Abnormal Labour Flashcards
when is a baby pre-term?
born <37 weeks
when is a baby post term?
born >42 weeks
what is obstruction of labour?
when there isn’t satisfactory progress in labour
what outlines the foetal vertex?
anterior fontanelle
posterior fontanelle
parietal eminences
name three possible types of malpresentation
breech
transverse lie
brow/face
what is transverse lie presentation?
when the baby is transverse in the uterus
arm/shoulder can prolapse through the cervix
what can increase the risk of a transverse lie?
pre-term
increased amniotic fluid
uterine abnormalities
what needs to be done if a baby presents in transverse lie?
c-section
what medications can be given for pain relief in labour?
entonox (inhaled)
IM opiates
IV remifentanil
epidural
what drugs are given in an epidural and give examples?
opiate and anaesthetic
morphine + levobupivacaine
what are some possible complications of an epidural?
hypotension dural puncture headache high block atonic bladder
what is another name for obstructed labour?
failure to progress
what are some potential risks associated with obstructed labour?
sepsis uterine rupture AKI PPH fistula formation foetal asphyxia
what are some signs of obstructed labour?
moulding caput anuria Haematuria vulval oedema
what is caput?
swelling of the foetal scalp
when should obstructed labour be suspected in a nulliparous woman?
<2cm dilatation in 4 hours
when should obstructed labour be suspected in a parous woman?
<2cm dilatation in 4 hours OR slowing in progress
what are the three causes of failure to progress?
power = inadequate contractions
passages = problems with the pelvis
passenger = problems with the foetus i.e. too big, malpresentation
what three things are involved in an intra-partum foetal assessment?
doppler auscultation of the foetal heart
CTG
amniotic fluid assessment
what does CTG stand for?
cardiotocograph
what is stage 1 of doppler auscultation of the foetal heart?
during and after a contraction, every 15 minutes
what is stage 2 of doppler auscultation of the foetal heart?
at least every 5 minutes during and after a contraction for one minute
check maternal pulse at least every 15 minutes
name some risk factors for foetal hypoxia
small foetus APH hypertension diabetes epidural analgesia
what should be done if any risk factors for foetal hypoxia are present?
continuous monitoring of the foetal heart
name some acute causes of foetal hypoxia
abruption cord prolapse uterine rupture vasa praevia regional anaesthesia
name some chronic causes of foetal hypoxia
placental insufficiency
foetal anaemia
name some chronic causes of foetal hypoxia
placental insufficiency
foetal anaemia
what four features need to be assessed when reviewing a CTG?
baseline foetal heart rate
baseline variability
presence/absence decelerations
presence/absence accelerations
what are the three possible classifications for a CTG trace?
normal
suspicious
pathological
what findings on a CTG suggest foetal hypoxia is developing?
loss of accelerations
repetitive deeper + wider decelerations
rising foetal baseline heart rate
loss of variablity
what management would be done if there is an abnormal CTG?
change maternal position IV fluids scalp stimulation consider tocolysis maternal assessment consider foetal blood sampling
what drug should be stopped if there is an abnormal CTG trace?
syntocinon
what should be done in a maternal assessment in an abnormal CTG?
pulse
BP
abdominal exam
VE
what drug can be given for tocolysis?
terbutaline 250mg SC
what does it mean if a foetuses scalp pH is >7.25 and what action needs to be taken?
normal
no action
what does it mean if a foetuses scalp pH is 7.20 - 7.25 and what action needs to be taken?
borderline
repeat after 30 mns
what does it mean if a foetuses scalp pH is <7.20 and what action needs to be taken?
abnormal
deliver the baby
