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RB Y3 3 Reproduction & Sexual Health > Labour and Monitoring > Flashcards

Labour and Monitoring Flashcards

1
Q

wht are the contractions called than occur towards the end of pregnancy, but are not labour

A

Braxton Hicks conctractions

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2
Q

how are braxton hicks contractions differentiated from labour

A

they are irregular, do not increase in frequency/intensity and are usually painless

there will be no cervical changes

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3
Q

when are BH contactsions usually seen

A

they can start as early as 6 weeks but are usually seen in the 3rd triemster

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4
Q

outline the positive feedback mechanism of cervical stretch

A

cervical stretch from the foetus head causes oxtyocin release, which stimulates PG etc

as the baby is pushed further down, this mechanism is activated more and more

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5
Q

what is the most suitable femal epelvic shape for birth

A

gynaecoid

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6
Q

which type of pelvis is seen in tall ppl

A

android

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7
Q

which type of pelvis is assoicated with labour problems and why

A

anthropoid, the AP diameter>transverse. this means that the head is often high at term and labour can be difficult to start

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8
Q

what is the latent part of the 1st stage of labour

A

the cervix dilating from a closed os to 4cm dilatation

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9
Q

what is the active part of the 1st stage of labour

A

4-10cm dilatation (full)

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10
Q

what should the rate of dilatation of teh active part of the 1st stage be

A

no slower than 0.5cm/hr in PG and 1cm/hr in MG

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11
Q

how is progress in the 1st stage of labour monitored

A

uterine contractions and dilatation of the cervix

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12
Q

what is the 2nd stage of labour

A

from complete dilatation of the cervix to the passage of the baby through the birth canal

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13
Q

what is the max time NICE say it should take for the baby to be delivered after onset of 2nd stage of labour

A

4 hours

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14
Q

what are real labour contractions like

A

regular, increase in strenght, frequency and duration

fundal dominance, adequate resting tone

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15
Q

how long do normal contractions usualyl last and how frequent

A

3-5 in 10 mins, duration of 10 sec building up to 45 sec

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16
Q

what are the 7 cardinal movements of labour

A

engagement

descent

flexion

internal rotation

extension

external rotation

expulsion

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17
Q

when is the head considered engaged

A

when 3/5 of the head has entered the pelvis (2/5 still felt abdominally) - the widest diameter of the head has entered

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18
Q

how is descenet of the foetal head measured

A

in stations - the bottom of the baby’s head in relation to ischial spines

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19
Q

why does the baby do flexion

A

to ensure that the occipital part of the foetal skull enters the birth canal first as this is the smallest dm of foetal head - minimises moulding

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20
Q

what is another word for external rotation

A

restitution - return of teh foetal head to the correct anatomical position

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21
Q

which shoulder is delivered first

A

anterior

then posterior

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22
Q

how do you manage the 3rd stage

A

can manage it expectantly or actively

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23
Q

what does expectant 3rd stage involve

A

no drugs etc, delivery of placenta by maternal effort

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24
Q

what does active 3rd srage involve

A

the use of IM oxytocic drugs and controlled cord traction

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25
Q

how would you deliver the oxytocin for active management of 3rd stage

A

IM

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26
Q

is active or expectant management of 3rd stage preferred

A

no consensus - active reduces risk of PPH

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27
Q

how do you know if the placenta has separated from mum

A

uterus will contract, harden and rise

the umbilical cord will lengthen permanently

blood

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28
Q

what are the 2 different ways in which the placenta can separate

A
  • matthew duncan - from edges first, middle last

schultz- from the middle first

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29
Q

can TENS be used for analgesia during birth? and what is it

A

yes, electrical stimulus is applied to the skin over the back where the pain is through electrodes

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30
Q

what is Entonox

A

a half and half mix of O2 and NO (laughing gas)

