Womens health basics Flashcards
what is the definition of
- LMP
- Cycle
- Parity
- Gravidity
LMP = first day of last normal menstrual period
Cycle = number of days from first day of bleeding to next period e.g. 5/28 is 5 days of bleeding with 28 day cycle
Parity = number of deliveries after 24 weeks incl stillborn, miscarriage, terminations and ectopic pregnancies, if terminated before 24 weeks, ^x
Gravidity = total number of pregnancies inc current pregnancy, regardless of outcome
if someone has 4 children, currently pregnant and has had 2 miscarriages how would that be expressed in GxPn
G7P4^+2
what would G4P4 mean
pregnant 4 times, gave birth 4 times.
how do you ask if someone has been having heavy periods
flooding through pad
clots
frequency of changing pad
what are some abnormal bleeding
heavy periods
intermenstrual bleeding
postcoital bleeding
what is dyspareunia
painful intercourse
what to clarify in painful intercourse
superficial or deep pain
what is the guideline for taking pap smears
from 25, every 3 years
till 49 then every 5 till 65 the stop
in gynae history, what to ask about previous pregnancy
how many, when, mode of delivery, birth weights
what is naegeles rule, what is it used for
to calculate EDD from LMP
LMP + 1 year - 3 mths + 7 days
other way to calculate EDD?
crown-rump length
when is booking appointment usually done
8 weeks
what are some definitions of high risk pregnancies
> 35 age
35 BMI
H/T
difficult pregnancy hx
what blood information is required in obs history
blood type/group rhesus factor blood born virus (HIV, HBV) syphillis FBC (anaemia)
who are required to go for monthly growth scans
high risk pregnancies
what scans are done for low risk pregnancies
12 and 20 weeks
when is the first scan done and what does it look for
12 weeks
viability dating scan
is baby viable position of baby EDD (crown rump length) number of babies combined test (13 18 21)
what ways of managing miscarriages are there
conservative
medical
surgical
what 5 past medical history are important in Obs history
Diabetes Epilepsy Asthma Thromboembolism/thyroid Hypertension
what is normal fetal movement like
after 20 weeks, fetal movements should be the same throughout, any reduction is abnormal
what is the folic acid recommendation
400micrograms for low risk till 13 weeks pregnant
5 miligram for high risk
what is the combined screening
scan done 11-14 weeks (can be done during first scan)
look at patau, edwards and downs by nuchal thickness
also bloods assoc with downs - beta hcg and low PAPP-A
what can be done to confirm a positive result from a combined screening
chrionic villus sampling
amniocentesis
what scan is done from 18 to 20+6 weeks?
anomaly scanning - 11 conditions
what is done during a growth scan
est fetal weight via HC, AC, FL
amniotic fluid index
umbilical artery doppler
who gets serial growth scans
high risk pregnancies
medical disorders
previous IUGR
multiple pregnancies
what 2 hormones rise in normal labour
prostaglandins, estrogen and oxytocin
what is the most common baby head position during birth
occiput-anterior
how often are contractions at the maximum during labour
5 every 10 mins
describe stage 1 2 3 of labour
stage 1 onset of labour to full dilatation of cervix (10cm)
stage 2 full dilatation to delivery of baby
stage 3 delivery of baby and placenta
describe stage 1 of labour
latent phase - irreglar painful contractions, start of cervical changes, up to 4cm dilatation
active phase - regular painful contractions + 10cm dilatation
how is stage of descent described using the fifths and ischial spines?
before baby head at ischial spines, palpate abdomen to feel for how much of baby head is still above, count in fifths (e.g. 4/5ths of baby head is above)
when baby’s head is at ischial spines, that is zero station, once below is +1 station e.g
how are fetuses monitored during labour
intermittent auscultation with doppler or pinnard - 1 min, after contraction every 15 minutes for first stage and every 5 mins in second stage
what pharmacological options are there for women in labour?
paracetamol
entonox
diamorphone
epidurals
describe second stage of labour
passive second stage - from full dilatation, allow spontaenous descent, don’t push yet.
