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Phase 3a - Women's Health > Women's Health : Problems in Labour > Flashcards

Women's Health : Problems in Labour Flashcards

1
Q

First Stage Delay in Labour Definition

A

cervical dilatation of less than 2cm in 4 hours.

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2
Q

Nulliparous Second Stage Delay

A

> 2 hour duration of second stage of labour.

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3
Q

Multiparous Second Stage Delay

A

> 1 hour duration of second stage of labour.

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4
Q

Actively Managed (oxytocin injection) Third Stage Delay

A

> 30 minutes without delivery of placenta

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5
Q

Physiological Third Stage Delay

A

> 60 minutes without delivery of placenta.

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6
Q

Three Ps’ of Delayed Labour

A

Power, Passenger, Passage

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7
Q

What is “Power” in relation to delayed labour?

A

Uterine contractions - deviation from normal (i.e. 3-5 contractions of 30 seconds duration per 10 minutes).

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8
Q

What is considered a deviation from normal uterine contractions?

A

3-5 contractions/30 sec/10 min

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9
Q

What are important factors related to the ‘Passenger’ in labor?

A

Size, presentation, position of the foetus

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10
Q

How is size of foetus monitored?

A

head diameter, shoulder diameter etc

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11
Q

How is foetal presentation monitored?

A

Cephalic:vertex, brow, face vs breech

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12
Q

How is foetal position monitored?

A

occipito-anterior (normal), occipito-posterior, occipito-transverse

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13
Q

What is the normal fetal position?

A

Occipito-anterior

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14
Q

What is “Passage” in relation to delayed labour?

A

Cephalopelvic disproporion

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15
Q

How are delays in labour investigated?

A

● Diagnosed by regular foetal monitoring in labour. ● Aberrant foetal position can be diagnosed on vaginal examination.

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16
Q

How is aberrant foetal position diagnosed?

A

Vaginal examination

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17
Q

What is the first stage in the management of delayed labour?

A

Membranes intact - consider amniotomy. ○ Consider oxytocin infusion - requires continuous foetal monitoring (CTG).

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18
Q

What is the second stage in the management of delayed labour?

A

Consider oxytocin infusion. ○ Offer expedited delivery i.e. instrumental delivery or caesarean section if vaginal delivery is improbable.

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19
Q

What is the third stage in the management of delayed labour?

A

Controlled cord traction, IM oxytocin / ergometrine.

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20
Q

What to consider if membranes are intact in the first stage?

A

Amniotomy

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21
Q

What is shoulder dystocia?

A

(RCOG) Vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the foetus after the head has delivered and gentle traction has failed.

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22
Q

What causes shoulder dystocia?

A

Discrepancy between size of foetal shoulders and maternal pelvic inlet leads to impaction: ○ Anterior shoulder behind maternal pubic symphysis (commonest). ○ Posterior shoulder behind maternal sacral promontory (more rare). ● Delay in delivery can result in hypoxic ischaemic encephalopathy (HIE) due to compression of the umbilical cord against the maternal pelvis. ● Another notable complication is brachial plexus injury resulting in Erb’s palsy (C5-6) or less commonly Klumpke’s palsy (C8-T1).

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23
Q

Where does the anterior shoulder get impacted?

A

Behind maternal pubic symphysis (commonest)

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24
Q

Where does the posterior shoulder get impacted?

A

Behind maternal sacral promontory (more rare)

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25
Q

What is Erb’s palsy?

A

C5-6 brachial plexus injury

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26
Q

Risk Factors for Shoulder Dystocia

A
  1. Previous shoulder dystocia 2. Macrosomia (foetal weight > 4500g) 3. Maternal diabetes mellitus 4. High maternal BMI 5. Induction of labour 6. Prolonged labour.
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27
Q

Signs of Shoulder Dystocia (which can lead to diagnosis)

A

○ Difficulty delivering face / chin ○ Turtle-neck sign (head retracts into birth canal) ○ Failure of restitution ○ Failure of shoulder descent

28
Q

When can a definitive diagnosis of Shoulder Dystocia be made?

A

Definitive diagnosis is made when normal axial traction cannot deliver the baby’s body after the head has been delivered.

29
Q

First Line Management for Shoulder Dystocia

A
  1. McRoberts’ manoeuvre (mother hyperflexes hips, bringing her thighs to her abdomen) plus
  2. Suprabupic pressure (to disimpact anterior shoulder) plus
  3. Discourage pushing (to prevent further impaction.
30
Q

Second Line Management for Shoulder Dystocia

A
  1. Deliver posterior arm 2. Attempt internal rotation manoeuvres.
  2. If above fails - all fours position and repeat manoeuvres
31
Q

Third Line Management (rare) for Shoulder Dystocia

A

○ Cleidotomy
○ Symphysiotomy
○ Zavanelli manoeuvre.

