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Phase 3a conditions list flashcards > Women's health - Labour + delivery + postpartum > Flashcards

Women's health - Labour + delivery + postpartum Flashcards

1
Q

What are the stages of labour?

A
  • First stage - until fully dilated (10cm)
  • Second stage - full dilation until delivery
  • Third stage - delivery of baby until delivery of placenta
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2
Q

What is stage 1 of labour divided into and what are the criteria (2)?

A
  • Latent = 0-3/4 cm dilated
  • Active(established labour) = 3/4-10 cm dilated
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3
Q

What are the 4 signs of the start of labour?

A
  • Regular painful contractions
  • Show (mucous plug from cervix)
  • ROM
  • Dilating + thinning (effacement) cervix
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4
Q

What is stage 2 of labour divided into?

A
  • Passive stage - head descends down pelvis
  • Active phase - mother bears down
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5
Q

How long should the first two stages of labour last in a primigravida women?

A
  • Latent stage 1 = less than 20 hours
  • Active stage 1(established labour) = 1 cm/hour
  • 2nd stage = 2 hours
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6
Q

How long should the first two stages of labour last in a multigravida women?

A
  • Latent stage 1 = less than 14 hours
  • Active stage 1 (established labour) = 1.5 cm/hour
  • 2nd stage = 1 hour
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7
Q

How long should 3rd stage last?

A

30 minutes

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8
Q

What is important to give to some mothers during labour (not to do with progression or pain management) (2)?

A
  • IV benzylpenicillin (if GBS infection)
  • Anti-D Ig
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9
Q

What are contractions in the 2nd/ 3rd trimesters that do not progress to labour known as?

A

Braxton-hicks contractions

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10
Q

What influences the progression of labour (3)?

A

Three Ps
* Power - uterine contractions
* Passenger - size, presentation
* Passage - shape + size of pelvis/ soft tissues

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11
Q

What are the seven stages of the mechanism of delivery?

A
  1. Descent - head moves down pelvis
  2. Flexion - chin to chest
  3. Internal rotation - to occipital-anterior position
  4. Extension - of head to push through vagina
  5. Restitution - occiput re-aligns with shoulders
  6. External rotation - shoulders rotate to anterior-posterior position (perpendicular to mothers)
  7. Delivery of shoulders - anterior shoulder delivered, then posterior
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12
Q

What is involved in an initial assessment of a woman in labour (4)?

A
  • History
  • Obs + urinalysis
  • Abdominal palpation - lie, contractions, engagement, ect
  • Vaginal exam
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13
Q

What is the standard monitoring performed during labour (5)?

A
  • Foetal HB (every 15 min)
  • Contractions (every 30 min)
  • Maternal pulse + BP
  • Vaginal exam (every 4 hours)
  • Urine dip (every 4 hours)
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14
Q

What is recorded on a partogram (lots of things)?

A
  • Progress - dilation, descent, contractions
  • Foetal wellbeing - CTG, amniotic fluid colour
  • Maternal wellbeing - pulse, BP, temp, urinalysis
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15
Q

What does CTG stand for?

A

Cardiotocography

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16
Q

What are some indications for CTG (3)?

A
  • Unwell mother (tachycardia, sepsis, bleeding)
  • Delay in labour
  • Use of oxytocin
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17
Q

What is monitored on a CTG (2)?

A
  • Foetal heartbeat
  • Uterine contractions
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18
Q

What are 4 reassuring features of a CTG?

A
  • Rate = 110-160
  • Decelerations = absent
  • Accelerations = present
  • Baseline variability = 5-25 bpm
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19
Q

What is an acceleration/ deceleration on a CTG?

A

Increase/ decrease of 15 bpm for 15 seconds

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20
Q

What are the types of deceleration and what do they mean? (4)

A
  • Early (heart rate drops in time with peak of contraction) = innocent finding associated with compression of foetal head
  • Late (HR drops after peak of contraction) = foetal distress e.g. hypoxia
  • Variable (<2 min) = transient umbilical cord compression
  • **Prolonged ** (2-10 min) = compression of umbilical cord
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21
Q

What is the most common cause of reduced foetal HB variability (<5)?

A

Sleeping foetus

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22
Q

How can foetal distress be further investigated, after a CTG has been done, during labour?

