Labour Flashcards by Sumaya L

What is labour?

onset of regular and painful contractions associated with cervical dilation and descent of the presenting part

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What are the signs of labour?

*regular and painful uterine contractions
*a show (shedding of mucous plug)
*rupture of the membranes (not always)
*shortening and dilation of the cervix

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What is stage 1 labour?

from the onset of true labour to when the cervix is fully dilated

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What is stage 2 labour

from full dilation to delivery of the fetus

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What is stage 3 labour

from delivery of fetus to when the placenta and membranes have been completely delivered

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What should be measured in labour?

Foetal heart rate
Contractions
Maternal pulse rate
Maternal BP and temp
VE
Maternal urine

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How often should foetal heart rate be measured?

FHR monitored every 15min (or continuously via CTG)

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How often to assess heart rate?

FHR monitored every 15min (or continuously via CTG) for baseline, variability and acceleration

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What is a normal baseline FHR?

110-160 bpm

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What is a tachycardia FHR?

160bpm for 10 minutes

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What is a bradycardia FHR?

Less than 100bpm for 10 minutes

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What is a minimal variability in FHR?

5bpm change

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What is a moderate variability in FHR?

5-25bpm

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What is a severe variability in FHR?

Over 25bpm

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What does acceleration FHR mean?

Synchronises with foetal movement bursts

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What is normal acceleration in FHR?

Before 32 weeks, increase by 10Bpm for 10 seconds over 2 minute tracing

After 32 weeks, increase in FHR BY 15bpm for 15 seconds over 2 minute tracing

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How often to measure contractions?

Every 30 minjted

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How to measure strength of uterine contraction?

Montevideo units

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What is normal rate of contractions?

5 or less in 10 minutes

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What is uterine tschysystole?

Over 5 contractions in 10 minutes

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How often to measure maternal heart rate?

Every hour

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How often to measure maternal BP and temp

Every r hours

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How often to check maternal urine?

Very r hours for ketones and protein

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How often to do vaginal exam?

Every 4 hours

What are the pelvis types?

* gynecoid pelvis * anthropoid pelvis * android *Platypelloid

What is the ideal pelvis shape?

Gynaecoid

What is the pelvis with the most difficult delivery?

Android, similar to anatomical male pelvis with heart shaped inlet

Which pelvis type is common in African?

Platypelloid, causing foetal head to be in a transverse position rather than OA or OP position, making it difficult to pass through the widest point of the pelvis at 10 cm

How to differentiate labour from braxron hicks contraction?

Characterised by irregular, non-progressive contractions that do not result in cervical dilation

Where does pain commonly occur in labour?

discomfort or aching in the lower back, abdominal cramping, pelvic pressure, and uterine contractions during labour.

What is the pain ladder for obstetric analgesia?

*Conservative *Inhaled analgesia. *Simple analgesia *Opiate analgesia *Regional anaesthesia *Spinal block *Pudendal nerve block

Which analgesics should be avoided in pregnancy.

*Aspirin *Strong Opioids Gabapentin and Pregabalin NSAIDs: Avoid during pregnancy

Why to avoid NSAIDs in pregnancy?

Avoid during pregnancy. It can increases risk of miscarriage in the first trimester, and after 30 weeks risk of premature closure of the ductus arteriosus and oligohydramnios.

What is the exception to aspirin use in pregnancy?

For pre-eclampsia

What inhaled analgesia is given in pregnancy?y

Nitric oxide with side effects including nausea, dizziness, and lightheadedness

What is the simple obstetric analgesia?

Paracetomol

Which opiate analgesia can be given?

Oral Codeine Phosphate and IV/IM Diamorphine

What to consider when administering opiate analgesia?

. Only for severe, acute pain, short-term and avoid 4 hours before delivery

What regional anaesthesia is used in vaginal delivery!

Epidural analgesia by placing indwelling catheter into epidural space containing local anaesthetic/ opioid for continuous analgesia below T8

What is a risk of epidural anaesthesia?

Risks include hypotension both maternal and foetal, reducing acceleration of labour, epidural haematoma and causes loss of motor function as patient is confined to bed, However, lasts a long time and can be adjusted during labour.

Which regional anaesthetic is used in C-section?

Direct,y inject local anaesthetic into spinal fluid for analgesia from T10 and below, lasting 2-4 hours. It does not cause loss of motor function

What is a key side effect of spinal block?

limited in duration and can cause post-dural headaches as well as hypotension, nausea and urinary retention

What is the regional anaesthesia for operative vaginal delivery ?

Pudendal nerve block at S2 to S4used in labour or episiotomy,

What is a risk fo a pudendal nerve block?

Haemorrhage with injury to pudendal artery

When is an epidural contraindicated?

Coagulopathiee due to risk of epidural haematoma

What drug is used in patient controlled analgesia?

Morphine

What are the pharmacodynamic actions of morphine?

Short half life and poor bioavailability

What is pet hiding?

Synthetic opioid which is structurally different from morphine but which has similar actions. Has 10% potency of morphine

What is a risk of pet hiding use?

Pethidine has a toxic metabolite (norpethidine) which is cleared by the kidney, but which accumulates in renal failure or following frequent and prolonged doses and may lead to muscle twitching and convulsions

What is the action of paraceotmol?

