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Reproduction Week 4 2018/19 > 7: Abnormal labour > Flashcards

7: Abnormal labour Flashcards

1
Q

In general terms, what can go wrong in the course of labour?

A

Too early

Too late

Too quick - hyperstimulation

Too slow - failure to progress

Too painful

Malpresentation and/or malposition

Foetal distress

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2
Q

What percentage of women have a normal vaginal delivery?

A

60%

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3
Q

What percentage of women have a forceps delivery?

A

15%

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4
Q

What percentage of women have Caesarean sections?

A

25%

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5
Q

What is malpresentation?

A

A non-vertex delivery

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6
Q

What is the vertex?

A

Space between the anterior/posterior fontanelles and parietal eminences

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7
Q

What is malposition?

A

Non occipito-anterior position

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8
Q

What is the definition of pre-term labour?

A

< 37 weeks

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9
Q

What is the definition of post-term delivery?

A

> 42 weeks

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10
Q

Beyond 42 weeks, the risk of what increases exponentially?

A

Stillbirth

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11
Q

What is a Category 1 Caesarean section?

A

C section within 30 minutes of diagnosis

Everyone is bleeped to come and help

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12
Q

In which malpresentation does the baby’s feet emerge first?

A

Breech

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13
Q

What is the risk of a breech birth?

How can this be avoided?

A

Head gets stuck –> foetal hypoxia

Caesarean section

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14
Q

Apart from breech, what are some other types of malpresentation?

A

Transverse

Shoulder / Arm

Face

Brow

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15
Q

Which terms are used to describe the position of face presentations?

A

Mento-anterior

Mento-posterior

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16
Q

Which analgesia is used in obstetric emergencies?

A

Spinal or general anaesthetic

because they’re quickest acting - spinal is ideal

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17
Q

In general terms, what does failure to progress mean?

A

Baby isn’t coming out

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18
Q

If the cervix dilates less than ___ in 4 hours, there is failure to progress

A

< 2cm in 4hrs

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19
Q

What is the station of a baby?

A

Position of lowest bit of presenting part compared to ISCHIAL SPINES

negative numbers - above spines - not engaged - bad

positive numbers - below spines - good

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20
Q

What is the name of the synthetic oxytocin used to stimulate uterine contractions?

A

Syntocinon

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21
Q

What tool can be used to view the course of labour?

A

Partogram

22
Q

How is fetal distress monitored?

A

Doppler ultrasound for heart rate

CTG for heart rate

Colour of amniotic fluid

23
Q

What pattern of foetal heart rate, relative to contractions, indicates foetal distress?

A

Late decelerations

Foetal heart rate decreases at the onset of a contraction (something to do with their head being compressed)

If that occurs late on in a contraction, it means that the body is reflexively trying to keep HR up due to poor oxygenation - baby is hypoxic

24
Q

What are the three Ps influencing the success of vaginal delivery?

A

Power

Passage

Passenger

25
Q

What does foetal distress mean?

A

Foetal hypoxia

characteristic CTG patterns

26
Q

What conditions cause foetal distress?

A

Placental abruption

Cord prolapse

Uterine rupture

Antepartum haemorrhage

Foetal anaemia

27
Q

Are early decelerations on CTG normal?

A

Yes

Baby’s head squashed by uterus during contractions causing vagal bradycardia

28
Q

Are late decelerations on CTG normal?

A

No

Indicates foetal hypoxia, because the body is reflexively trying to keep foetal HR up for as long as possible

29
Q

What is the mnemonic used for interpreting CTGs?

A

DR C BRAVADO

30
Q

What does DR C BRAVADO stand for in terms of CTGs?

A

DR - determine risk

C - contractions

BRA - baseline rate

V - variability

A - accelerations

D - decelerations

O - overall impression

31
Q

What is CTG?

A

Cardiotocography

Measurement of foetal heart rate AND uterine contractions, allowing you to compare them

32
Q

How do you determine the risk of a patient before looking at their CTG?

A

From history

33
Q

The ___ and ___ of contractions increase during the course of labour.

A

number and duration of contractions

34
Q

What is a normal foetal heart rate?

A

120 - 160bpm

faster than adults

35
Q

Is increase in foetal heart rate on examination normal?

A

Yes

Normal sympathetic response

It’s an example of variability, which is a reassuring sign on CTG

36
Q

What is variability in terms of a CTG?

A

Fluctuations in foetal heart rate

Normal and desired, given they’re not too extreme

37
Q

(Accelerations / decelerations) on a CTG are normal.

A

accelerations are normal

38
Q

What kind of decelerations are benign on a CTG?

A

Early decelerations

Mixed decelerations

39
Q

What kind of decelerations are a sign of foetal distress?

A

Late decelerations

40
Q

What maternal measurements should you do in suspected foetal distress?

A

BP

HR

41
Q

Where can you take blood from to determine if a foetus is hypoxic?

A

Scalp capillaries via vaginal exam

Umbilical cord on delivery

42
Q

What are two tools used in assisted vaginal delivery?

A

Forceps

Ventouse suction

43
Q

Say there is failure to progress in pregnancy (without epidural anaesthesia). How long would you try for a spontaneous vertex delivery before attempting assisted vaginal delivery in a

a) primagravida

b) multiparous woman?

A

a) 2 hours

b) 1 hour

44
Q

What type of pain relief prolongs labour?

A

Epidural anaesthesia

45
Q

Between forceps and Ventouse delivery, which is more successful?

A

Forceps

Suction cups tend to fall off

46
Q

Which placental problems are more likely in subsequent Caesarean sections?

A

Placenta accreta

Placental abruption

47
Q

What are the reversible causes of cardiac arrest?

A

FOUR Hs:

hypoxia, hypovolaemia, hyper/hypokalaemia, hypothermia

FOUR Ts:

tension pneumothorax, tamponade, thrombosis, toxins

48
Q

Which type of drug should you consider using if uterine contractions are causing foetal distress in premature labour?

A

Tocolytic drugs

e.g terbutaline, they terminate contractions for up to 48h

49
Q

What are the four Ts of reversible cardiac arrest?

A

Tension pneumothorax

Cardiac tamponade

Thrombosis

Toxins

50
Q

What are the four Hs of reversible cardiac arrest?

A

Hypovolaemia

Hypoxia

Hyper/hypokalaemia

Hypothermia

51
Q

Why may a pregnant woman become shocked if she is lying on her back?

A

Compression of aorta/IVC

If a pregnant woman needs CPR, immediate C section is often lifesaving because otherwise she can’t lie flat

Reproduction Week 4 2018/19 (9 decks)

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