A

Foetal scalp sample
can indicate hypoxia

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23
Q

What are some non-pharmacological options for pain relief during labour (3)?

A
  • Birthing pool
  • Relaxation techniques
  • Aromotherapy
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24
Q

What are some medical options for pain relief during labour (4)?

A
  • Paracetamol/ codeine
  • Entonox (gas + air = 50/50 NO and O)
  • IM opioids (e.g. diamorphine)
  • Epidural
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25
Q

Where is an epidural carried out?

A

L3-4 epidural space (acts on nerve roots)

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26
Q

What medication is used in an epidural?

A

Bupivacaine + fentanyl

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27
Q

What are some adverse effects of an epidural (6)?

A
  • Hypotension
  • Motor weakness
  • Nerve damage
  • Prolonged second stage + increased likelihood of instrumental delivery
  • Headache after insertion
  • Urine retention
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28
Q

What score can be used to determine whether to induce labour?

A

Bishop score

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29
Q

What are the criteria included in the bishop score (5)?

A
  • Consistency (cervix)
  • Dilation
  • Effacement
  • Foetal station (how much engaged)
  • Position (cervix)
    CEDFP
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30
Q

What do different bishop scores mean (3)?

A
  • 1-5 = unripe, inaction needed
  • 6-7 = intermediate
  • 8-13 = ripe, likely to spontaneously deliver
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31
Q

What are ways to induce labour (5)?

A
  • Membrane sweep
  • Vaginal prostaglandin E2/ misoprostol (oral prostaglandin E1)
  • Amniotomy (breaking waters)
  • Balloon catheter
  • Oxytocin infusion
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32
Q

When is a membrane sweep typically performed?

A

41 week antenatal visit
nulliparous also at 40w

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33
Q

How should a bishop score of 1-6 be managed (2)?

A
  • Vaginal prostaglandins
    or
  • Oral misoprostol
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34
Q

How should a bishop score of 7-13 be managed (2)?

A
  • Amniotomy
    and
  • IV oxytocin (e.g. syntocinon)
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35
Q

What are some infections for induction of labour (4)?

A
  • Prolonged labour
  • Prolonged pregnancy
  • PPROM
  • Maternal GDM, pre-eclampsia, obstetric cholestasis
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36
Q

What is the main complication of induction of labour?

A

Uterine hyperstimulation:
* Foetal ischemia
* Uterine rupture

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37
Q

What are the categories of c-sections?

A
  1. Immediate threat to life - deliver within 30 min
  2. Not an imminent threat to life - deliver within 75 min
  3. Mother and baby are stable - deliver soon
  4. Elective c-section
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38
Q

What are some indications for an elective c-section (6)?

A
  • Previous c-section (2 c-section = contraindication for vaginal)
  • Placenta praevia
  • Vasa praevia
  • Breech
  • Multiple pregnancy
  • Herpes/ HIV
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39
Q

How is a c-section performed (2)?

A
  • Joel-cohen incision = straight transverse incision
  • Classical incision = midline
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40
Q

What are the layers of the abdomen that need to be directed for a c-section (7)?

A
  • Skin
  • Subcutaneous tissue
  • Rectus sheaf/ fascia
  • Rectus abdominis
  • Peritoneum
  • Uterus
  • Amniotic sac
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41
Q

What are some complications of c-sections (3)?

A
  • VBAC (vaginal birth after c-section) –> uterine rupture
  • PPH
  • Endometritis
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42
Q

What risk is associated with classical c-section incision?

A

Uterine rupture if vaginal birth after c-section (VBAC)

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43
Q

What are the two instrumental deliveries?

A
  • Ventouse delivery
  • Forceps delivery
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44
Q

What are some complications of ventouse delivery for the foetus (3)?

A
  • Caput succedaneum
  • Cephalohaematoma
  • Subgaleal haematoma (even worse)
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45
Q

What is a complication of a forceps delivery for the foetus?

A

CN 7 palsy (facial paralysis)

46
Q

What are some indications for instrumental delivery (3)?

A
  • Failure to progress
  • Foetal distress
  • Maternal exhaustion
47
Q

What is a key risk factor for needing an instrumental delivery?

A

Epidural

48
Q

What are some risks to the mother from an instrumental delivery (4)?

A
  • PPH
  • Perineal tears
  • Incontinence
  • Nerve injury
49
Q

What is PPROM vs PROM (2)?

