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3a > WH: Labour > Flashcards

WH: Labour Flashcards

1
Q

When does labour and delivery usually occur?

A

between 37 - 42 weeks

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2
Q

how many stages does labour have?

A

3 stages

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3
Q

When does first stage of labour start and end?

A

starts from onset of labour (true contractions) until 10 cm cervical dilation

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4
Q

How many phases are there in the first stage of labour? what are they called ?

A

3 phases to first stage of labour
- Latent
- Active
- Transition

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5
Q

describe latent phase of labour? how many cm cervical dilation? rate of cervical dilation? describe the contraction?

A

Latent phase (Phase 1 of stage 1)
- 0 - 3cm cervical dilation
- 0.5cm/hr
- irregular contractions

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6
Q

describe active phase of labour? how many cm cervical dilation? rate of cervical dilation? describe the contraction?

A

Active phase (phase 2 of stage 1)
- 3 - 7 cm cervical dilation
- 1cm/hr
- regular contractions

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7
Q

describe the transition phase of labour? how many cm cervical dilation? rate of cervical dilation? describe the contraction?

A

Transition phase (phase 3 of stage 1)
- 7-10cm cervical dilation
- 1cm/hr
- strong and regular contractions

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8
Q

what 2 things happen to the cervic during the first stage of labour?

A
  • Dilatation (opening up/widening)
  • Effacement (thinning out)
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9
Q

What are the 2 layers to the fetal membranes ? how do they change before labour?

A

chorion + amnion
- They become weaker Ian prep for labour

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10
Q

What is the show? what does it usually do? why does it come out?

A

mucus plug preventing bacteria entrance falls out
- creates space for baby

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11
Q

What are Braxton-hicks contractions ? when do they occur?

A

not true contraction in 2nd/3rd trimester
- not labour (they do not progress)

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12
Q

What marks the beginning and end of the second stage of labour?

A

from 10cm cervical dilatation until delivery of baby

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13
Q

What does success of the second stage of labour depend on?

A

3 (4) Ps
- Power
- Passenger
- Passage
- (Psyche)

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14
Q

What does power refer to in terms of the second stage of labour?

A

strength of uterine contractions

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15
Q

What does passenger refer to in terms of the second stage of labour?

A

the fetus
- Size
- Attitude (posture)
- Lie
- Presentation

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16
Q

what does passage refer to in terms of the second stage of labour?

A

size and shape of the passageway (mainly pelvis)

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17
Q

what marks the beginning and end of the third stage of labour?

A

from delivery of baby until delivery of placenta

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18
Q

When should you consider active management of the third stage of labour? (2)

A
  • haemorrhage
  • more than 60 min delay in placenta delivery
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19
Q

What drug is often sued in active management of third stage of labour? how does it work?

A

IM oxytocin helps uterus contract + expel placenta

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20
Q

Name some signs of labour

A
  • Show (mucus plug)
  • SROM (all at once or trickle)
  • cervical dilatation 10 cm
  • Regular painful contractions
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21
Q

what is failure to progress in labour? leads to?

A

labour not delivering at a satisfactory rate => increase risk to mother + fetus

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22
Q

what is used to measure progress during first stage of labour?

A

monitored for progress using a partogram

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23
Q

what can be used to help progress the second stage of labour? (6)

A
  • Changing positions
  • Encouragement
  • Analgesia
  • Oxytocin
  • Instrumental delivery
  • CS
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24
Q

What are the 8 key fetal stages to a vaginal birth?

A
  • Descent
  • Engagement
  • Neck flexion
  • Internal rotation
  • Crowning
  • Extension of the presenting part
  • Restitution + external rotation
  • Delivery of shoulders + body
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25
Q

what is fetal descent ? when does this happen ?

A

the fetus descent into the pelvis
- around 38 weeks onward

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26
Q

what is fetal descent encouraged by? (3)

A
  • Increased abdo muscle tone (contraction)
  • Increased frequency + strength of contractions
  • Increased amniotic fluid pressure
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27
Q

What is fetal engagement ?

A

when the latest diameter of fetal head descends into maternal pelvis
- the head turns to allow widest part of head through widest part of pelvic inlet

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28
Q

What triggers pelvic neck flexion? why is this important?

A

fetal head comes in contact with pelvis floor => cervical flexion
- allows for smaller head circumference

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29
Q

what is the smallest fetal head circumference ?

A

suboccipitobregmatic

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30
Q

describe the movement of internal rotation of the fetal head? what encourages this?

A

head rates from R or L occipto transfers => occipital anterior position
- encourage by gutter shape of pelvis

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31
Q

What is crowning?

