Obstetrics Phase 3A Stephen Lau & George Lam The Peer Teaching Society is not liable for false or misleading information…

Outline Labour Abnormal Fetal Presentations Preterm Birth Postterm Birth Puerperium NOT Multiple Pregnancy The Peer Teaching Society is not liable for false or misleading information…

Labour G1P0 34+2/40 26 year old woman is experiencing contractions. They are decreasing in frequency and intensity. List 3 Clinical Features of Labour If this is not labour, what is it? The Peer Teaching Society is not liable for false or misleading information…

Labour G1P0 34+2/40 26 year old woman is experiencing contractions. They are decreasing in frequency and intensity. List 3 Clinical Features of Labour If this is not labour, what is it? Braxton-Hicks Contractions The Peer Teaching Society is not liable for false or misleading information…

Labour Same woman is now 39+1/40 and experiencing regular strong contractions. What Are The 3 Stages of Labour? Describe Start/End Points of Each Name 2 Maternal and 2 Fetal Parameters to be Monitored Initially and How Frequently The Peer Teaching Society is not liable for false or misleading information…

Labour Same woman is now 39+1/40 and experiencing regular strong contractions. What Are The 3 Stages of Labour? Stage 1  Regular Contractions to Full Cervical Dilatation/Effacement Stage 2  Full Cervical Dilatation/Effacement to Delivery of Baby Stage 3  Delivery of Baby to Delivery of Placenta Name 2 Maternal and 2 Fetal Parameters to be Monitored Initially and How Frequently Maternal Obs q2h Maternal Contractions q30 min Maternal Cervix q4h Fetal HR q15 min/After Contraction Fetal Station q4h Fetal Liquor on ROM The Peer Teaching Society is not liable for false or misleading information…

Labour The Peer Teaching Society is not liable for false or misleading information…

Labour You assess the woman’s cervix to be fully effaced. What Are The 2 Phases of Stage 1 Called? What Is The Cervical Dilatation Cut-Off Between Them? The Peer Teaching Society is not liable for false or misleading information…

Labour You assess the woman’s cervix to be fully effaced. What Are The 2 Phases of Stage 1 Called? Latent Active What Is The Cervical Dilatation Cut-Off Between Them? 4 cm (…6 cm) The Peer Teaching Society is not liable for false or misleading information…

Labour The woman’s cervix is now dilated 6 cm. What is the minimum rate of cervical dilatation for nulliparous and multiparous women in the active phase? Name 1 hormone involved in cervical ripening and where it’s synthesized Name 1 hormone involved in promoting contractions and where it’s synthesized The Peer Teaching Society is not liable for false or misleading information…

Labour The woman’s cervix is now dilated 6 cm. What is the minimum rate of cervical dilatation for nulliparous and multiparous women? Nullip  1 cm/h Multip  2 cm/h Name 1 hormone involved in cervical ripening and where it’s synthesized Prostaglandins  Uterus Relaxin  Ovaries (CL) Name 1 hormone involved in promoting contractions and where it’s synthesized Prostaglandins Oxytocin  Hypothalamus (to Post. Pituitary) Estrogen  Placenta The Peer Teaching Society is not liable for false or misleading information…

Labour The woman’s cervix is now dilated 10 cm and is feeling the urge to push. How frequently do you monitor the baby’s HR now? Fill in the blanks Engagement in ___ Position Descent ? Extension Expulsion The Peer Teaching Society is not liable for false or misleading information…

Labour The woman’s cervix is now dilated 10 cm and is feeling the urge to push. How frequently do you monitor the baby’s HR now? q5 min Fill in the blanks Engagement in OT Position Descent Flexion IR  OA Position Extension ER (Restitution)  OT Position Expulsion The Peer Teaching Society is not liable for false or misleading information…

Labour The baby is delivered and the umbilical cord is clamped. What is the cut-off time before worrying about retained placenta? The Peer Teaching Society is not liable for false or misleading information…

Labour The baby is delivered and the umbilical cord is clamped. What is the cut-off time before worrying about retained placenta? 30 min The Peer Teaching Society is not liable for false or misleading information…

