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Flashcards in Malpresentation Deck (13)
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1
Q

Instrumental delivery - requirements:

FORCEPS

A
F - Full dilatation
O - Occipto-anterior position
R - Ruptured membranes
C - Cephalic presentation
E - Engaged with pelvis
P - Pain relief adequate
S - Sphincter (bladder empty)
2
Q

Active labour management.

PROGRESS

A
P - Pain relief adequate
R - Rupture membranes
O - Oxytocin
G - Glandins (PGE2 pessary or gel)
R - Rate (contractions and FHR monitoring)
E - Examine vagina
S - Sweep (cervical)
S - Support patient
3
Q

Stages of labour.

a) Stage 1 - latent and active
b) Stage 2
c) Stage 3

A

a) Begins with contractions; ends with full dilatation (~ 10cm); may also have a ‘show’ and ROM.
- Latent: non-painful contractions at 5-10 minute intervals; 0 - 3 cm dilatation
- Active: contractions less than every 5 minutes; last around 60 seconds; dilatation from 3 - 10 cm

b) Begins at full dilatation; ends with delivery of the baby
c) Delivery of placenta

4
Q

Second stage of labour - 7 movements of baby

Ellie Du Fresne Is Eating English Eggs

A

Engagement (at station 0 - level with ischial spines)
Descent
Flexion
Internal rotation
Extension
External rotation (restitution)
Expulsion - anterior shoulder, then posterior shoulder and body

5
Q

Baby begins to crown, then retracts back into birth canal.

a) what is this sign?
b) what is it caused by?
c) what is the management? (HELPERR)

A

a) Turtle neck sign
b) Shoulder dystocia

c) H - call for help
E - episiotomy
L - legs (McRoberts)
P - pressure (suprapubic)
E - enter (rotational manoeuvres)
R - remove posterior arm
R - roll patient onto side
6
Q

Complications of shoulder dystocia.

a) Foetal
b) Maternal

A

a) Fracture, brachial plexus injury, hypoxic-ischaemic brain injury and death
b) PPH, 3rd/4th degree perineal tear, rupture of organs,

7
Q

3 Ps of failure to progress

A

Powers
Passage
Passenger

8
Q

Failure to progress: define

a) 1st stage
b) 2nd stage
c) Total

A

a) - Nulliparous: < 0.5 cm /hr
- Multip: slowing of progress

b) - Nullip: > 3 hours (intervene when > 2 hours)
- Multip: > 2 hours (intervene when > 1 hour)

c) Nulliparous: > 20 hours
Multiparous: > 14 hours

9
Q

Breech: management

A

ECV at term

Planned CS if ECV fails

10
Q

Bishops score

- Call PEDS to determine station

A

Cervical…

Position, Effacement, Dilation, Softness; Foetal Station

11
Q

A 26 year old at 40 weeks gestation in her first pregnancy has been experiencing regular, painful contractions every 10-15 minutes for the last 8 hours. She was anticipating a home birth and has been labouring at home supported by her partner and her community midwife. Her community midwife has requested admission to labour ward because cervical dilatation has remained 5cms for the previous 6 hours. Membranes are intact.

a) What are the possible reasons for failure to progress in this scenario?
b) Outline your initial management
c) What advice would you give to the couple?
d) Describe your subsequent management?
e) What factors will influence and help decide mode of the delivery?

A

a) Powers - nulliparous
Passage -
Passenger -

b) P - Pain relief adequate
R - Rupture membranes
O - Oxytocin
G - Glandins (PGE2 pessary or gel)
R - Rate (contractions and FHR monitoring)
E - Examine vagina
S - Sweep (cervical)
S - Support patient

If these fail - CS

c) ?
d) ?
e) ?

12
Q

A 33 year old woman at 38 weeks gestation in her first straight forward pregnancy has been admitted on labour ward having ruptured her membranes four hours ago. She is experiencing regular contractions, intensity of which has increased since admission. A meconium stained liquor is noted on the pad. She is now requesting for epidural analgesia. On examination, the cervix is 3 cm dilated, fully effaced, but the midwife is
not sure of the presenting part. An Obstetrician is asked to review her.

a) What is the possible diagnosis in this scenario?
b) What is the significance of meconium liquor in this case?
c) How would you approach the woman and what initial assessment should be
undertaken?
d) Describe your subsequent management and care she should receive?

A

a)

13
Q

Normal position, presentation, etc.

A

Lie: longitudinal (rather than oblique or transverse)

Presentation: cephalic (rather than breech)
- Cephalic can be further categorised as vertex (flexed), brow (deflexed) or face (extended)

Position: OA (rather than OP)

Station:

  • during pregnancy at -3, then -2 and -1
  • engagement = 0
  • then as expelled, moves from +1, +2. +3