EHPLE Midwifery flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Naegele's rule

Estimated due date calculation: add 280 days (9 months and 7 days) to the first day of the last menstrual period, adjusting for cycle length by adding cycle length minus 28 days.

Fundal height rule

From 20 to 36 weeks, fundal height in centimetres roughly equals gestational age in weeks; a measurement 3 cm or more below dates prompts ultrasound assessment.

Physiological anaemia of pregnancy

Plasma volume rises 40-50% while red cell mass increases less, diluting haemoglobin; this is normal and haemoglobin values in pregnancy are interpreted against pregnancy-specific ranges.

Hyperemesis gravidarum

Severe persistent pregnancy vomiting with weight loss over 5%, dehydration and electrolyte disturbance; management is intravenous fluids, antiemetics and correction of ketosis, often as an inpatient.

Anti-D prophylaxis timing

Rhesus-negative unsensitised women receive anti-D at around 28 weeks and within 72 hours of birth of a Rh-positive infant, plus after sensitising events such as amniocentesis or bleeding.

Active first stage of labour

The period from 5 cm cervical dilatation until full dilatation, with regular painful contractions; progress slower than 0.5 cm per hour over 4 hours warrants reassessment.

Normal CTG baseline

A baseline fetal heart rate between 110 and 160 beats per minute with variability of 5-25 bpm and no concerning decelerations; this is classified as normal.

Late decelerations

Decelerations that begin after the peak of a contraction and return after it ends, indicating uteroplacental insufficiency; they require repositioning, stopping oxytocin and urgent review.

Sinusoidal CTG pattern

A smooth undulating baseline of 5-15 bpm without accelerations, associated with fetal anaemia; it is abnormal and requires urgent escalation and further investigation.

Prolonged deceleration definition

A deceleration lasting more than 3 minutes; if it lasts more than 15 minutes it is reclassified as a baseline change and requires emergency obstetric review.

Third stage of labour

The interval from birth of the baby to expulsion of the placenta; active management includes a prophylactic uterotonic, controlled cord traction and assessment of uterine tone.

Primary postpartum haemorrhage

Blood loss of 500 mL or more within 24 hours of birth, or 1000 mL or more after caesarean birth; management includes uterine massage, uterotonics, tranexamic acid and resuscitation.

Lochia stages

Lochia rubra is red for days 1-4, serosa pink-brown for days 4-10, and alba white-yellow up to 4-6 weeks; offensive odour or fever suggests infection.

Uterine involution

The fundus is at the umbilicus after birth, descends roughly 1 cm daily, and becomes impalpable abdominally by 10-14 days postpartum; failure suggests infection or retained tissue.

Mastitis management

A tender red breast with fever and flu-like symptoms is treated with continued milk removal and antibiotics such as flucloxacillin; breastfeeding from the affected breast may continue.

Apgar score components

Five components scored 0-2 each at 1 and 5 minutes: appearance, pulse, grimace, activity and respiration; the score reflects condition and response to resuscitation.

Newborn resuscitation sequence

Dry and stimulate, assess tone, breathing and heart rate, open the airway, give five inflation breaths if not breathing, then ventilate if heart rate stays below 100.

Newborn compression ratio

Chest compressions are started when the heart rate is below 60 bpm despite effective ventilation, using a 3:1 compression-to-ventilation ratio at 120 events per minute.

Newborn bloodspot timing

Screening is taken on day 5, acceptable from day 5 to day 8, and covers congenital hypothyroidism, phenylketonuria, cystic fibrosis, sickle cell disease and some metabolic disorders.

Vitamin K prophylaxis

All newborns are offered vitamin K to prevent vitamin K deficiency bleeding: 1 mg intramuscularly for term infants, or an oral three-dose regimen.

Pre-eclampsia diagnostic criteria

New hypertension of 140/90 mmHg or above after 20 weeks with proteinuria or maternal organ dysfunction; severe features include 160/110 or above and symptoms.

Magnesium sulfate toxicity signs

Loss of deep tendon reflexes, respiratory depression and reduced urine output indicate toxicity; stop the infusion and give calcium gluconate 10% as the antidote.

Placenta praevia presentation

Painless bright-red vaginal bleeding in later pregnancy with a soft uterus; the placenta lies over or near the cervical os and vaginal examination is avoided until the diagnosis is excluded.

Shoulder dystocia manoeuvres

Call for help, perform McRoberts manoeuvre with suprapubic pressure, then internal manoeuvres such as Rubin II, Wood's screw or delivery of the posterior arm; never use fundal pressure.

Cord prolapse management

Call for emergency help, elevate the presenting part, position the woman knee-chest or Trendelenburg, and prepare for immediate birth, often by caesarean.

Ergometrine contraindications

Ergometrine is avoided in hypertension, pre-eclampsia and heart disease because it causes vasoconstriction; it is given only after the baby is born.

Tranexamic acid in PPH

A 1 g intravenous dose given within 3 hours of birth reduces mortality in postpartum haemorrhage; it complements but does not replace uterotonics and surgical measures.

Carboprost contraindication

Carboprost, a prostaglandin F2-alpha analogue used for postpartum haemorrhage, is contraindicated in asthma because it can cause bronchospasm.

Codeine while breastfeeding

Codeine is avoided in breastfeeding because ultrarapid metabolisers convert it to high morphine levels, risking infant sedation and respiratory depression.

Valid consent requirements

Consent requires capacity, sufficient information and voluntariness; a competent pregnant woman can refuse any intervention, including caesarean birth, even if the fetus may be harmed.

Duty of candour

When something goes wrong, professionals must be open with the woman and family, offering an apology, an explanation of what happened and what will be done to prevent recurrence.

Emergency contraception options

Levonorgestrel 1.5 mg is licensed to 72 hours, ulipristal acetate 30 mg to 120 hours, and a copper intrauterine device can be inserted up to 5 days after unprotected sex, being most effective.