Pregnancy 2.0

What is important to establish when taking a labour history

The frequency, duration and intensity of contractions and whether labour progressed normally.

What complications are associated with persistent occiput posterior

Prolonged labour, LBP, postpartum haemorrhage, perineal trauma.

List 6 common MSK presentations in pregnancy

Pubic symphysis px
LBP
SIJ px
Thoracic/rib px
HA
Carpal tunnel

What happens to the pubic symphysis during pregnancy

Widens by 3mm, especially in 3rd trimester

Does the level of relaxin directly predict the severity of pubic symphysis symptoms

No.

How can pubic symphysis dysfunction present

Burning, shooting, grinding or stabbing px in the pubis

Where can pubic symphysis dysfunction present

Low back, abdomen, groin and legs.

Why can thoracic and rib pain occur during pregnancy

Anteroposterior diameter of the rib cage increases as pregancy progresses altering mechanics.

What is important when assessing a headache during pregnancy

Preeclampsia must be ruled out before assuming it is a primary HA.

Why can pregnancy cause carpal tunnel syndrome

Fluid retention reduces the available space within the carpal tunnel.

What conservative management can help pregnancy-related carpal tunnel syndrome

Night splinting and managing upper limb fluid dynamics.

How does pregnancy-related rib pain typically change throughout the day?

It may be worse in an upright position, improve when lying down and worsen throughout the day

What are the three main stages of labour
First stage:
Second stage:
Third stage:

Cervical effacememt and dilation from 0-10cm
Full cervical dilation to delivery of the baby
Delivery of placenta

What is the first stage of labour broken up into

Latent and active.

What happens during the latent phase of labour

Cervix begins to soften, thin and dilate to 5cm. Typically takes 9 - 12 hrs.

What happens during the active phase of labour

Cervix dilates to 10cm. Contractions become stronger, longer and more frequent. Baby’s head descends further into the pelvis.

What causes cervical dilation during labour

Uterine contractions generate preassure against the cervix. Prostaglandins promote cervical softening and remodelling.

What is the difference between foetal:
Lie:
Presentation:
Position:

Relationship between babys lo’s long axis and mothers long axis.
The part of the baby that will enter the maternal pelvis first.
The direction the presenting part faces.

Describe these breech presentations:
Frank breech:
Complete breech:
Footling breech:

Hips flexes, knees extended.
Hips and knees flexed
One or both feet present first

What is a ventouse (assissted labour delivery)

A sunction cup attached to the babys head to assist delivery with traction during contractions.

What is a forceps (assissted labour)

Surgical instrument placed around babys head.

What are some reasons for an assisted vaginal delivery

Prolonged second stage, maternal exhaustion or concerns about the babys well being.

What is the difference between induction and augmentaion of labour.
Induction:
Augmentation:

Starting labour artificially.
Strengthening or increasing contractions when labour is progressing inadequately.

What are the cardinal movements of labour:
Enagement:
Descent:
Flexion:
Internal rotation:
Extension:
External rotation:
Expulsion:

Widest transverse diamter of babys head enters the pelvic inlet.
Baby moves down through pelvis.
Babys neck flexes, presenting smaller head diameter.
Head rotates.
Head extends beneath pubic symphysis.
Head realigns with shoulders.
Shoulder and body are delivered.

List the criteria for hyperemesis gravidarum

Persisting vomiting
Acue deyhdration and starvation
Weight loss of over 5% total body mass
A clinical DD of exclusion

Why does epigastric px in Preeclampsia signal severe progression of the disease.

Reflects end-organ damage and HELLP syndrome. Preeclampsia is a disease of endothelial dysfunction and widespread vasospasm. This causes hepatic ischemia, leading to tissue necrosis and hypertrophy of the liver.

Why does swelling of the liver in preeclampsia generate pain

It is enclosed in a fibrous capulse highly innervated with pain fibers.

What are the indications for an episiotomy in pregnancy

Baby’s shoulder is stuck behind the pelvic bones, has an unusual heart rate, or forceps or vacuum extraction is needed.

Describe the perineal tear grades and their duration of healing:
1st degree:

2nd:

3rd:

4th:

Perineal skin and tissue.

Skin and muscle of the perineum. Requires stitches and a few weeks to heal.

Extends into the anal sphincter. Requires surgical repair and months of recovery. Faecal incontinence & painful sex.

Extends through the anal sphincter and into the mucous membrane.

What medications can be taken and cannot be taken during pregnancy:
Can:

Can not:

NSAIDs, as they can result in heart defects.
Panadol and codeine.