Inhibits prostaglandin synthesis

What idnicated high likelihood of early lanour?

Raised foetal fibronectin, especially if experiencing tightening. You should adminsitered steroids

How to consider steroid prophylaxis for early labour in diabetics?

Administering steroids can cause hyperglycemia in diabetics, and therefore HOURLY close attention should be paid to the blood glucose measurements

How often to measure maternal urine?

Every 4 hours for ketones and protein

How often should vaginal exam be done in kabour?

Every. 4 hours

How often to assess contractions?

Every 30 mins

How often to assess FHR?

Every 15 minutes

How often to assess maternal BP and temp?

Every 4 hours

What is normal FHR?

normal fetal heart rate varies between 100-160 / min

What is foetal bradycardia?

Heart rate less than 100 beats per minute

What causes foetal bradycardia?

Increased fetal vagal tone maternal beta-blocker use

What is foetal bradycardia?

Heart rate over 160

What causes foetal bradycardia?

*Maternal pyrexia *chorioamnionitis *hypoxia *prematurity

What is baseline variability in foetal heart rate?

5 beats per minute

What is loss of baseline variability?

Change of over 5 beats in a minute. This is due to prematurity or hypoxia

What is early deceleration?

Deceleration of the heart rate with the onset of a contraction and returns to normal on completion of the contraction. It is Usually an innocuous feature and indicates head compression.

What vis late deceleration.

Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction

What does late deceleration indicate?

fetal distress e.g. asphyxia or placental insufficiency

What is variable deceleration?

Independent of contraction and may idnicate cord compression

When is deceleration considered abnromal?

A single prolonged deceleration lasting 3 minutes or more is considered abnormal. Variable decelerations occurring with over 50% of contractions when it is NON responsive to conservative treatment.

What is the requirement of continuous CTG monitoring.

*suspected chorioamnionitis or sepsis, or a temperature of 38°C or above *severe hypertension 160/110 mmHg or above *oxytocin use *the presence of significant meconium fresh vaginal bleeding that develops in labour

What blood pressure requires continuous CTG monitoring.

severe hypertension 160/110 mmHg or above

What are the features of braxron hicks?

Occurs in the last 4 weeks of pregnancy Presentation: contractions felt in the lower abdomen. The contractions are irregular and occur every 20 minutes. Progressive cervical changes are absent

What causes variable deceleration?

Cord compression

What causes early deceleration?

Head compression

What causes late deceleration?

Placental insufficiency

What causes short episodes of decreased variability on CTG?

Foetus is asleep if less than 40 minutes

What causes prolonged deceleration?

*maternal drugs (such as benzodiazepines, opioids or methyldopa - not paracetamol) *foetal acidosis (usually due to hypoxia) *prematurity (< 28 weeks, which is not the case here) *foetal tachycardia (> 140 bpm, again not the case here) * congenital heart abnormalities.

When is C-section idnicated?

the late decelerations which are a worrying sign especially in the context of foetal bradycardia

When is instrumental delivery not possible?

cervix is NOT fully dilated and the head of the baby is high

What are the indications for instrumental deliveries?

FORCEPS F= fully dilated cervix O= OA position R= ruptured membranes C= cephalic presentation E=engaged presenting part P= pain relief S= sphincter bladder empty

What are the methods of labour induction stepwise!

Membrane sweep Vaginal prostaglandin Oral prostaglandin Oxytocin infusion Amniotomy Cervical ripening balloon

Which nerve block is done for instrumental delivery?

Pudendal nerve

What are changes that occur with late pregnancy?

Mucous plug Baby dropping lower Backache Nesting behaviour

What is entonox?

Nitric oxide and oxygen via face mask or mouth piece that requires continued use for effective

How does TENS work in labour?

Self-adminsitered through electrodes that stimulate production of natural endorphins. Can control frequency and intensity of impulses

How does water immersion work in lanour?

Body temperature water, only suitable for low risk labouring women.

What are the draw backs of water birth immersion?

Reduced length of lanour and no adverse effects physically on mother of foetus, Emergencies may be difficult for birth attendants to respond ton

What opiate is given for birth analgesia!

IM pet hi dime, taking 20 minutes to work and last 4 hours

What analgesia does not receive contraction pain?

Pudendal block

What to give to relax the abdomen in labour?

Terbutaline for delaying labour

What contraction pattern indicates labour?

Contractions 5 minutes apart lasting 1 minute within an hour

How long is active labour in Nulliparous women?

8 hours

How long is active labour in Multiparous women?

5 hours

What inhibits labour progression?

Oxytocin production is inhibited by fear of anxiety

What does epidural contain!

Epidural contains 1% bupivicaine and 2mcg fentanyl.

Which analgesic increases labour time?

Epidural by 30 minjtes

What montofing is required with elidural?

Monitor BP every 5 mins and continuous EFM for at least 30 minutes requiring IV access

What monitoring is reccomended after oxytocin?

Vaginalnexamination after 4 hours

What causes intense abdominal pain and loss of contractions And loss of trace through cardiotocography?

Uterine rupture which puts mother of risk of haemorrhagic shock and needs to be managed with emergency laparotomy c-section. There is kiss if foetal station as the baby may move Howard’s and signs of sternal shocks

Which abnormality is vaginal examination appropriate during lanour?

Cord prolapse

Labour Flashcards

(103 cards)