A

widest part of head passes narrowest part of pelvis

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32
Q

what happens during the extension of the presenting part of labour?

A

fetal head extends

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33
Q

what is fetal restitution and external rotation?

A

head externally rotates to face R or L medial thigh

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34
Q

which shoulder comes out first in delivery?

A

anterior shoulder then posterior should then rest of body

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35
Q

What is preterm birth?

A

birth before 37 weeks gestation

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36
Q

What does ROM stand for ? and mean?

A

Rupture of membranes
- the amniotic sac has ruptured (+ leakage of fluid)

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37
Q

what does SROM stand for? and mean?

A

Spontaneous rupture of membranes (SROM)
- The amniotic sac has rupture spontaneously

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38
Q

What does PROM stand for? and mean?

A

Prelabour rupture of membranes (PROM)
- the amniotic sac has ruptured before the onset of labour

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39
Q

what does P-PROM stand for? and mean?

A

Preterm prelabour rupture of membranes (P-PROM)
- the amniotic sac has ruptured (and release amniotic fluid) before the onset of labour and before 37 weeks gestation (preterm)

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40
Q

What is prolonged ROM?

A

the amniotic sac ruptures more than 18 hours before delivery

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41
Q

When are babies considered viable? why is this important

A

from 24 weeks onward
- resuscitation is offered as there is increased chase of survival

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42
Q

describe the preterm ranges
- Extreme preterm
- Very preterm
- Moderate/late preterm
- full term
- Overdue

A
  • Extreme preterm: <28
  • Very preterm: 28-32
  • Moderate/late preterm: 32-37
  • full term: 37-42
  • Overdue: >42
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43
Q

what can be used as prophylaxis for preterm labour?

A
  • Vaginal progesterone
  • Cervical cerclage
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44
Q

how does progesterone work as prophylaxis for preterm labour?

A

it maintains pregnancy + prevents labour by decreasing activity of myometrium + prevents cervix remodelling

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45
Q

How does cervical cerclage work? when removed?

A

add stitch to cervix to keep it closed
- removed in labour or term

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46
Q

How is P-PROM diagnosed?

A

history and speculum exam
- women is before 37 weeks, signs of ROM, no signs of labour

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47
Q

what would be seen on speculum exam of P-PROM?

A

amniotic fluid pooling in vagina

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48
Q

P-PROM management ? explain

A

Need to weigh up risk of staying in vs delivery (infection vs prem)
- prophylactic Abx (preven chorioamnionitis dev)
- IOL

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49
Q

From When is IOL considered in P-PROM?

A

from around 34 weeks

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50
Q

What is preterm labour with intact membranes?

A

regular painful contractions + cervical dilatation without amniotic sac rupture

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51
Q

How is preterm labour with intact membranes diagnosed?

A

speculum exam (cervical dilatation)
TVUS

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52
Q

preterm labour with intact membranes management?

A
  • Fetal monitoring
  • Tocolysis (short term measure (<48 hrs))
  • Antenatal steroids
  • IV Mg sulphate
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53
Q

what is tocolysis? when (how many weeks gestation)

A

using medications to stop contractions (between 24 and 33+6 weeks)

54
Q

what is main drug used in tocolysis? what type of drug is this?

A

Nifedipine (CCB)

55
Q

what do antenatal steroids do?

A

help develop fetal lungs => decrease risk of RDS (for less than 36 weeks gestation)

56
Q

what do IV Mg Sulphate do? decrease risk of what?

A

protest fetal brain in premature delivery
- decrease risk of CP

57
Q

woman just given birth has low RR, low BP and absent reflexes. What should you be concerned about?

A

Magnesium toxicity
(caused by IV Mg sulphate)

58
Q

What is Induction of Labour (IOL)?

A

the use of medications or manoeuvres to stimulate onset of labour

59
Q

name some indications for IOL?

A
  • 41-42 weeks gestation
  • Pre labour ROM
  • FGR
  • pre-eclampsia
  • fetal death
60
Q

what does IOL reduce the risk of in pre labour ROM ?

A

reduce risk of ascending infection (chorioamnionitis)

61
Q

what does IOL reduce the risk of in 41-42 weeks gestation

A

reduce risk of stillbirth

62
Q

what score is used to determine whether to induce labour?

A

the bishop score

63
Q

what is the bishop score an assessment of? what does low score mean ?

A

assessment of cervical ripness
(determine whether to induce labour)
- lower score => less ripe so consider prostaglandins

64
Q

Name some options for IOL? (3)

A
  • membrane weep
  • Vaginal prostaglandins
  • Artificial ROM with oxytocin infusion
65
Q

what prostaglandin is used in IOL? drug name?