A
  • Preterm premature ROM = before 37 weeks and not directly preceding labour
  • Premature ROM = not directly preceding labour but after 37 weeks
50
Q

What are two prophylactic options for the prevention of preterm labour (2)?

A
  • Vaginal progesterone
  • Tocolytics (reduce uterine contractions)
  • Cervical cerclage (stitch in cervix)
    can be offered when cervical length is short on USS
51
Q

What are some causes of PPROM (5)?

A
  • TORCH infections
  • Trauma
  • CVS/ amniocentesis
  • BV
  • LLETZ
52
Q

How can PPROM be investigated if there is doubt over whether the membranes have ruptured (3)?

A
  • Sterile speculum = fluid pooled in posterior fornix
  • USS = oligohydramnios
  • IGF-1/ PAMG-1 tests
53
Q

How should PPROM be managed (3)?

A
  • Erythromycin for 10 days
  • Steroids + MgSO4
  • Induction (from 34 weeks)
54
Q

What is cord prolapse?

A

When the umbilical cord presents before the foetus

55
Q

What are some risk factors for cord prolapse (4)?

A
  • Abnormal foetal lie
  • Polyhydramnios
  • ARM (artificial rupture of membranes)
  • Multiple pregnancies
56
Q

What are the signs/ symptoms of prolapsed cord (3)?

A
  • Foetal bradycardia
  • Visible cord
  • Felt on vaginal exam
    speculum exam can confirm
57
Q

How is a cord prolapse managed (2)?

A
  • Immediate c-section
  • Go on all 4s + catheterise (reduces pressure on cord)
58
Q

What medications can be used to manage cord prolapse?

A

Tocolytics e.g. terbutaline
minimise contractions

59
Q

What are some compilations of a cord prolapse (2)?

A
  • Foetal ischemia
  • Nuchal cord (wraps around babies neck)
60
Q

What are the types of breech presentation (3)?

A
  • Complete = flexed at hips and knees
  • Frank = flexed at hips, extended at knees
  • Footling = 1 foot hangs down
61
Q

What can be used to treat breech presentations?

A

External cephalic version

62
Q

When is external cephalic version done?

A

37 weeks
can do at 36 weeks if first time

63
Q

What are some risk factor for breech presentation in labour (2)?

A
  • Polyhydramnios
  • Prematurity
64
Q

What are some risks associated with breech position (3)?

A
  • DDH
  • Hypoxic ischemic encephalopathy
  • Uterine rupture
65
Q

What are the ways the “position” of a foetus is described in the womb (5)?

A
  • Lie
  • Presentation
  • Position
  • Attitude
  • Station
66
Q

What are the 3 types of lie of a foetus?

A
  • Longitudinal (parallel to mothers spine)
  • Transverse (perpendicular to mothers spine)
  • Oblique (diagonal)
67
Q

What are the 3 presentations of a foetus?

A
  • Cephalic (head)
  • Breech (bum/ feet)
  • Shoulder
68
Q

How is the position of the presenting part described (2)?

A
  • Right/ left
  • Anterior/ posterior
    in relation to occiput/ sacrum of foetus
69
Q

How is the attitude of the foetus described (2)?

A
  • Flexed
  • Extended
70
Q

What is the station of the foetus?

A

How far descended into the pelvis the foetus is (fifths engaged)

71
Q

What are the types of perineal tears (4)?

A
  • First degree = mucosa
  • Second degree = muscle
  • Third degree = anal sphincter
  • Fourth degree = rectal mucosa
72
Q

How are perineal tears managed (3)?

A
  • First = northing
  • Second = midwife stitch
  • Third/ fourth = theatre stitching
73
Q

What are some risk factors for perineal tears (5)?

A
  • First birth
  • Large baby
  • Shoulder dystocia
  • Instrumental deliveries
  • Occipito-posterior lie
74
Q

What is an obstructed labour?

A

Mechanical obstruction to the descent of the baby

75
Q

How can an obstructed labour be treated?

A

Episiotomy (cut down the perineam and around the anal sphincter)

76
Q

What can sometimes happen if the babies head is large?

A

Cephalopelvic disproportion = babies head is too large to fit through the mothers pelvis

77
Q

What is it known as when the anterior shoulder of the baby gets stuck on the pubic symphysis?

A

Shoulder dystocia

78
Q

What is a common cause of shoulder dystocia?

