Abnormal Labour Flashcards
What does presentation mean?
Part of foetus overlying maternal pelvic inlet
Vertix?
Area of foetal skull outlined by the anterior and posterior fontanelles and parietal eminences
Breech Presnetation is generally safest delivered by?
C section
Transverse or shoudler/arm presnetation delivery?
NOT vaginal
High risk of sever sepsis as uterus will keep contracting and then it will rupture and = death
If vaginal is attempted
Position of the foetal head is defined as?
Relationship of denominator to fixed points of maternal pelvis
Denominator of head defined as?
Most definable prominence at periphery of presenting part
Occipitoanterior position is though to be strange or normal?
Normal- back of babys head is at front
How can you tell if back of baby head is at fornt?
Anterior fontanelle looks bigger and is at back
2 exmaples of malposition?
Occipitoposterior (back of babys head at back)
Occipitotransverse (back of babys head in transverse plane)
Failure of labour to progress in stage 1?
Defined as <2cm dilation in 4 hours or slowing progress
Normal duration of 2nd stage primiparous?
a) epidural
b) No epidural
2 hours: no
3 hours: epi
Normal duration for 2nd stage of labour if multiparous?
a) Epidural
b) No epidural
1 hour: no epidural
2 hours: epidural
Failure of labour to progress is due to 3 Ps?
Powers
Passages
Passenger
Power:
Inadequate contractions in frequency and/or strength
Passages?
Short stature, trauma, shape of pelvi
Passenger?
Big baby, malosition
What does a partogram do?
Allows recognition of labour that is not progressing
Moulding menaing?
Bones overlapping so head fits through pelvis, signif moulding can be sign of cephalon-pelvic disproportion up to 2+ is normal
Caput is?
Diffuse swelling of scalp caused by presssure of scalp against dilated cervix in labour assoc with moulding
Descent of foetal head is recorded by?
Assessing at level of presenting part in cm above or below the ischial spine and marked as +1, +2, +3 below spines and -1, -2, -3 if above spine
What is liquor?
Amniotic fluid and if ruptured colour is recorded, meconium stained liquor can be sign of foetal distress
Assessment of foetal wellbeing involves?
Low risk women: dopler monitoring at intervals
High risk women: CEFM with CTG screens for foetal hypoxia
CEFM= Continuous electronic foetal monitoring
What is CTG
Cardiotocography
Pneumonic for interpreting CTG?
DR C BRAVADO
DR stands for in CTG interpretation?
Define risk
C stands for in DR C BRAVADO?
Contractions
-Peaks at bottom of trace, small nox= 1 min, CTG only demonstrates contraction frequency, not strength, expect 3-5 contractions in 10 mins in established labour
How many contractions per 10 mins in established labour o CTG?
3-5 in 10 minutes
BRA in BRAVADO of CTG interpretation?
Baseline rate foetal baseline HR should be 110-160 BPM, look at average rate over 10 mins ignoring accelerations or decelerations, tachycardia
What is tachycardia in foetu?
> 160 bpm, bradycardia is <110 bpm
V in BRAVADO?
Varaibility
Good= 5-25 bom
<5bpm= reduced variability, which can be reduced by foetal sleep state but not for longer than 40 mins
A in BRAVADO?
Accelerations
Increase in FHR by at least 15 bpm for 15s or more and assoc with foetal movement
D in BRAVADO?
Decelerations
O IN BRAVADO?
Overall impression/diagnosis
2 important things to be aware of on CTG?
Terminal bradycardia
Decelerations
What does operative vaginal delivery involve use of?
Forceps
Vacuum extraction/ventouse
Indications for opertaive vaginal delivery?
Failure to progress in 2nd stage
Foetal distress
Maternal exhaustion
Requirements for forceps delivery?
Fully dilated OA position Ruptured membranes Cephalic presentation Engaged presenting part Pain relief Sphincter
FORCEPS acronym
Main indications for C section?
Prev C section Foetal distress Failure to progress in labour Breech presentation Maternal request
Indications for induction of labour?
Prolonged pregnancy (XS of 42 weeks) Pre-eclampsia Placental insufficiency and IUGR APH Rh isoimmunization Diabetes Chronic renal disease
What allows you to determine likely outcome of induction of labour
BIshops score
What are methods of induction of labour decided by?
Whether membranes are still intact and score on cervical assessment
Examples of induction techniques?
-Stripping of membranes
-Artificial ROM
-Medical induction following artificial ROM with syntocinon
Medical induction by cervical ripening with prostaglandins
Mechanical cervical ripening using balloon catheter
Types of pain management in labour?
Narcotic analgesia Inhalation analgesia Epidural analgesia Pudendal nerve block Spinal anaesthesia General anaesthesia
Examples of narcotic anaglesia?
Pethidine and morphine
-Helpful if unsuitable for regional analgesia
What can narcotic analgesia cause?
Foetal resp depression
Examples of inhalational analgesia?
Etonox (AKA gas and air)
Often in early labour but sometimes inadequate
Epidural analgesia gives how much pain relief?
Usually complete pain relief
When can epidural be commenced?
Established Labour usually
SE of epidural?
Can cause abnormal foetal HR Risk of Hypotension in mum Accidental dural puncture risk Postdural headache Atonic bladder High block can cause resp depression in mother
What is pudendal nerve block often used for?
Operative vaginal delivery
Spinal anaesthesia used for?
Operative delivery
General anaesthesia used for?
Emergency
