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49 Cards in this Set
- Front
- Back
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When was the partograph developed?
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It was developed about 30 years ago
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What is the Partograph?
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Graphic Representation of Labor
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Describe the multicenter trial of the partograph in Southeast Asia.
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It looked at labor over 35,000 women and it was shown to be a feasible tool and cost effective way of intervening
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How did the Partograph help deliveries?
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1. Labors that lasted 18 hours previously went down by 50%
2. reduced need for C Section by 5% 3. directed new interventions where necessary |
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What is necessary for Partograph to be effective?
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It must be accompanied by appropriate training program. Workers must meet minimum standards in order to use this
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What is the partograph designed to be used as?
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A low level in healthcare system and when labor hits the alert line, the idea is that the woman in labor needs to be referred to a higher level of obstetrical care where people can make more sophisticated observation and intervention is necessary
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For the purpose of hte partograph, when does the active phase of labor start?
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3 cm
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For purpose of partograph, What rate should cervix dilate during active phase of labor?
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1cm/hr
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For purpose of partograph, Latent phase of labor should not last more than ____ hours.
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8
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What is fetal evaluation?
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Graph of fetal heart rate which is normally 120-160 beats per minute
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What is molding of fetal head?
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The way the cranial bones overlap, women who have difficult labor will have much more moulding of the fetal head
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What are two main functions of partograph?
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Tell hospital personal when they should intervene and tell when auxillary personal should refer to someone else
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About ____________ women die each year due to pregnancy related diseases.
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500,000
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What happens when labor goes on for extended period of time?
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Risk of complication, risk of infection, risk of bleeding increases,
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Prolonged labor is marker for neonatal _____ and _____.
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Mortality and Morbidity
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Why did most interventions during complicated pregnancies in the past fail?
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They were not based on any understanding of reproductive physiology. There was also lack of anasthesia and treatment for infections
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What were the most common traditional techniques when the baby wouldn't come out?
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Clucking noises and pulling whatever was available - catastrophic consequences
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Why do they recommend an intervention to rupture membranes when woman reaches alert line in partograph?
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Rupturing membranes gives you information about intrauterine environment. If fluid is clear and slightly turbid it is normal but if fluid is turbid this is sign of infection, bloody sign of bleeding in uterus, and dark green and chunky is fetal stool in uterus - meconium
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What is Meconium during labor a sign of ?
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Distress on fetus and it is a potential problem because fetus might suck its fecal matter into lungs and harm respiration
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What are the main reasons for rupturing uterus?
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Prostaglandins are synthesized in the amniotic membranes and their release of it when membranes ruptures helps stimulate contractions. When you get to the action line in partograph, means you have abnormal labor and need to intervene.
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What are the two questions in clinical obstetrics?
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Does the patient need delivery now? If yes, How?
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What are the options if the patient needs immediate delivery?
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Augmentation of labor or operative intervention such as C-Section
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What is oxytocin used for?
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Speed up birth and increase rate of contractions
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What was the first synthetic polypeptide hormone that was created?
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Oxytocin
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Why doesn't oxytocin work if you give it to pregnant woman early in pregnancy?
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Uterus is not ripe enough; it hasn't developed oxytocin receptors yet
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What must the doctor do with the patient if he gives the pregnant woman oxytocin?
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He must be able to evaluate strength of clinical contractions
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What other hormone is oxytocin related to? How?
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ADH, it shuts down urine production. If you give someone too much oxytocin you may get crossover effect where you stop producing urine. This causes fall in Na and could lead to other complications such as seizures - WATCH OXYTOCIN
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Describe Oxytocin.
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It is nine member peptide made in brain and put in pituitary gland until released
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What is active management of labor?
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Philosophy of obstetric care pioneered in Ireland where physicians avoid C-Sections by using aggressive management of labor using high doses of oxytocin so everyone who comes in gets a delivery within a certain parameter of time.
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Women in active management of labor are guaranteed delivery within _____ hours of admission.
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12
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National hospital in Dublin dropped its C-Section rate by ____% with the active management of labor.
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5
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Why did US rates of C-Section rise while Dublin's rate of C-Section declined with active management care?
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They had 7 fold increase in fetal death and 2 fold increase in number of babies who had seizures
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What happened if baby didn't come out and there was no oxytocin in 16th, 17th, 18th century Europe?
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Intervention to destroy fetus and save mother - most common was craniotomy.
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What is one of the greatest inventions in medical history?
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Obstetrical Forceps
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Describe the obstetrical forceps parts.
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Blades look like salad tongs with two curves, cephalic and pelvic curve. Top of blade is toe and bottom is heel. At bottom, there is a lock that allows you to put blades together. You apply forceps to fetal head and pull fetus out along pelvic curve. The handle helps put appropriate curve on use of instrument.
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What were crude forceps originally used for in history?
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Instrument of fetal destruction
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Modern forceps were invented by an interesting group called the ___________ towards the end of 16th century.
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Chamberlen family
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What did Dr. William Chamberlain's sons do when they moved to London?
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They were Barber Surgeons and they joined Barber Surgeon Guild in London.
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What special delivery did Peter Elder attend?
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Delivery of Queen Anne of England
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Which member of the Chamberlain family was the star and actual physician?
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Peter Younger son, Peter III
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Who were Peter the Physician's sons?
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Hugh and Paul
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Why was Peter the Physician such a big deal?
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Peter Elder got him to become physician of royal household
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In what did Hugh and Paul make names for themselves?
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They made names for themselves in London as doctors who had special interest in midwifery
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What did Hugh do when he suddenly got into debt?
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He fled England and went to Paris and tried to sell family secret of forceps to Morseaux but Morseaux wouldn't buy it unless Hugh performed difficult delivery that noone else could do.
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What was difficult delivery Hugh had to perform to sell his family secret?
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He had to deliver baby from pregnant dwarf with rickets and tiny pelvis
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Who did Hugh Chamberlain sucessfully sell his family secret to?
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Dutch doctors who paid him an enormous sum of money but he only gave them one blade
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Who is Dr. Hugh Dewar?
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He is a successful physician in 1896 London who was a master of surgery. He was called to deliver a complicated pregnancy. He used forceps and when trying to remove placenta he removed a tube and accidently pulled out large intestine. Baby healthy but mother died during delivery and they assumed death was due to shock and loss of blood. He was charged with homicide, then he overdosed and died.
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How could have Dr. Hugh Dewar avoid the problem he caused?
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The answer was in the work of Smellie. He was the most important obstetrician in 18th century and he was a pioneer in use of obstetrical forceps. He discovered a mechanism of labor and accuratelyt described the course of fetal head throughout this mechanism and used forceps to guide babies head.
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What are basic rules of application of forceps which Smellie articulated?
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Head must be engaged deep in pelvis. Fetus must be head first with face presentation or chin anterior. You have to know where fetal head is so you can apply forceps without causing trauma. Membranes must be ruptured and no bony obstruction to delivery. Cervix must be completely effaced and dilated: only 2nd stage of labor. If all of these things in place you can apply forceps.
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