32
Q

What does suprapubic pressure aim to do?

A

Disimpact anterior shoulder.

33
Q

Why should pushing be discouraged during shoulder dystocia?

A

Prevent further impaction.

34
Q

What to do if first line options fail?

A

All fours position, repeat manoeuvres

35
Q

What is assisted vaginal birth (by forceps or vacuum) also known as?

A

Instrumental Delivery

36
Q

How common are instrumental deliveries in the UK?

A

10-15% of deliveries ; ; ⅓ of first deliveries for nulliparous women.

37
Q

What are the 2 types of instrumental delivery?

A

Forceps and Vacuum

38
Q

What is typical for forceps delivery?

A

Interlocking blades fit around the baby’s head and guide it down the birth canal,
typically alongside medio-lateral episiotomy.

39
Q

What is vacuum delivery?

A

Suction cup adheres to the baby’s head to assist with delivery

40
Q

What is an outlet classification in assisted vaginal birth?

A

The fetal scalp is visible, the skull has reached the perineum, and the required rotation is less than 45 degrees.

41
Q

What is a low cavity classification in assisted vaginal birth?

A

The fetal station is at +2 cm, but the skull has not yet reached the perineum.

42
Q

What is a mid cavity classification in assisted vaginal birth?

A

The fetal head is less than 1/5th palpable abdominally, and the station is between +1 cm and 0 cm.

43
Q

What type of instruments are used for non-rotational assisted deliveries?

A

Neville Barnes forceps (low cavity) : Simpson’s forceps
Wrigley forceps (outlet, also used in caesarean sections)
Anterior cup

44
Q

What type of instruments are used for rotational assisted deliveries?

A

Kjelland’s forceps ; Posterior cup (e.g., Kiwi)

45
Q

When are rotational instruments used in assisted vaginal deliveries?

A

Rotational instruments are used when the fetal position is occipito-posterior or occipito-transverse.

46
Q

When are Wrigley forceps typically used?

A

Wrigley forceps are used for outlet deliveries and during caesarean sections

47
Q

What classifies an outlet-assisted vaginal birth?

A

Visible scalp, <45° rotation.

48
Q

What classifies a low cavity-assisted vaginal birth?

A

Station +2cm, not perineum.

49
Q

What classifies a mid cavity-assisted vaginal birth?

A

Station +1 to 0cm.

50
Q

When are rotational instruments used in assisted deliveries?

A

Occipito-posterior/transverse position.

51
Q

Non-rotational forceps examples

A

Neville Barnes, Simpson’s, Wrigley

52
Q

Rotational forceps example

A

Kjelland’s

53
Q

Use of Wrigley forceps

A

Outlet, caesarean sections

54
Q

Indications for Instrumental Delivery

A
  1. Suspected foetal compromise 2. Delayed second stage 3. Maternal exhaustion / distress 4. Medical contraindication to Valsalva
55
Q

Risks of Forceps

A
  1. Vaginal trauma 2. Postpartum haemorrhage 3. Obstetric anal sphincter injury (3rd degree tear) 4. Facial / scalp laceration
56
Q

Risks of Vacuum

A
  1. Vaginal trauma 2. Postpartum haemorrhage 3. OASI 4. Facial / scalp laceration 5. Retinal haemorrhage 6. Cephalohematoma 7. Subgaleal haemorrhage
57
Q

How are obstectric injuries classified?

A

Degrees of Tears

58
Q

1st Degree Tear

A

Skin only

59
Q

2nd Degree Tear

A

Perineal muscle

60
Q

3rd Degree Tear Types

A

Type A <50% external AS, Type B >50% external AS, Type C internal & external AS

61
Q

4th Degree Tear

A

Anorectal epithelium

62
Q

Caesarean Sections are categegorised by….

A

classifications of urgency

63
Q

Category 1 Caesarean

A

within 30 minutes of decision - immediate threat to life of woman or foetus e.g. pathological CTG, placental abruption.

64
Q

Category 2 Caesarean

A

within 75 minutes of decision - maternal / foetal compromise, not immediately life-threatening but birth must be expedited.

65
Q

Category 3 Caesarean

A

no compromise, early birth indicated.

66
Q

Category 4 Caesarean

A

elective

67
Q

Indications for a Caesarean Section

A

-Breech presentation (resistant to external cephalic version).Placenta praevia
- Placenta accreta spectrum
- Maternal choice
- Emergency: foetal bradycardia, abruption, uterine rupture, cord prolapse, foetal pH <
7.20, failure of instrumental delivery.

Phase 3a - Women's Health (21 decks)

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