week 4 Flashcards
Visceral Pain
distension of the lower uterine segment, stretching of cervical tissues as it effaces and dilates, pressure and traction on adjacent structures (e.g., fallopian tubes, ovaries, ligaments) and nerves, and uterine ischemia
Referred Pain
originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs
Somatic Pain
intense, sharp, burning, and well localized
Nerve Block Analgesia and Anaesthesia
local infiltration anaesthsia
spinal nerve block
epidural
nitrous oxide
Maternal Hypotension
signs drop 20% from pre block baseline or less than 100mmHg systolic
fetal bradycardia
absent or minimal fetal heart variabiltiy
Preterm Labour
Regular uterine contractions with cervical effacement and dilation before end of week 37
One of most common obstetric complications
Can be spontaneous or indicated
Tocolytic drugs: none first-line; may prolong pregnancy for 2 to 7 days while steroids are given to promote fetal lung maturity
What is magnesium sulphate used for?
fetal neuroprotection
What is Nifedipine used for?
Blocks calcium movement into muscle cells, inhibits uterine activity to reduce or arrest preterm labour
What is Indomethacin used for?
Inhibits prostaglandin synthesis (stimulates contractions), therefore reduces uterine activity to delay or arrest preterm labour
What is Betamethasone used for
Promotes fetal lung maturity by stimulating surfactant production; prevents or reduces risk of respiratory distress syndrome and intraventricular hemorrhage in the preterm neonate less than 34 weeks’ gestation
Post Term Pregnancy
pregnancy continuing past 42 weeks gestation
Maternal risks for Post Term Pregnancy
Caesarean birth, dystocia, birth trauma, postpartum hemorrhage, and infection
Fetal Risks for Post Term Pregnancy
Macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, and cephalopelvic disproportion
What is Dystocia?
Abnormally slow progress of labour caused by various conditions related to the five P’s of labour
Induction of Labour
The deliberate initiation of labour through medical means:
Induction
Augmentation
Induction:
Use of indwelling catheter
Use of osmotic dilator
Use of prostaglandins (Cervidil, Prostin, misoprostol)
Use of oxytocin
Artificial Rupture of Membranes (ARM)
Forceps or Vacuum Assisted Birth
Application of traction to fetal head
Operative Vaginal Deliveries
Application of forceps or a vacuum extractor to the fetal head to assist during the 2nd stage of labour and facilitate delivery.
Caesarean Birth
Classic or low transverse incision
Major surgical procedure with accompanying risks
Vaginal Birth After c Section
Controversy related to risk of uterine rupture and hemorrhage
Contraindications
Special areas of focus: consent, documentation, surveillance, and readiness for emergency
5 P’s of labour
passenger, passage, powers, placenta, and psychology
