Abnormal Labour

Question 1

when is a baby pre-term?

Answer 1

born <37 weeks

Question 2

when is a baby post term?

Answer 2

born >42 weeks

Question 3

what is obstruction of labour?

Answer 3

when there isn’t satisfactory progress in labour

Question 4

what outlines the foetal vertex?

Answer 4

anterior fontanelle
posterior fontanelle
parietal eminences

Question 5

name three possible types of malpresentation

Answer 5

breech
transverse lie
brow/face

Question 6

what is transverse lie presentation?

Answer 6

when the baby is transverse in the uterus

arm/shoulder can prolapse through the cervix

Question 7

what can increase the risk of a transverse lie?

Answer 7

pre-term
increased amniotic fluid
uterine abnormalities

Question 8

what needs to be done if a baby presents in transverse lie?

Answer 8

c-section

Question 9

what medications can be given for pain relief in labour?

Answer 9

entonox (inhaled)
IM opiates
IV remifentanil
epidural

Question 10

what drugs are given in an epidural and give examples?

Answer 10

opiate and anaesthetic

morphine + levobupivacaine

Question 11

what are some possible complications of an epidural?

Answer 11

hypotension 
dural puncture 
headache 
high block 
atonic bladder

Question 12

what is another name for obstructed labour?

Answer 12

failure to progress

Question 13

what are some potential risks associated with obstructed labour?

Answer 13

sepsis 
uterine rupture 
AKI
PPH 
fistula formation 
foetal asphyxia

Question 14

what are some signs of obstructed labour?

Answer 14

moulding 
caput 
anuria 
Haematuria 
vulval oedema

Question 15

what is caput?

Answer 15

swelling of the foetal scalp

Question 16

when should obstructed labour be suspected in a nulliparous woman?

Answer 16

<2cm dilatation in 4 hours

Question 17

when should obstructed labour be suspected in a parous woman?

Answer 17

<2cm dilatation in 4 hours OR slowing in progress

Question 18

what are the three causes of failure to progress?

Answer 18

power = inadequate contractions

passages = problems with the pelvis

passenger = problems with the foetus i.e. too big, malpresentation

Question 19

what three things are involved in an intra-partum foetal assessment?

Answer 19

doppler auscultation of the foetal heart
CTG
amniotic fluid assessment

Question 20

what does CTG stand for?

Answer 20

cardiotocograph

Question 21

what is stage 1 of doppler auscultation of the foetal heart?

Answer 21

during and after a contraction, every 15 minutes

Question 22

what is stage 2 of doppler auscultation of the foetal heart?

Answer 22

at least every 5 minutes during and after a contraction for one minute

check maternal pulse at least every 15 minutes

Question 23

name some risk factors for foetal hypoxia

Answer 23

small foetus 
APH
hypertension
diabetes
epidural analgesia

Question 24

what should be done if any risk factors for foetal hypoxia are present?

Answer 24

continuous monitoring of the foetal heart

Question 25

name some acute causes of foetal hypoxia

Answer 25

``` abruption cord prolapse uterine rupture vasa praevia regional anaesthesia ```

Question 26

name some chronic causes of foetal hypoxia

Answer 26

placental insufficiency | foetal anaemia

Question 26

name some chronic causes of foetal hypoxia

Answer 26

placental insufficiency | foetal anaemia

Question 27

what four features need to be assessed when reviewing a CTG?

Answer 27

baseline foetal heart rate baseline variability presence/absence decelerations presence/absence accelerations

Question 28

what are the three possible classifications for a CTG trace?

Answer 28

normal suspicious pathological

Question 29

what findings on a CTG suggest foetal hypoxia is developing?

Answer 29

loss of accelerations repetitive deeper + wider decelerations rising foetal baseline heart rate loss of variablity

Question 30

what management would be done if there is an abnormal CTG?

Answer 30

``` change maternal position IV fluids scalp stimulation consider tocolysis maternal assessment consider foetal blood sampling ```

Question 31

what drug should be stopped if there is an abnormal CTG trace?

Answer 31

syntocinon

Question 32

what should be done in a maternal assessment in an abnormal CTG?

Answer 32

pulse BP abdominal exam VE

Question 33

what drug can be given for tocolysis?

Answer 33

terbutaline 250mg SC

Question 34

what does it mean if a foetuses scalp pH is >7.25 and what action needs to be taken?

Answer 34

normal no action

Question 35

what does it mean if a foetuses scalp pH is 7.20 - 7.25 and what action needs to be taken?

Answer 35

borderline repeat after 30 mns

Question 36

what does it mean if a foetuses scalp pH is <7.20 and what action needs to be taken?

Answer 36

abnormal deliver the baby