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FINALS - OBS, GYNAE, BREAST > abnormal labour > Flashcards

abnormal labour Flashcards

1
Q

what does reduced fetal movements indicated

A

fetal distress + hypoxia

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2
Q

what is considered reduced fetal movements

A

<10 movements within 2 hours

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3
Q

when should fetl movements be established

A

24 weeks

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4
Q

risk factor reduced fetal movements

A

posture // distracted // anterior placenta or fetus // alcohol, opiates, benzos // obese // oligo or poly hydramnios // SGA

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5
Q

invx reduced fetal movements

A

doppler –> USS

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6
Q

invx reduced fetal movement >28 weeks

A

doppler, if no HB –> USS (+ abdo circumference + amniotic fluid volume)

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7
Q

invx reduced fetal movement 24-28 weeks

A

handheld doppler

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8
Q

invx reduced fetal movement <24 weeks

A

if movements felt previously –> doppler // if no movements previously –> refer

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9
Q

normal fetal pH bloods

A

from scalp // should be ph > 7.25

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10
Q

complications of preterm prelabour ROM

A

premature, infection, pulm hypoplasia // chorioamnionitis

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11
Q

invx PPROM

A

speculum –> amniotic fluid in posterior vagina // if no pooling –> test fluid for PAMG1 or IGF P1 // USS

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12
Q

mx PPROM

A

admit + oral erythro 10 days + steroids

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13
Q

when should PPROM be delivered

A

34 weeks

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14
Q

what is failure to progress in the 1st stage

A

> 3-8 hours to get to 4cm

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15
Q

what is primary arrest of the 1st stage

A

<2cm after 4 hours

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16
Q

what is failure to progress in second stage

A

nullparous - >2 hours or >3 epidural // multiparous - >1 hours or >2 epidural

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17
Q

causes failure to progress

A

big head // feotal distress // uterine rupture // obstruction // malpresentation

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18
Q

symptoms obstruction in labour

A

vulva oedema // moulding // anuria // haematuria // caput

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19
Q

types of malpresentation

A

breech // brow (worst) // face // transverse

20
Q

types of breech

A

complete = baby legs crossed // footing = 1 foot down // frank = bum first with legs at head

21
Q

RF breech

A

uterus malformation eg fibroids // placenta praevia // poly or oligo hydramnios // fetal abnormality // premature

22
Q

mx breech

A

<36 wks = wait // 36 (np)-37 (mp) weeks = external cephalic version // term = c section usually

23
Q

contraindications external cephalic version

A

C section required // APH within 7 days // abnormal CTG // uterine anomaly // ruptured membrane // multiple pregnancy

24
Q

methods of operative vaginal delivery

A

vacuum or forceps

25
Q

indication operative vaginal delivery

A

fetal or maternal distress second stage // failure to progress second stage (epidural) // control head in breech

26
Q

requirement for forceps

A

fully dilated

27
Q

complications ventouse or forceps

A

Failure, cephalohaeatoma, retinal haemorrhage, maternal worry

28
Q

injury to baby head after delivery

A

Caput succedaneum (soft swelling on presenting part, crosses sutures, resolves in days) // Cephalohematoma (haemorrhage from instruments, does not cross suture, jaundice, months) // chignon (swelling after ventouse)

29
Q

indications c section

A

cephalopelvic disproportion (eg transverse) // placenta praevia grade 3-4 // pre-eclampsia // post dates // IUGR // detal distress // cord prolapse // failure to progress // herpes // cervical cancer

30
Q

category of C section

A

cat 1 = emergency // cat 2 = emergency not life threatening // cat 3 = stable but urgent // cat 4 = elective

31
Q

causes cat 1 C secition

A

uterine rupture // placental abruption // cord prolapse // fetal hypoxia or bradycardia

32
Q

time from for cat 1 c section

A

within 30 mins

33
Q

time from for cat 2 c section

A

75 minutes

34
Q

when is vaginal birth ok after C section

A

> 37 weeks with single previous C section

35
Q

contraindications vaginal birth after C section

A

previous uterine rupture or classic C section (longitudinal)

36
Q

what is umbilical cord prolapse

A

cord descending ahead of presenting part of fetus

37
Q

RF cord prolapse

A

premature // multiparous // polyhydramnios // twins // cephalopelvic disproportion eg breech, transverse

38
Q

commonest cause cord prolapse

A

ARM

39
Q

complication cord prolapse

A

cord compression or spasm –> hypoxia + death

40
Q

mx cord prolapse pre delivery

A

push fetus back in // if cord past introtois do not touch // get women on all 4s // tocolytics // fill bladder

41
Q

delivery cord prolapse

A

c section // maybe vaginal if fully dilates and head is low

42
Q

RF shoulder dystocia

A

macrosomnia // BMI // DM // prolonged labour

43
Q

mx for shoulder dystocia

A

McRoberts (bring mum thigh to abdomen) // epsiotomy

44
Q

complication shoulder dystocia

A

PPH, tear // brachial plexus injury, neonatal death

45
Q

when is episiotomy indicated

A

after crowning to protect anal sphincter

FINALS - OBS, GYNAE, BREAST (27 decks)

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