Labour Summary Labour Dx vs. Braxton-Hicks Stage 1  Contractions to 10 cm Dilatation Monitoring Latent Phase  4 cm Active Phase 1 cm/h (Nullip), 2 cm/h (Multip) Hormones Involved Stage 2  10 cm Dilatation to Baby Delivery Monitoring (FHR) 7-Step Process Stage 3  Baby Delivery to Placental Delivery Prolonged After 30 min The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Define & Give Example Lie Presentation Position Engagement Station The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Define Lie  Fetal Long Axis WRT Maternal Long Axis E.g.) Longitudinal, Transverse, Oblique Presentation  Fetal Part @ Lower Uterine Pole E.g.) Cephalic, Breech, Shoulder, Cord Position  Leading Fetal Part WRT Transverse Plane E.g.) Occiput (OA, OT, OP, etc.), Chin (MA, MP), Sacrum Engagement  Leading Fetal Part WRT Pelvic Inlet 0-1/5 (5/5 completely above pelvic brim) Station  Leading Fetal Part WRT Ischial Spine +5 to -5 (+5 Outwards, -5 Inwards) The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Define & Give Example Lie Presentation Position Engagement “Engaged” = Station 0 = At Ischial Spine Station The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation What is the ideal lie, presentation and position? The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation What is the ideal lie, presentation and position? Longitudinal Cephalic OA The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Woman is pregnant. On examination, wide uterus and fetal head at mother’s left flank are appreciated. Diagnosis? Investigation? 2 Things on Ix? 2 Management Options The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Woman is pregnant. On examination, wide uterus and fetal head at mother’s left flank are appreciated. Diagnosis? Transverse Lie Investigation? USS  Confirm Lie + ?Placenta Previa 2 Management Options ECV + Normal Delivery C/S The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Woman is pregnant. On examination, subcostal tenderness and presenting part is softer than expected. Diagnosis? Investigation? The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Woman is pregnant. On examination, subcostal tenderness and presenting part is softer than expected. Diagnosis? Breech Investigation? USS The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Woman is pregnant. On examination, subcostal tenderness and presenting part is softer than expected. Name 2 other types of breech presentation other than a frank breech presentation Apart from traumatic injury, what is another important complication that can occur delivering The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Woman is pregnant. On examination, subcostal tenderness and presenting part is softer than expected. Name 2 other types of breech presentation other than a frank breech presentation Frank  Flexed Thighs, Extended Legs Complete  Flexed Thighs, Flexed Legs Incomplete/Footling  Extended Thighs Apart from traumatic injury, what is another important complication that can occur delivering Cord Prolapse The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation A 30 year old G3P0+2 with PMH of DM and BMI of 35. After the head is delivered, the baby retracts backwards. Name of the sign? Diagnosis? What Is It? Management? The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation A 30 year old G3P0+2 with PMH of DM and BMI of 35. After the head is delivered, the baby retracts backwards. Name of the sign? Turtle Sign Diagnosis? Shoulder Dystocia What Is It? Anterior Shoulder Trapped Under Symphysis The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation A 30 year old G3P0+2 with PMH of DM and BMI of 35. After the head is delivered, the baby retracts backwards. Management Help Episiotomy Legs in MacRoberts (Knee to Chest) Pressure on Suprapubic Area Enter Pelvis Rotational Manoeuvres Remove Posterior Arm Roll Pt on All Fours The Peer Teaching Society is not liable for false or misleading information…

Abnormal Fetal Presentation Summary Definitions Transverse Lie Breech Presentation Shoulder Dystocia Didn’t Cover Brow/Face Presentation Didn’t Cover Malpositions (OP, OT) The Peer Teaching Society is not liable for false or misleading information…

Preterm Birth A 24 year old, G2P1 32+3/40 woman presents at A&E complaining of contractions. How can we classify prematurity? What are the clinical manifestations for preterm labour? The Peer Teaching Society is not liable for false or misleading information…

Preterm Birth A 24 year old, G2P1 32+3/40 woman presents at A&E complaining of contractions. How can we classify prematurity? Week of Pregnancy Birth Weight of the Baby What are the clinical manifestation of preterm labour? Regular, painful contractions Cervical Effacement/Dilation Backache Cervical Discharge The Peer Teaching Society is not liable for false or misleading information…

Preterm Birth Her previous pregnancy was delivered at 34 weeks. What are the risk factors for preterm birth? What is a biomarker for predicting preterm birth? The Peer Teaching Society is not liable for false or misleading information…

Preterm Birth Her previous pregnancy was delivered at 34 weeks. What are the risk factors for preterm birth? Infection Reproductive History Multifetal Gestation Lifestyle Factors Autoimmune Disease Cervical Surgery Uterine Malformations What is a biomarker for predicting preterm birth? Fetal fibronectin The Peer Teaching Society is not liable for false or misleading information…

Preterm Birth Your history and examination confirms that she is undergoing preterm labour. What medicines should now be given to the patient? The Peer Teaching Society is not liable for false or misleading information…