A

prostaglandin E2
(dinoprostone)

66
Q

what does vaginal progesterone do? what is it used in?

A

stimulate cervix + uterus to cause onset of labour
- IOL

67
Q

name a side effect of vaginal prostaglandin use for IOL? causes what?

A

SE: can cause uterine hyperstiumulation => fetal distress

68
Q

what is done throughout IOL?

A

cardiotocography (CTG) to assess fetal HR + uterine contractions

69
Q

What is oxytocin ? produced and secreted where?

A

It is a hormone produced by the hypothalamus and secreted by the posterior Pituitary

70
Q

what does oxytocin stimulate ? (4)

A
  • Ripening of cervix (in preparation for delivery)
  • Contractions of uterus (in labour)
  • Aid lactation after childbirth
  • Social interactions (sexual arousal, romantic attachment, parent-infant bonding)
71
Q

what are oxytocin infusions used for? (4)

A
  • IOL
  • Progress labour
  • Progress frequency + strength of uterine contractions
  • Prevent or treat PPH
72
Q
A
73
Q

What is ergometrine used in? how does it work?

A

(drugs in labour)
- used in a active management of the 3rd stage of labour
-stimulate smooth muscle contraction in uterus + blood vessels

74
Q

What are prostaglandins ? what are they used in?

A

local hormones that stimulate contraction of uterine muscles + cervical ripening
- useful in IOL

75
Q

What prostaglandin is used in IOL? type and drug name?

A

Prostaglandin E2 (dinoprostone)

76
Q

What is mifepristone? used in what?

A

anti-progesterone that blocks action of progesterone => halt pregnancy + ripens cervix + enhances effects of prostaglandins (uterine contractions)
- One of the drugs used in TOP

77
Q

What is nifedipine? how does it work? and what is it used in?

A

CCb that reduces smooth muscle contraction in blood vessels + uterus
- Used in tocolysis (Premature labour) and to reduced BP (preeclampsia)

78
Q

What is the first level of analgesia used in labour?

A

paracetamol often used in early labour (+/- codeine)

79
Q

what analgesia is avoided in pregnancy?

A

NSAIDs are avoided in pregnancy and labour

80
Q

what is another name for gas + air ? What drugs are in it ?

A

Entonox
- 50% nitrous oxide
- 50% oxygen

81
Q

what kind of pain relief does entonox provide

A

gas+air
- short term pain relief used during contractions

82
Q

name some side effects of entonox (3)

A

gas+air
- light headedness
- Nausea
- Sleepiness

83
Q

what is an epidural?

A

local anaesthetic administered via a Catheter into the epidrual space

84
Q

SE of epidural? (4)

A
  • Headache after insertion
  • Hypotension
  • Increase probability of instrumental delivery
  • Motor weakness
85
Q

how is it that an epidural might cause motor weakness?

A

due to Catheter being in subarachnoid space rather epidural

86
Q

What is an instrumental delivery ?

A

It is a vaginal delivery assisted by venous suction cup of forceps

87
Q

how many births in the UK are via instrumental delivery

A

about 10%

88
Q

what is given to the mother with a instrumental delivery? why?

A

single dose co-amoxiclave (broad spectrum Abx) to reduce risk of maternal infection

89
Q

indications for instrumental delivery? (3)

A
  • Failure to progress
  • Fetal distress
  • Maternal exhaustion
90
Q

What analgesia increases the risk of instrumental delivery ?

A

epidural

91
Q

what are the requirements for consideration of instrumental delivery ? (state of the mother) (3)

A
  • Fully dilated
  • ruptured membranes
  • Cephalic presentation
92
Q

what risks are there to the mother with an instrumental delivery ? (5)

A
  • PPH
  • Perineal tears
  • Epiostomy
  • Injury to anal sphincter
  • Incontinence (future)
93
Q

what risks are there to the baby with a ventouse instrumental delivery ?

A

cephalohaematoma

94
Q

what risks are there to the baby with a forceps instrumental delivery ?

A

facial nerve palsy

95
Q

What causes a perineal tear?

A

it occurs when external vaginal opening is too narrow to accommodate the baby => skin + tissue tears

96
Q

RF for perineal tears? (5)

A
  • First birth (nulliparity)
  • Are babies (>4kg)
  • Shoulder dystocia
  • Instrumental delivery
  • Occipito-posterior position
97
Q

how many different categories of perineal tears are there?

A

4

98
Q

what is a first degree perineal tear?

A

Injury limited to frenulum of labia minora + superficial skin

99
Q

what is second degree perineal tear?

A

perineal muscles (but not anal sphincter)

100
Q

what is a third degree perineal tear?

