus, placenta, and membranes via the birth canal
- spont.
- 37-42w gestation
- fetus presenting by the vertex
= spontaneous vaginal birth

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

Mechanism of labour

A
  1. engagement of head and descent
  2. flexion: cervical flexion upon pelvic floor = smaller diameter allowing passage
  3. int. rotation
  4. crowning @ vulva and extension of the head
  5. ext rotation & restitution: realignment of shoulders w/ head
  6. internal rotation of the head and external rotation of the head
  7. lateral flexion of shoulders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is engagement

A

largest diameter of fetal head fits into the largest diameter of the maternal pelvis

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

What is descent

A

baby descends through the pelvic inlet towards the pelvic floor

dt
- uterine contractions
- amnio fluid pressure
- abdo muscle contractions

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

What is internal rotation

A

head rotates from Left/Right occipito-transverse to an OCCIPTO-ANTERIOR POSITION followed by CROWNING

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

Assessing fetal wellbeing

A

auscultation or continuous monitoring to assess fetal heart rate
* 110-160bpm

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

describe the stress of labour on the fetus

A
  • hypoxic stress
  • infection
  • cord prolapse
  • placental abruption
  • vasa praevia
  • uterine hyper. stim
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe complications in labour and understand the basis of their management

A

indications for induction:
-DM
- after due date
- maternal need for planning of delivery: DVT tx
- fetal reasons
- social/maternal requests

  • intrapartum complications: powers, passages, passenger
  • weak uterine contractions
  • malposition (common)

> IV oxytocin = increase contractions (power)

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

Labour Induction

A

> cervical ripening via PROSTAGLANDINS or BALLOON

  • BISHOP’S SCORE: clinically assess success of induction
  • AMNIOTOMY. = artifical rupture of fetal membranes
  • followed by IV oxytocin = contractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Whats effacement

A

Effacement is the thinning and shortening of the cervix. It happens at the end of pregnancy in preparation for childbirth.

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

Monitoring fetus

A
  • auscultation
  • CTG: cardiotocography
  • fetal blood sampling: speculum scalp blood sample
  • fetal ecg = abn = blood sample
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

3rd stage complications

A
  • retained placenta
  • post partum haemorrhage
    4Ts
  • tone
  • trauma
  • tissue
  • thrombin
  • tears: graze; 1st to 4th degree
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Signs of PPH (post part. haemorr.)

A
  • hypotensive, tachycardic
  • decreased red cell
  • pale, clammy, vommy
  • abdo pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Outline the global burden of maternal and perinatal mortality

A

prolonged labour = complications
- uterine rupture
- obstetric fistula
- pphaemor.

untreated hypertensive disorders

infection: leading cause in sub-sahran africa
- post-birth infect. top mortality cause

intrauterine death, preterm birth, neonatal death

17
Q

Outline a basic understanding of the definitions, data sources and measurement challenges

A

a

17
Q

Outline the major options for reducing the magnitude of maternal mortality at a population level

A
  • oxytocin injections
  • hygiene
  • early tx of infection
  • BP control and Mg sulphate in severe pre-ecampsia
  • education
  • better infrastructure and access
  • poverty; cultural practice; poor health services
18
Q

Obstetric fistula

A

prolonged labour ompresses soft tissues around uterus/baby head = necrosis = fistula forming between spaces such as bladder or rectum

> sx repair

19
Q

Morbidly adherent placenta

A

normal placenta = placenta separated from uterine wall by fibrinous layer

placenta accreta = firm attach. to uterine

placenta increta = invasion at elast halfway

placenta percreta = invasion THROUGH to nearby tissues/ structures

20
Q

To describe the normal changes to the mother in the puerperium

A

*6w post-birth; midwife first 9-10d then health visitor
- screen for abn bleeding, infection
- debrief emergency events
- mental health
+ 6w postnatal check at GP

21
Q

To describe the potentially serious medical problems arising in the postpartum period

A
  • complications in breast feeding
  • blocked ducts, mastitis
  • p.partum haemorr.
  • venous thromboem.
  • significantly postpartum hypercoagulable state

> prophylaxis
LMWH (warfarin safe for breast feeding)

  • sepsis

> IV abx

  • psychiatric disorders
  • postnatal depression

> tx

  • pre-eclampsia: postnatal eclamptic seizures
    > antihypertensives
    + follow up
22
Q

1º and 2º PPHaemorr.

A

1º = 500ml loss within 24hrs
- tone
- trauma
- tissue
- thrombin

2º = 500ml+ loss from 24hrs to 6w
- retained tissue
- endometritis
- tears/trauma

23
Q

Red flags for thromboembolic disease post partum

A

unilateral leg swelling/pain
SOB or chest pain

unexplained tachy.

= high index of suspicion for VTE

24
Q

CTGs: how, and indications

A

Abn or intrapartum complications = indicate CTG

  • autonomic and CNS activity changes dt hypoxia
  • USS detects fetal HR
  • contractions of uterine wall detected
  • continual CTG dt
  • induction of labour, post maturity/ pre-maturity
25
Q

CTG Interpretation

A

DR C BRAVADO

DR = determine risk

C = contractions/10mins
* lower bar; no. of peaks per 20squares = peaks/10mins

BRA = Baseline Rate when accelerations and decelerations excluded

V = variability: zig zaggging

A = accelerations: upward peaks

D = decelerations: troughs
* prolonged/late = fetal hypoxia

O = overall: good/bad/ etc.

26
Q

Fetal blood sampling: decisions

A

blood sampling confirms signs of CTG hypoxia

pH > 7.25 = rpt in 1hr if CTG remains abn

pH 7.21-7.24 = rpt in 30mins if CTG remains abn.

pH < 7.2 = IMMEDIATE DELIVERY

27
Q

C-Section types

A

-Lower uterine segment incision; commonest

  • Classical: rarely used - longitudinal
28
Q

Indications of C-sect

A
  • foetal distress
  • failure to progress in labour/ induction
  • malpresentation
  • severe pre-eclampsia
  • placenta praevia
29
Q

Categories of C-sect

A

I: emergency = within 30mins

II: urgent = 90mins: maternal/foetal compromise

III: scheduled: early delivery but no compromise

IV: elective: time to suit woman and team

30
Q

Complications of C-Sect

A
  • injury: bladder, ureters
  • haemorr
  • DVT

> abx
lmwh

+ catheterisation
+ regional anaesthesia

LT risk:
* placenta praevia or accreta
* antepartum stillbirth
* uterine rupture
* post-op lesions

A3 ME3034 REPRO (21 decks)

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