Preterm Birth Your history and examination confirms that she is undergoing preterm labour. What medicines should now be given to the patient? Tocolytics Calcium Channel Blockers (nifedipine) NSAIDs (indomethicin) Beta adregenic receptor antagonists (salbutamol/ritodrine) Steroids Antibiotics Magnesium Suphate The Peer Teaching Society is not liable for false or misleading information…

Postterm Birth 5% of pregnancies are delivered after term What is the upper limit of time for a pregnancy? What are the strongest risk factors for a postterm birth? The Peer Teaching Society is not liable for false or misleading information…

Postterm Birth 5% of pregnancies are delivered after term What is the upper limit of time for a pregnancy? 42+6 weeks What are the strongest risk factors for a postterm birth? Previous postterm birth Nulliparity Obesity Male Foetus Older maternal age Maternal or Paternal history of postterm birth The Peer Teaching Society is not liable for false or misleading information…

Postterm Birth A 26 year old woman, G1P0 with a 41+1 week pregnancy of a single male foetus wants have a home birth. The foetus is in a cephalic, left occiput anterior position. Will you let this woman give birth at home? Explain your answer The Peer Teaching Society is not liable for false or misleading information…

Postterm Birth Liz, 26 year old woman, G1P0 with a 41+1 week pregnancy of a single male foetus wants have a home birth. The foetus is in a cephalic, left occiput anterior position. Will you let this woman give birth at home? Explain your answer No, pregnancies past the 41st week should be induced. The Peer Teaching Society is not liable for false or misleading information…

Postterm Birth What are the dangers of a postterm pregnancy? Mother Child The Peer Teaching Society is not liable for false or misleading information…

Postterm Birth What are the dangers of a postterm pregnancy? Mother Child Postpartum Haemmorhage Macrosomia 3/4th degree perineal tears Fetal Dysmaturity Syndrome Failed Induction Perinatal Mortality The Peer Teaching Society is not liable for false or misleading information…

Postterm Birth Liz arrives at the maternity unit in hospital. How is labor iatrogenically induced? Cervical status is important for predicting success of induction. What scoring system is used for assessing cervical status? The Peer Teaching Society is not liable for false or misleading information…

Postterm Birth Liz arrives at the maternity unit in hospital. How is labor iatrogenically induced? Oxytocin IV Amniotomy PGE1/PGE2 The Peer Teaching Society is not liable for false or misleading information…

Postterm Birth 2. Cervical status is important for predicting success of induction. What scoring system is used for assessing cervical status? The Peer Teaching Society is not liable for false or misleading information…

The Puerperium What changes can you expect in the postpartum period in the following areas? Uterus Cervix Vagina/Vulva Reproductive Hormones Breasts The Peer Teaching Society is not liable for false or misleading information…

The Puerperium What changes can you expect in the postpartum period in the following areas? Uterus Uterine involution and Lochia Cervix Contraction of the cervix. External os never fully recpovers. Vagina/Vulva Contracts but not to its nulligravid size Reproductive Hormones Beta HCG returns to normal levels in 12 days. 70% menstruate by week 12 postartum Breasts Swelling of the breasts and milk production The Peer Teaching Society is not liable for false or misleading information…

The Puerperium The observations show Liz has a temperature of 38 C. Are you worried? What other routine procedures should be done for Liz after birth? The Peer Teaching Society is not liable for false or misleading information…

The Puerperium The observations show Liz has a temperature of 38 C. Are you worried? No, only after the first 24 hours. Most common is cause is infection. What other routine procedures should be done for Liz after birth? Counselling/Practical help with breastfeeding HR/BP/RR/Temp monitoring. Examine for signs of bleeding Distended bladder examination Examine for perineal damage The Peer Teaching Society is not liable for false or misleading information…

The Puerperium Liz bled a lot during the birth. The nurse tells you she bled 800mls of blood. What is the definition of primary postpartum haemorrhage in a vaginal delivery? What about after Caesarean section? What are the causes of postpartum haemorrhage? The Peer Teaching Society is not liable for false or misleading information…

The Puerperium Liz bled a lot during the birth. The nurse tells you she bled 800mls of blood. What is the definition of primary postpartum haemorrhage in a vaginal delivery? What about after Caesarean section? >500ml blood loss, >1000ml in C - Section What are the causes of postpartum haemorrhage? Retained Placenta Uterine atony Trauma to uterus and vaginal tract Clotting abnormalities The Peer Teaching Society is not liable for false or misleading information…

The Puerperium Venous thrombosis is 21 – 84x more common in women postpartum. Risk assess and treat with stockings and LMWH Urinary Retention Urinary/Fecal Incontinence. Haemorrhoids Varicose Veins Postpartum Depression – 10% of women The Peer Teaching Society is not liable for false or misleading information…