**CPGs 2020 > Maternity > Flashcards

Maternity Flashcards

(20 cards)

Study These Flashcards
1
Q
  1. What does the rupture of membranes represent?
A

A hole/tear forms in the amniotic sac, can either be spontaneous, most often after active labour has started, or can be ruptured by a doctor/midwife. It is normally a cloudy-white - amber-straw colour and has a sweeter smell or no smell.
Lying down more likely to feel gush than standing because baby’s head acts a plug.

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2
Q
  1. What are the characteristics of first and second stage of labour?
A

First: onset of contractions every 2-20mins, 20-60secs, duration to full cervical dilation
Second: full cervical dilation to birth of the baby - primipara 1-2hrs, multipara 15-45mins

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3
Q
  1. What are considerations for maternity destination?
A

> 36 weeks and uncomplicated Tx to booked maternity unit/closest
32-36 weeks consult PIPER
<32 weeks Tx to closest of Women’s, Mercy, Women Heidelberg or MMC
*Not to Alfred unless in cardiac arrest <24 weeks gestation with mCPR in progress

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4
Q
  1. What is the Rx for pre-eclampsia?
A
  • Severe HTN SBP>170 or DBP>110 and pre-eclampsia s&s - consult with PIPER to Mx HTN
  • Seizure activity: Mx as per CPG, left lateral tilt, High flow O2
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5
Q
  1. What are the S+S of pre-ecmlampsia?
A
  • Headache
  • Cerebral irritation/agitation
  • Visual disturbances (flashing lights, shimmering)
  • N/V
  • Heartburn
  • Hyper-reflexia
  • Elevation of 20mmHg above normal BP may be sufficient sign if other Sx present
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6
Q
  1. What are the main steps to consider for a Normal Birth?
A
  • As head advances encourage mother to push with each contraction, if birthing too fast encourage mother to pant instead
  • Gentle pressure to perineum to reduce tear
  • Note time of head delivery
  • Check for umbilical cord around neck, if loose unwrap, if tight encourage pushing, otherwise clamp and cut cord
  • Gentle downwards pressure to deliver anterior shoulder and upward for posterior, note time of birth - if body fails to deliver <60secs after head Mx as shoulder dystocia
  • Cord - wait for it to stop pulsating 1-2mins - clamp 10cm from baby and second a further 5cm
  • Placenta takes 15-60mins, position sitting/squatting, breast feeding may assist separation - ask mother to push - ease out with see-saw motion, note time of delivery and place into container
  • Don’t massage fundus once firm
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7
Q
  1. What should be done in the setting of imminent breech birth with back not uppermost?
A

Position mother kneeling on all fours to allow restitution.

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8
Q
  1. What are key things to remember and encourage for mother during breech birth?
A
  • Encourage mother to push hard with contractions
  • Lithotomy position
  • HANDS OFF approach - only touch to gently support - main force of birth is maternal effort
  • Maintain warmth of body
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9
Q
  1. Delivery of babies head in Frank position and back uppermost (most common):
A
  • Let baby hang until nape of neck is visible
  • Mauriceau-Smellie Veit: non-dominant index and ring finer on shoulders, middle finger on occiput - Flexion of head
  • dominant hand under baby to support body - ring and index fingers on cheekbones
  • Lift baby straight up in a circle onto mother’s abdomen , allowing head to birth slowly
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10
Q
  1. What to do when Frank position but back not uppermost?
A
  • Place thumbs on bony sacrum - fingers around thighs
  • Rotate between contractions
  • Do not squeeze abdo and take care of spine
  • Never pull the baby
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11
Q
  1. What to do when baby is in Frank presentation and arms aren’t birthing spontaenously?
A

Lovsett’s manoeuvre
- hold baby by sacrum - turn baby 90deg, so shoulder in anterior-posterior
- insert finger into brachial plexus and sweep arm over baby’s chest
- turn 180deg and repeat
- turn 90deg again so back uppermost

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12
Q
  1. What is the Rx for Antepartum haemorrhage?
A

Clinical signs of altered perfusion: internal bleeding may greatly exceed visible external bleeding
- Place pt in left lateral tilt position
- Tx to appropriate obstetric hospital with notification
- Less than adequate perfusion - NS 40mL/kg, consult for further or 20mL/kg
- Pain relief

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13
Q
  1. What is the Rx for Preterm Labour?
A

Contractions present and birth not imminent (<34wks)
Consult for 50mg GTN patch applied to abdomen, additional one may be applied after an hour if contractions persist

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14
Q
  1. What is the Mx of Cord Prolapse?
A
  • Birth commencing: instruct mother to push, prepare for resus, cord handling kept to a minimum
  • Birth not imminent:
    Mother: position semi-prone, hips elevated over towels; High flow O2
    Cord: keep warm and moist, use 2 fingers to gently place in vagina, if unsuccessful cover with warm saline packs
    Presenting part: if pressure on cord, push presenting part away from cord, maintain pressure
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15
Q
  1. What is the Hx needed for Cord Prolapse?
A
  • Time membranes ruptured?
  • How long has cord been visible?
  • Due date?
  • Foetal movement felt?
  • Onset of labour? Contractions present?
  • Foetal presentation?
  • PV bleeding?
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16
Q
  1. What is the Mx of Shoulder Dystocia?
Study These Flashcards
A

Prolonged head to body delivery >60secs:
- note birth of head time - 5-7mins from then
- position mother buttocks at bed edge and ask to push with focused effort
- apply gentle downward traction to deliver anterior shoulder - NEVER ATTEMPT TO ROTATE BABY’S HEAD, ROTATE SHOULDERS WITH PRESSURE ON SCAPULA
- McRobert’s: knees to nips, as far back as poss - 30-60secs
- Suprapubic pressure behind symphysis pubis at 45deg angle along baby’s back - 30sec downward pressure than 30sec rocking motion
- Gaskins: All 4s - gentle downward traction on baby’s head to deliver posterior shoulder

17
Q
  1. What is the Mx for PPH - Fundus Firm?
Study These Flashcards
A
  • High flow O2
  • Pain relief
  • BP<90: NS 40mL/kg, consult for more or 20mL/kg
  • Mx any laceration with dressing and firm pressure
18
Q
  1. What is the Mx for PPH - Fundus Not Firm?
Study These Flashcards
A
  • Mx as per fundus firm
  • Fundus not firm usually until after placenta delivered
  • Massage fundus after placenta delivery (if not firm) - cupped hand, firm pressure in circular motion
  • Encourage mother empty bladder and baby to suckle breast
  • Fundus remain not firm: Oxytocin 10 IU IM, repeat @5min if bleeding continues
  • DO NOT ATTEMPT DELIVERY OF PLACENTA DUE TO RISK OF UTERINE INVERSION
  • Intractable haemorrhage: external abdominal aortic compression - just above umbilicus and slightly left
19
Q
  1. What are the 4 causes of PPH?
Study These Flashcards
A

Tone - uterine atony - most common
Trauma - to genital structures
Tissue - retention of placenta or membranes
Thrombin - coagulopathy
(An empty and contracted uterus doesn’t bleed)

20
Q

What is a precipitate birth?

Study These Flashcards
A

Unusually rapid labour <4hrs with extremely quick birth. The rapid change in pressure from intrauterine life may cause cerebral irritation.

**CPGs 2020
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