A

Macrosomia due to GDM

79
Q

How does shoulder dystocia present?

A

Head delivers but shoulders then become stuck and won’t come out

80
Q

How is shoulder dystocia managed (3)?

A
  • McRoberts manoeuvre = flex hips (bring knees to abdomen)
  • Pressure to anterior shoulder
  • Zavanelli manoeuvre = push babies head into uterus to allow for c-section
81
Q

What are some complications of shoulder dystocia (4)?

A
  • Foetal hypoxia
  • Erbs palsy
  • Perineal tears
  • PPH
82
Q

What is Erbs palsy?

A

Injury to brachial plexus

83
Q

What is the position of the arm in Erbs palsy?

A

Internal rotation of the arm with flexion of wrist + hand/ fingers

84
Q

What are the types of PPH in terms of time frame (2)?

A
  • Primary < 24 hours
  • Secondary 24 hours - 6 weeks
85
Q

What are the severities of PPH (3)?

A
  • Minor 500-1000ml
  • Moderate 1000-2000ml
  • Severe > 2000ml
    c-section > 1000ml = PPH
86
Q

What are the causes of PPH (4)?

A
  • Tone (decreased pressure on spiral arteries) = mc
  • Tissue (retained products)
  • Thrombin (DIC)
  • Trauma (tears, uterine rupture)
87
Q

What are some risk factors for PPH (6)?

A
  • Prolonged labour
  • C-section
  • Polyhydramnios
  • Twins
  • Fibroids
  • Multiparity
88
Q

How is PPH managed (6)?

A
  • A-E
  • Group + save
  • Fundal massage + catheterise
  • 2 x large bore canular (IV fluids + transfusion)
  • IV oxytocin
  • Intrauterine balloon tamponade + compression sutures
89
Q

How is retained tissue of conception managed?

A

Surgical D+C

90
Q

What are some complications of PPH (3)?

A
  • Sheehans syndrome
  • DIC
  • Shock –> death
91
Q

What risk to the mother should be assessed at the time of birth?

A

VTE risk assessment (more than 4 risk factors = high risk)

92
Q

How should women at high risk of DVT be managed after giving birth?

A

LMWH for 6 weeks

93
Q

What is a common infection that occurs in women after childbirth (especially c-sections)

A

Endometritis

94
Q

How does endometritis after pregnancy present (4)?

A
  • Fever (>38)
  • Lower abdo pain
  • Offensive discharge
  • Bleeding
95
Q

How soon after birth does endometritis usually present?

A

Within 72 hours
although can present weeks after

96
Q

What bacteria commonly cause endometritis after pregnancy (2)?

A
  • GBS
  • E. coli
    other KEEPS bacteria
97
Q

How is endometritis after pregnancy investigated?

A
  • Blood cultures
  • Vaginal swabs
  • TVUSS
98
Q

How should endometritis after pregnancy be managed?

A

IV clindamycin + gentamicin

99
Q

What conditions can affect the mental health of women who have recently given birth (3)?

A
  • Baby blue
  • Postpartum depression
  • Postpartum psychosis
100
Q

When should baby blues resolve within?

A

2 weeks of delivery
peaks in first week

101
Q

How common are baby blues?

A

More than 50% of women

102
Q

What are the signs/ symptoms of baby blues (4)?

A
  • Low mood
  • Mood swings
  • Tearful
  • Anxiety
103
Q

How should baby blues be treated?

A

No treatment needed

104
Q

How long should postnatal depression last before being diagnosed?

A

2 weeks

105
Q

What are the signs/ symptoms of postnatal depression (3)?

A
  • Anhedonia
  • Low mood
  • Anergia
    same as depression
106
Q

What criteria can be used to diagnose postnatal depression?

A

Edinburgh scale

107
Q

How should postnatal depression be managed (3)?

A
  • Self help
  • CBT
  • SSRIs (sertraline)
108
Q

What are the signs/ symptoms of puerperal psychosis (5)?

A
  • Delusions
  • Auditory hallucinations
  • Severe mood swings
  • Thoughts to harm baby
  • Depression
109
Q

How is puerperal psychosis managed (4)?

A
  • Admit to mother + baby ward
  • CBT
  • Medications
  • ECT
110
Q
A

Phase 3a conditions list flashcards (29 decks)

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