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Repro and Sexual Health > Week 5 > Flashcards

Week 5 Flashcards

1
Q

How do Braxton Hicks contractions present?

A

Irregular contractions that do not increase in frequency or intensity and are NOT PAINFUL (and resolve with movement)

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2
Q

When do Braxton Hicks contractions present?

A

Usually felt in the 3rd trimester but can be felt in the first 6 weeks

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3
Q

What is the main difference between Braxton Hicks contractions and True Labour contractions

A

Braxton Hicks contractions are NOT PAINFUL

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4
Q

What is the maximum, safe, number of contractions in 10 minutes?

A

3-4 contractions in 10 minutes

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5
Q

What are the 3 main types of pelvis?

A

Gynaecoid
Anthropid
Android

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6
Q

What are some of the pain relief options whilst in labour?

A

Non-opioid
Entonox
Opioid
Epidural
Remifentanyl

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7
Q

Define first stage of labour

A

From the beginning of true contractions to full dilatation

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8
Q

What is the latent phase of labour?

A

From the beginning of contractions to 4cm dilated

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9
Q

What is the active phase of labour?

A

From 4cm dilation to full dilation

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10
Q

What are some of the ways we can induce labour?

A

Prostaglandin- PGE2, dinoprostone
Mechanical- membrane sweep, foley balloon catheter
Amniotomy- artificial rupture of membranes
IV Syntocinon- this is a form of oxytocin

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11
Q

What are some of the risk factors for shoulder dystocia?

A
  • previous shoulder dystocia
  • fetal macrosomia
  • diabetes
  • BMI>30
  • less than 5 foot
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12
Q

Complications of shoulder dystocia?

A

Fetal:
- hypoxia
- Brachial plexus injury
- fracture of clavicle/humerus
- intracranial haemorrhage
- death
Maternal:
- PPH
- Genital tract trauma
- pelvic injury

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13
Q

Which degrees of perineal tears are most common?

A

First degree and second degree

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14
Q

Which perineal tears usually require stitches?

A

second, third and fourth degree tears

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15
Q

Describe the 4 stages of perineal tears

A

First Degree: injury to the perineal skin only
Second Degree: injury to the perineal skin and
muscles but NOT THE ANAL SPHINCTERS
Third degree: Injury involving the anal sphincters
3A- involves part of the external anal sphincter
3B- involves all of the external anal sphincter
3C- involves the internal anal sphincter
Fourth Degree: disruption of anal epithelium/mucosa

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16
Q

What are some risk factors of a morbidly adherent placenta?

A
  • previous CS
  • previous uterine surgery
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17
Q

What are the 3 types of morbidly adherent placenta and describe each type?

A

Placenta accreta- the placenta is too deep within the
endometrium
Placenta increta- the placenta is buried into the
myometrium
Placenta Percreta- the placenta goes through the wall
of the uterus and can dig into other organs e.g.
bladder or bowel

18
Q

Post Partum Haemorrhage management?

A
  1. ABCDE
  2. Uteretonics is the main mode of management
    • Syntocinon (oxytocin)- first line
    • Ergometrine (can be given combined with
      syntocinon to form syntometrine)
    • Hemabate- can be given up to 8 doses- a
      prostaglandin so not given for severe asthmatics
    • Misoprostol- prostaglandin so not given for severe asthmatics
    • Tranexamic acid- stops major bleeding
  3. Surgical options
    • Intrauterine balloon
    • Brace sutures
    • Interventional radiology
    • Hysterecomy
19
Q

What is the use of Tranexamic acid in PPH?

A

Helps if someone has major bleeding as slows major bleeding

20
Q

What is the traditional definition of primary PPH?

A

More than 500ml of blood loss within 24 hours of giving birth

21
Q

How long should the 3rd stage of labour last?

A

If actively managed , up to 30 minutes. If physiological, up to 60 minutes

22
Q

How do you actively manage the 3rd stage of labour?

A

Uteretonics: syntocinon, syntometrine

23
Q

Who should be offered active management of the 3rd stage of labour?

A

Prophylactic uterotonics should be routinely offered in the management of the third stage of labour in all women as they reduce the risk of PPH.

24
Q

What are the advantages of actively managing the 3rd stage of labour?

A

Decreases length of 3rd stage
Decreases risk of PPH

25
Q

What are some risk factors for Maternal sepsis?

A

Pre-natal invasive diagnostic procedures e.g. amniocentesis, CVS
Cervical suturing
Prolonged rupture of membranes
Operative delivery
Retained Products of Conception (RPOC)
Maternal diabetes, maternal obesity, maternal anaemia, maternal immunosuppression

26
Q

Define placental abruption

A

The separation of a normally implanted placenta partially or totally before the birth of the fetus

27
Q

What are some of the adverse affects of Synotinon?

A
  • uterine hyperstimulation
  • Water intoxication
  • Hyponatraemia
28
Q

What is induction of labour?

A

Induction is the process of starting labour by uterine stimulation. It should be used when it is thought that the baby will be safer delivered than it is in utero. Induction needs to be clearly distinguished from augmentation of labour, which is the enhancement of uterine contractions once labour has started.

29
Q

Who should we offer induction of labour to?

A
  1. Women with a healthy pregnancy after 41 weeks
  2. Women who’s pregnancy is complicated by diabetes- pre-term
  3. In women with pre-labour ruptured membranes after 37 weeks (6-19% of pregnancies), they should be given a choice of either immediate induction, or watchful waiting for up to maximum of four days
30
Q

Define Antepartum Haemorrhage (incl. cut-offs)

A

bleeding from the genital tract >24 week gestation and before the end of 2nd stage labour

31
Q

What are the 3 most common causes of antepartum haemorrhage?

A

Placenta praevia
Placental abruption
Vasa praevia

32
Q

How do you manage placenta praevia when it is diagnosed on the anomaly scan (20 weeks)

A

Repeat scan at 32 weeks gestation then again at the 36 week scan.
Corticosteroids are given between 34 and 35+6 weeks gestation to mature the fetal lungs, given the risk of preterm delivery.
Planned delivery(c section) is considered between 36 and 37 weeks gestation. It is planned early to reduce the risk of spontaneous labour and bleeding.

33
Q

Define placenta praevia

A

when the placenta lies directly over the internal os

34
Q

Define low lying placenta

A

when the placental edge is less than 20mm from the internal os on transabdominal or transvaginal scanning (TVS)

35
Q

Does a low lying placenta require a planned c section?

A

Yes

36
Q

What is the most common form of malpresentation?

A

Breech presentation

37
Q

What does the anterior fontanelle become 18-24 months after birth?

A

Bregma

38
Q

Describe malposition

A

Malpositionsareabnormal positions of the vertex (with the occiput as the reference point) relative to the maternal pelvis

39
Q

What are the signs of hypoxia on Cardiotocography?

A
  1. Loss of accelerations
  2. repetitive deeper and wider decelerations particularly late
  3. rising fetal baseline heart rate
  4. loss of variability
    1. this is a late sign
40
Q

For premature deliveries what mode of assisted birth is preferred?

A

Forceps may be recommended over ventouse.
This is because forceps are less likely to cause damage to your baby’s head, which is softer at this point in your pregnancy

41
Q

What is the management for babies that are breech before 36 weeks?

A

Nothing- this often corrects itself by term

42
Q

Define stillbirth

A

Stillbirth is defined as the birth of a dead fetus after 24 weeks gestation. Stillbirth is the result of intrauterine fetal death (IUFD). It occurs in approximately 1 in 200 pregnancies.

Repro and Sexual Health (7 decks)

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