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31
Q

why is Entonox good to use

A

it has no effect on the baby

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32
Q

what stronger pankiller can be used as analgesia during labour

A

diamorphine (heroin!) - less commonly used

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33
Q

how is diamorphine adminstered

A

deep IM injection, with an anti emetic eg prochloperazine or cyclizine

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34
Q

what are the risks of using diamorphine, and what steps are taken to avoid these

A
  • respiratory depression in baby - dont use wtihin 2-3 hours of delivery
  • mother: resp depression, constipation, headache, euphoria, nausea, vomiting, itch, confusion etc etc
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35
Q

what can be adminstered to counteact the effects of diamorphine

A

naloxone - opioid antagonist

36
Q

how does resp depression from diamorphine manifest in the baby

A

bradycardia and decreased variability on CTG

37
Q

pain sensation - how is pain from the top of teh pelvic organs (ones that touch the peritoneum) transmitted

A

the visceral afferents run alongside synmpathetic fibres and enter the spinal cord between levels T11 and L2

38
Q

how is pain from the inferior aspects of the pelvic organs, that is not in contact with the peritoneum, transmitted

A

the visceral afferents run back with parasympathetic fibres and enter the spinal cord between S2 and S4

39
Q

what structure marks the boundary between the pelvis and perineum

A

levator ani (pelvic floor)

40
Q

how does pain transmission differ between teh pelvis and perineum

A

above the levator ani, the pain fibres run back with the parasympathetic fibres (S2-4)

below, the pain is sensed by the pudendal nerve, which runs back and enters the spinal cord between S2 and 4. this would be felt as localised pain in the perineum

41
Q

where is a spinal anaesthetic injected into

A

subarachnoid space L3/4

42
Q

where is teh epidural injected into

A

epidural space, at L3/4 region

43
Q

what is found in the epidural space

A

loose fat, tissue and veins

44
Q

epidural adverse effects - low bood pressure

how does this happen

A

it blocks the sympathetic system so causes vasodilatation - sudden and profound hypotension

45
Q

epidural adverse effects - hypotension

what precautions are taken

A

a cannula is inserted into the arm incase IV fluids are needed quickly and BP is monitored

46
Q

epidural adverse effects - hypotension

what effect would this have on baby

A

reduced perfusion could cause foetal hypoxia

47
Q

epidural adverse effects - bladder problems

A

person cant feel bladder so often goes into urinary retention - insert a catheter

48
Q

epidural adverse effects - what is often felt in the legs

A

heavy/weak legs are common

numbness and tingling

49
Q

epidural adverse effects - headache

A

if the injection goes too deep and makes a hole into the subarachnoid space there can be CSF leakage. if too much CSF is lost there will be a severe headache that can last a few days unti CSF replenishes

the headache is worsen when standing up and relieved by lying down (gravity)

50
Q

epidural adverse effects - total spinal syndrome

A

if the anaesthesia is accidentally injected into the spinal cord –> unconsciousness and general anaesthesia

the mother will need to be intubated ventilated and receive CV support

51
Q

what negative effect can an epidural have on labour

A

as the mother cant feel when it is time to push the 2nd stage may be prolonged

she may need help from doctors and midwives

52
Q

give an example of a local anaesthetic used in spinal anaesthesia

A

bupivacaine

53
Q

when is spinal anaesthesia generally used

A

in C section or assisted vaginal delivery

54
Q

why are you less likely to use spinal anaesthesia in normal labour

A

it blocks the feeling of uterine contractions so the mum finds it arder to push

it also can wear off before labour is complete, whereas an epidural you can leave in and give top ups

