Labour

Front 1

Role of progesterone in labour

Back 1

Keeps uterus settled, prevents contractions

Front 2

Role of oestrogen in labour

Back 2

Makes uterus contract, prostaglandin production

Front 3

Role of oxytocin in labour

Back 3

Initiates and sustains contractions, promotes prostaglandin

Front 4

First stage of labour

Back 4

Latent phase - up to 3/4cms dilatation

Active phase - 4cms to 10cms (full dilatation)

Front 5

Second stage of labour

Back 5

Full dilatation to delivery of baby

Front 6

Third stage of delivery

Back 6

Delivery of baby to expulsion of placenta and membranes

Front 7

When is second stage of labour considered prolonged in nulliparous women?

Back 7

2 hours

Or 3 hours (with regional analgesia)

Front 8

When is the second stage of labour considering prolonged in multiparous women?

Back 8

1 hour

(2 hours if regional anesthesia)

Front 9

Average duration of third stage of labour?

Back 9

10 minutes

Front 10

Braxton hicks contractions

Back 10

Tightening of muscles thoughts to aid the body prepare for birth

Can start 6 weeks into pregnancy

Not usually felt into second or third trimester

Front 11

True labour contractions

Back 11

Described as a wave, abdomen hard during contraction
Start about 5 mins apart

Front 12

What hormone causes real contractions?

Back 12

Oxytocin

Front 13

Cervix is made of

Back 13

Collagen tissue (types 1, 2, 3, 4), smooth muscle and elastin

Front 14

Normal fetal position

Back 14

Longitudinal lie, cephalic presentation
Presenting part - vertex

Front 15

Normal blood loss in labour

Back 15

Less than 500mls

Front 16

How long for tissues to return to pre-pregnancy state?

Back 16

6 weeks

Front 17

What is lochia?

Back 17

Vaginal discharge after birth containing blood, muscus and endometrial castings

Front 18

Hormones in puerperium

Back 18

Descrease in oestrogen/progesterone

Prolactin is maintained

Front 19

Stage 1 failure to progress suspected if

Back 19

<2cm dilation in 4 hours

Front 20

Normal fetal scalp pH

Back 20

>7.25

If less than 7.2 deliver baby

Front 21

When is anti D test done?

Back 21

28 weeks and 34 weeks

Front 22

When is booking visit done?

Back 22

8-12 weeks

Front 23

Gestational hypertension description

Back 23

New elevated BP at >20 weeks (NO proteinuria)

Front 24

HELLP syndrome

Back 24

Haemolysis

Elevated Liver enzymes

Low Platelet count

Can look like preclampsia

Front 25

Hypertensive drugs NOT used in pregnancy

Back 25

ACEis/ARBs

Front 26

Hyertensive drugs USED in pregnancy

Back 26

Labetalol
Methyldopa
Nifedipine

Front 27

If maternal BP <130/90 on medication

Back 27

Reduce dose of HTN

Front 28

If preeclampsia is present, deliver at

Back 28

37 weeks

Front 29

Risk factors for preeclampsia

Back 29

Previous preeclampsia

First pregnancy

New partners

Aged over 40

Obesity

Multiple pregnancies (twins etc)

Little or lots of time between pregnancies

Front 30

Diabetic drugs safe in pregnancy

Back 30

Metformin

Insulin

Front 31

How does maternal diabetes cause macrosomia?

Back 31

Hyperglycaemia causes fetal hyperinsulinaemia

Front 32

Polycythaemia in fetus caused by

Back 32

Maternal diabetes

Front 33

Management of DVT/PE in pregnancy

Back 33

LMWH

Front 34

Treatment for hypothyroid in pregnancy

Back 34

Levothyroxine

Front 35

Treatment for hyperthyroid in pregnancy

Back 35

Carbimazole/PTU

Propanolol if IUGR

Front 36

Epilepsy medication in pregnancy:
Pre-conception
During pregnancy

Back 36

Pre conception - 5mg folic acid

During - continue folic acid. Continue current medication (except phenobarbitone), Vit K from 34 weeks onwards

Front 37

Advice to epileptic mothers

Back 37

Shallow baths/unlocked doors incase of fit

Front 38

Bleeding in late pregnancy is considered after

What is the other name for this?

Back 38

24 weeks

Antepartum Haemorrhage (APH)

Front 39

Causes of antepartum haemorrhage

Back 39

Placenta previa (20%)

Placental abruption (30%)

Local causes - polpys/cancer/infection

Uterine rupture

Vasa previa (rare)

40% there is no cause

Front 40

Causes of placental abruption

Back 40

Pre-eclampsia/hypertension
Trauma

Drug abuse/smoking

Polyhydraminos/multiple pregnancy

Abnormal placenta

Front 41

Bleeding in placental abruption can be

Back 41

Concealed by location

Front 42

Signs of placental abruption

Back 42

Sudden onset pain

Blood

Large, hard uterus

Difficulty feeling fetal parts

Front 43

What is placenta previa

Back 43

Placenta is partially or fully implanted in the lower segment of the uterus

Front 44

Symptoms of placenta previa

Back 44

Painless

Recurrent bleeding through third trimester

Soft, non-tender uterus

Front 45

Diagnosis of:
Placental abruption
Placenta previa

Back 45

Clinical (CTG may be abnormal)

Ultrasound (DO NOT PERFORM VAGINAL EXAM TILL PLACENTAL PREVIA IS EXCLUDED)

Front 46

Major placental previa (up to cm near os) requires

Back 46

C-section

Front 47

Bleeding in late pregnancy history

Back 47

Pain

Blood loss
Contractions
Fetal movements
Post-coital?
Smear history

Scan History

Front 48

Criteria for antenatal admission

Back 48

Bleeding from 23-32 weeks

Recurrent bleeding after 28 weeks

Any bleeding after 32 weeks

Major placenta previa after 36 weeks with no bleeding

Front 49

When should steroids be administered for fetus

Back 49

24-48h before delivery

Front 50

When should steroids be administered up to

Back 50

36 weeksW

Front 51

What steroid is given for fetus?

Back 51

Betamethasone

Front 52

Major postpartum haemorrhage =

Back 52

>1500ml

Front 53

PPH treatment

Back 53

Uterine massage + 5 units syntocinon stat

Then 40 units syntocinon in hartmaans solutionS

Front 54

Surgical treatments for PPH

Back 54

Undersuturing

Brace sutures

Arterial ligation

Front 55

What is placenta accreta and placenta percreta?

Risk factors

Back 55

Accreta - Placenta invades myometrium

Perceta - Placenta invades serosa

Placenta previa and previous cesarean section

Front 56

Trend of blood pressure in pregnancy

Back 56

Vasodilitation and fall in BP up to 22 weeks
Levels off at 22-24 weeks
Steady rise until term

Front 57

Diagnostic criteria for hypertension in pregnancy

Back 57

>140/90 on 2 occasions

DBP >100

30/15 greater compared to booking BP

Front 58

Hypertension before 20 weeks gestation

Back 58

Probably pre-existing

Front 59

Drugs used for eclampsia

Back 59

Magnesium sulphate (anti-convulsant)

IV labetolol or hydralazine

Front 60

Methyl dopa is contraindicated in
Labetolol is contraindicated in

Back 60

Depression

Asthma

Front 61

Breastfeeding on pregnancy hypertensives

Back 61

Is okay