3A OBS > labour > Flashcards

labour Flashcards

(56 cards)

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1
Q

what happens before labour

A
  • vague cramps in 3/3 called Braxton hicks- these are irregular, tightening of uterine wall called false labour
  • bloody show- mucus plug (operculum)
    just before- rupture of membranes, 3-4X Regular rising severe contractions 45-60 seconds for every 10 mins
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2
Q

what is mucus plug (operculum)?

A

a plug that fills and seals the cervical canal during pregnancy

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3
Q

what are the two main subdivisions in stage 1 of labour?

A
  • latent stage
  • active stage
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4
Q

what is the latent stage in stage 1 of labour?

A

length- 20 hours if primi ( first time) or 14h if multi
- cervix dilation <30%
-0-4 cm diameter
-contract 1-3 mins

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5
Q

what is the active stage in stage 1 of labour?

A

length- 6h if primi, 5 hours if multi
- cervix dilation 30-100%,
- diameter 5-10cm
- contract 60s every 1-2 min

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6
Q

what is the dilation rate in stage 1 of labour

A

primi- 1.2 cm
multi- 1.5 cm

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7
Q

what are the cardinal movements of labour

A
  1. engagement
  2. descent
  3. flexion
  4. internal rotation
  5. extension
  6. external rotation and restitution ( putting the head of foetus to normal position immediately after delivery),
  7. expulsion
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8
Q

what does the length of stage 2 of labour depend on?

A

power ( tone)
passage ( pelvic inlet dimensions) (s2-s4), passenger (Cephalopelvic disproportion)

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9
Q

how long does stage 2 of labour generally take?

A

2h primi, 1h multi

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10
Q

what is stage 3 of labour

A

30 mins
deliver placenta
monitor ppt for PPH ( post partum haemorrhage)
check placental remnants, check 2 umb arteries and 1 umb vein

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11
Q

what is a partogram?

A

parameters to measure maternal and fetal health during labour and can guide to change/add methods e.g cat 1 c section if destress

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12
Q

what does a partogram depend on?

A

depends on
labour progression
fetal condition,
maternal condition
drugs and iv fluid ( only 1st stage monitored)

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13
Q

what does the bishop score look at?

A

cervical ripeness
looks at CDEFP
Consistency
Dilation
Effacement
Fetal station
Position

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14
Q

what are the ranges of the bishop score

A

<5- unripe - therefore unlikely to spontaneously induce, induce labour
5-7- intermediate
>8- ripe, likely to spontaneously induce

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15
Q

what are the nice guidelines on if the bishop score is less than 6

A

membrane sweep, vaginal prostaglandin- dinoprostone (E2) , PO misoprostol ( prostaglandin E1)

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16
Q

what are the nice guidelines on if the bishop score is more than 6

A

amniotomy (rupturing amniotic sac) and iv oxytocin ( syntocinon e.g)

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17
Q

What are the indications to induce?

A

prolonged labour
PProm
maternal ( GDM, PRE ECLAMPSIA, OBS. CHOL)

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18
Q

What are other things given in labour?

A

iv benpen- if allergic clindamycin
rhoGAM if RH-

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19
Q

when are women given iv benpen in labour

A

if Group B Strep (GBS) bacteria or - GBS UTI
( can be given at any time in pregnancy)

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20
Q

in vasa previa and cord prolapse what are the complications of inducing?

A

uterine hyperstimulation (>6 contractions/10min )- risk of fetal ischema and uterine ruptures

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21
Q

what is conservative drain relief in labour?

A

perianal + fundal massage, TENS ( Transcutaneous Electrical Nerve Stimulation, )

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22
Q

what is the medial drain relief in labour

A

Entonox (nitrous oxide and oxygen), morphine ( only 2 boluses max)

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23
Q

what is epidural anaesthesia in drain relief in labour?

Study These Flashcards
A

inserting a small tube (catheter) into the epidural space in the lower back and infusing local anaesthetic medications that diffuse to the surrounding tissues and through to the spinal cord

24
Q

what are the anaesthetic options used in epidural anaesthesia

Study These Flashcards
A

levobupivacaine or bupivacaine, usually mixed with fentanyl.