active second stage, when head is visible, encourage mother to push
mechanism of body regarding babies’ positions
descent flexion internal rotation crowning extension restitution internal rotation of shoulders expulsion
what is caput succedaneum
temporary swelling of head due to compression by cervix
when is the cord cut?
after pulsation of cord stops
ways that placenta can be delivered
physiological or active
different degrees of perineal tear
1st degree is down to fourchette
2nd is skin, vaginal wall and perineal muscles
3rd includes anal sphincter
4th includes rectum
what to inspect the placenta for?
is it complete, how many vessels? (3), how many membranes (2), any malformations, histology or cytogenetics
most common cause of abnormal labour regarding “powers”
inefficient uterine action
hyperactive uterine action
how to manage inefficient uterine action?
augmentation - ARM, oxytocin
common abnormal fetal presentations
OP OT brow face breech
management of different abnormal fetal presentations
OP - instrumental OT - CS if progress to deep transverse arrest brow - C section face - C section if chin is posterior breech - C section
what is deep transverse arrest
if baby is stuck in OT position after 1 hour
common causes of abnormal labour regarding Passage
cephalo-pelvic disproportion (head>pelvis)
2 types of forceps
rotational and non-rotational
where are rotational forceps used?
in theatre because failure => csection
which instrument is more likely to fail
ventouse
why can using a ventouse cause jaundice to the baby
suction causes bruising on head leading to blood break down and build up of heme
what are the indications for isntrumental delivery
prolonged 2nd stage leading to maternal exhaustion
fetal compromise
prophylatically in high risk pregnancies
what analgesic is given to the mother in a low cavity instrumental delivery
pudendal block/local anaesthesia.
low cavity = baby below 0 station
prerequisites for instrumental delivery
maximum 1/5s head palpable on abdomen
cervix fully dilated
analgesia
consent
empty bladder
consider venue e.g theatre
what can be done to reduce instrumental delivery rates
midwife encouragement
encourage mobilisation of
mother during labour
altering maternal position
using oxytocin for slow 2nd stage progress
allow longer passive 2nd stage when epidural present
definition of inducing labour
at least 24 weeks gestation
intact or ruptured membranes, but not active labour
maternal indications for induction of labour
abnormal bleeding GDM/obesity prolonged pregnancy (41 weeks) risk to maternal life preterm-prelabour ruptured membranes hypertensive d/o obstetric cholestasis symphysis pubis dysfunction maternal request
fetal indications for induction of labour
growth restrictions risk to fetal life IUGR isoimmunisation IUD post maturity previous still birth recurrent reduced fetal movements
contraindications of induction of labour
active genital herpes/HIV
major placenta praevia
transverse or oblique fetal presentation
prior uterine incisions
how to induce labour?
membrane sweep
prostaglandin
amniotomy
IV oxytocin
what is included in the modified bishops score
dilatation length of vaginal canal consistency of cervix position of cervix head station
what do the scores in the modified bishops score mean
less the points the less advance labour
> 9 means labour imminent
risks of labour induction
failure can lead to C section uterine hyperstimulation infection (chorionamnioitis) fetal compromise cord prolapse post partum haemorrhage increased analgesic use
maternal indications for continuous EFM
high risk pregnancies, previous c section
fetal indications for continuous EFM
IUGR oligohydramnios preterm labour multiple pregnancies breech presentations rhesus iso-immunisation
describe DR C BRAVADO
define risk contractions Baseline rate variability accelerations decelerations overall assessment and plan
what does variability of baby heart rate indicate
working connection between parasymp and symp nervous system
what should be done if abnormal CTG
fetal scalp blood pH measurement to ascertain hypoxia status
<7,20 is abnormal
what is used in customised growth charts?
height, weight, ethnicity
previous birth weights
weeks and decile chart
symphisis pubis length
in obs hx, what to ask in past gynae hx?
contraception
smear history
fertility problems
gynae surgery
in obs hx what to ask about in past pregnancy hx?
year of births weeks gestation any pregnancy problems how they were delivered outcome and birth weight
at which stage of labour is the mother encouraged to push?
active phase of stage II