55
Q

when would a pudendal nerve block be used

A

localised effect on perineum

used for episiotomy, forceps or perineal stitching post delivery

56
Q

why are NSAIDs not used as anaesthesia for labour

A

they inhibit COX which would produce PG - these are needed to soften the cervix and cause uterine contractions

also cause premature close of patent ductus arteriosus and oligohydramnios

57
Q

what effect do opioids have on baby abd breastfeeding

A

poor suckling in baby

delayed onset of breastfeeding

58
Q

when should mum first be able to feel foetal movements

A

around 20o weeks

59
Q

how should foetal movements change over the course of labour

A

intensity (strength) should increase till about 24 weeks, then plateau, then may decrease close to labour as baby doesnt have much space

frequency should stay teh same throughout

60
Q

what should mum do if foetal movements decrease in frequency

A

see a healthare provider to asses baby further - could be first sign of foetal compromise

61
Q

when is CTG used to assess FHR

A

Intermittent auscultation with Pinard or handheld Doppler for low risk pregnancies, CTG monitoring for high risk.

62
Q

normal baseline heart rate

A

110-150

63
Q

how does foetal hypoxia change baseline rate

A

initally tachycardia, and then bradycardia?

64
Q

how many contractions is normal in 10 mins

A

3-5

65
Q

what may >5 contractions in 10 mins indicate

A

hyperstimulation of the uterus

66
Q

what is variability

A

the variation of the foetal heart rate between beats, seen as deviations in the baseline rate

67
Q

what is normal variability

A

5-25

68
Q

what could cause a reduction in variability

A

baby sleeping, hypoxia, tachycarida, drugs, prematurity etc

69
Q

what are accelerations

A

a transient increase in the baseline foetal heart rate by >15bpm for >15 seconds

70
Q

what does teh presence of accelerations indicate

A

need to be there for an antenatal CTG to be normal

dont need to be there in labour

71
Q

what are decelerations

A
  • Transient decrease in baseline foetal heart rate > 15bpm for >15 seconds
72
Q

what do early decelerations look like on CTG

A

the peak and trough will match

73
Q

what do early decelerations indicate

A

these are a normal finding, associated with foetal head compression during labour

74
Q

what are typical variable decelerations like

A

they have shouldering, last <60 sec

75
Q

what are typical variable decelerations a sign of

A

normal physiological response to transient acute hypoxia from cord compression during a contraction reflecting a well oxygenated foetus

76
Q

what are atypical variabel decelerations like

A

W shaped (biphasic), no shoulders, last >60 seconds, baseline rate doesnt return to normal after

77
Q

what do late decelerations look like on CTG

A

the trough of each deceleration is after the peak of each contraction

78
Q

what do late decelerations mean

A

they are a worrying sign - may indicate foetal hypoxia and acidosis

79
Q

how is the overall assessment of the CTG classified

A

reassuring, non-reassuring (1/4 abnormal feature) and abnormal (≥2)

80
Q

management of a non-reassuring CTG

A
  • Maternal position – lying supine causes aortocaval compression by gravid uterus, reducing maternal cardiac output
  • Dehydration
  • Low blood pressure
  • Hyperstimulation – if contraction frequency >5 and oxytocin being infused, stop/reduce it. If this doesn’t help or oxytocin is not being given – give tocolytic to relax uterus e.g. terbutaline (beta 2 agonist)
  • Infection
  • Rapid progress – sudden head decent
81
Q

how is hyperstimulation managed

A
  • if on oxytocin stop it
  • if this doesnt work/not on –> tocolytic eg erbutaline
82
Q

management of abnormal CTG

A

same as non reassuring

if the cervix is fully dilated and the foetus is easily deliverable perform an instrumental delivery

scalp stimulation - describe this

FBS

83
Q

contraindications to FBS

A
  • Maternal infection
  • Bleeding disorders
  • Breech position
  • Prematurity (<34 weeks)
84
Q

management of sustained foetal bradycardia >3 mins

A

emergency- obstetric review now

  • Abdominal and vaginal exam to assess for cause
  • Change maternal position
  • Rapid IV fluid for acute hypotension
  • If heart rate doesn’t recover à deliver now
85
Q
A

RB Y3 3 Reproduction & Sexual Health (21 decks)

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