25
what are the contriindications of epidural anaesthesia?
low platelets ( risk of bleeding), on DOAC, aspirin
26
when may somewhen get denied epidural in labour
may be denied in fetal distress and APH( antepartum haemorrhage)
27
what are the side effects of epidural anaesthesia
urine retention, hypotension, hypoanalgesia, headache post epidural Motor weakness in the legs Nerve damage Prolonged second stage Increased probability of instrumental delivery
28
what is CTG
Cardiotocography monitors the fetal heartbeat and uterine contractions during pregnancy and labour. can only do this in 28 weeks and onwards
29
what are the five key features of CTG?
Contractions – the number of uterine contractions per 10 minutes Baseline rate – the baseline fetal heart rate Variability – how the fetal heart rate varies up and down around the baseline Accelerations – periods where the fetal heart rate spikes Decelerations – periods where the fetal heart rate drops
30
How does CTG work?
2 transducers: 1- The transducer above the fetal heart monitors the heartbeat using Doppler ultrasound. 2- The transducer above the fundus uses ultrasound to assess the tension in the uterine wall, indicating uterine contraction.
31
what are the indications to continue using CTG?
Sepsis Maternal tachycardia (> 120) Significant meconium Pre-eclampsia (particularly blood pressure > 160 / 110) Fresh antepartum haemorrhage Delay in labour Use of oxytocin Disproportionate maternal pain
32
How do you assess a CTG? what is the mnemonic?
DR – Define Risk (define the risk based on the individual woman and pregnancy before assessing the CTG) C – Contractions BRa – Baseline Rate V – Variability A – Accelerations D – Decelerations O – Overall impression (given an overall impression of the CTG and clinical picture)
33
what are the three levels of CTG results
reassuring suspicious abnormal
34
what are the three categories you look for in CTG
- variability- FHR fluctuation, 6-25 bpm - acceleration - FHR.>15bpm increased baseline for >155 - decelerations FHR>15bpm decrease baseline for > 155
35
what % of all births are c sections
25%
36
what are the most common types on incision
Joel cohn incision Pfannenstiel incision both are transverse lower uterine segment incisions.
37
why may someone have an elective c section
Previous caesarean Symptomatic after a previous significant perineal tear Placenta praevia Vasa praevia Breech presentation Multiple pregnancy Uncontrolled HIV infection Cervical cancer
38
describe Joel-cohen incision
Joel-cohen incision is a straight incision that is slightly higher (this is the recommended incision)
39
describe Pfannenstiel incision
is a curved incision two fingers width above the pubic symphysis
40
what do you have to cut through in a c section
1. Skin 2. Subcutaneous tissue 3. Fascia / rectus sheath (the aponeurosis of the transversus abdominis and external and internal oblique muscles) 4. Rectus abdominis muscles (separated vertically) 5. Peritoneum 6. Vesicouterine peritoneum (and bladder) – the bladder is separated from the uterus with a bladder flap 7. Uterus (perimetrium, myometrium and endometrium) Amniotic sac ( 7 layers)!!
41
complications of Joel Cohen incision
Vaginal Birth After Caeserian rupture ( 1/200), TTON, PPH, endometritis
42
what are the different categories of c sections
1- emergency <30 mins- threat to life 2- <75- mother/baby compromised 3- needed but not immediate- stable 4- elective
43
who would be low risk when interpreting their CTG?
regular contractions HR 110-160 Variability 6-25 accelerations present early decels
44
what is a high risk when interpreting their CTG?
bradycardia/ tachy, variability < 5- ( <40 min= sleeping foetus), no accelerations , late or variable decels. consider fetal scalp sample- if low ph- indicates hypoxia
45
when are instrumental births offered
if fetal distress premature delivery HTN/ comorbities
46
two types of instrumental births?
ventouse forced
47
what are key indications of whteher to perform an instrumental delivery
Failure to progress Fetal distress Maternal exhaustion Control of the head in various fetal positions
48
what is reccommended to give after an instrumental delivery
a single dose of co amoxiclav to reduce risk of maternal infection
49
what does having an instrumental delivery increase the risk of?
Postpartum haemorrhage Episiotomy Perineal tears Injury to the anal sphincter Incontinence of the bladder or bowel Nerve injury (obturator or femoral nerve)
50
what is the key risk to the baby with a ventouse delivery?
Cephalohaematoma
51
what is the key risk to the baby with a forceps delivery?
Facial nerve palsy
52
what is a ventouse delivery
a suction cup on cord that goes on the babys head and the dr/mw apply traction help pull baby out of vagina
53
what is a cephalohaematoma.
a collection of blood between the skull and the periosteum.
54
what is a forceps delivery?
two pieces of curved metal that attach together, go either side of the baby’s head and grip the head in a way that allows the doctor or midwife to apply careful traction and pull the head from the vagina.
55
what nerve injury may an instrumental delivery rarely result in?
Femoral nerve Obturator nerve
56
how long do nerve injurys take to resolve after an instrumental delivery?
6-8 weeks
3A OBS
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