A

perineal muscles and anal sphincter but not rectal mucosa

101
Q

what is a 4th degree perineal tear?

A

perineal muscles and anal sphincter and rectal mucosa

102
Q

Which degrees of perineal tears require sutures?

A

2,3,4

103
Q

What is done to mange perineal tears?

A
  • sutures
  • Broad spectrum abs (decrease infection risk)
  • physiotherapy (decrease risk + severity of incontinence)
104
Q

name some complications of perineal tears? short term? long term?

A
  • Pain, infection, bleeding, wound dehiscence
  • long term: urinary incontinence, anal incontinence, dyspareunia
105
Q

What is a caesarian section?

A

it is a surgical operation to deliver baby via an incision in abdo + uterus
(elective or emergency)

106
Q

What is an elective CS? when? what anaesthetic ?

A

usually performed under spinal anaesthetic after 39 weeks

107
Q

name some indications for an elective CS ?

A
  • Prev CS
  • Symptomatic after significant perineal tear
  • Placenta praevia
  • Vasa praevia
  • Breech presentation
  • Multiple pregnancy
108
Q

What category of CS is an elective one ?

A

category 4 (highest one)

109
Q

what does category 1 CS mean? how quickly should procedure be done?

A

emergency
- <30min

110
Q

what are the layers to get through to do a CS? (8)

A
  • Skin
  • Sub cut tissue
  • fascia/rectus sheath
  • Rectus abdominus muscles
  • peritoneum
  • Vesicoutero peritonium
  • Uterus
  • Amniotic sac
111
Q

name the layers of the uterus from superficial to deep?

A

superficial
- Perimetrium
- Myometrium
- Endometrium
deep

112
Q

what drug is used in the anaesthetic for an elective CS?

A

spinal anaesthetic: local (lidocaine) into CSF

113
Q

name some complications of CS ?

A
  • PPH
  • Wound infection
  • Wound dehiscence
  • ## Damage to local structures
114
Q

What is given to mother doing CS to reduce risk of complications ?

A
  • Prophylactic Abx
  • Oxytocin (reduce PPH risk)
  • VTE prophylaxis (LMWH)
  • H2 receptor antagonist
  • anti d
115
Q

why is H2 receptor agonist given during CS ?

A

to reduce the risk of aspiration of gastric contents into lungs
(at higher risk diet pregnant women lying flat for CS)

116
Q

what risks re there to the baby in a CS ?

A
  • Laceration
  • Increase incidence of transient tachypnoea of newborn
117
Q

What is an important risk to consider in a vainal birth after caesarian (VBAC) ?

A

uterine scar rupture
(advice to continue with CS after the initial one)

118
Q

Why are elective Caesarean sections typically planned for >39 weeks gestation?

A

Reduce risk of respiratory distress in newborn

119
Q

Which medication is typically administered intra-operatively to aid delivery of the placenta?

A

oxytocin

120
Q

What are the 2 management approaches to the third stage of labour?

A

physiological or active management

121
Q

what does physiological management of the thirds stage of labour involve?

A

where the placenta is delivered by maternal effort only

122
Q

what does active management of the thirds stage of labour involve? (2)

A
  • IM oxytocin: helps uterus contract
  • Traction to the umbilical cord
123
Q

what does active management of the third stage of labour achieve ?

A
  • Shorten the 3rd stage of labour
  • Reduce risk of bleeding
124
Q

What is fetal lie (give some examples) ? and what examination do you do to confirm it ?

A

relationship between the long axis of fetus + mother (longitudinal, transverse, oblique)
- abdo exam to confirm

125
Q

What is fetal presentation (give some examples) ? and what examination do you do to confirm it ?

A

The fetal part that first enter the pelvis (cephalic, shoulder, brow, breech)
- abdo exam to confirm

126
Q

What is fetal position (give some examples) ? and what examination do you do to confirm it ?

A

Position of fetal head as exists birth canal (sally occipto-anterior)
- vaginal exam to confirm

127
Q

RF for abnorma fetal lie, malpresentation, malposition ? (3)

A
  • Prematurity
  • Multiple pregnancy
  • Uterine abnormailites
128
Q

Investigations for suspected abnormal fetal lie/presentation/position ?

A

should be confirmed with USS

129
Q

management of abnormal fetal lie ? how many weeks gestation ? success rate ?

A
  • External cephalic version (ECV): from 36-38 weeks
  • about 50% success rate
130
Q

malpresentation management ? in which presentation is CS necessary ?

A
  • Breech: ECV or vaginal breech dev or CS
  • CS necessary in Brow or shoulder presentation

3a (43 decks)

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