abnormal labour Flashcards
what does reduced fetal movements indicated
fetal distress + hypoxia
what is considered reduced fetal movements
<10 movements within 2 hours
when should fetl movements be established
24 weeks
risk factor reduced fetal movements
posture // distracted // anterior placenta or fetus // alcohol, opiates, benzos // obese // oligo or poly hydramnios // SGA
invx reduced fetal movements
doppler –> USS
invx reduced fetal movement >28 weeks
doppler, if no HB –> USS (+ abdo circumference + amniotic fluid volume)
invx reduced fetal movement 24-28 weeks
handheld doppler
invx reduced fetal movement <24 weeks
if movements felt previously –> doppler // if no movements previously –> refer
normal fetal pH bloods
from scalp // should be ph > 7.25
complications of preterm prelabour ROM
premature, infection, pulm hypoplasia // chorioamnionitis
invx PPROM
speculum –> amniotic fluid in posterior vagina // if no pooling –> test fluid for PAMG1 or IGF P1 // USS
mx PPROM
admit + oral erythro 10 days + steroids
when should PPROM be delivered
34 weeks
what is failure to progress in the 1st stage
> 3-8 hours to get to 4cm
what is primary arrest of the 1st stage
<2cm after 4 hours
what is failure to progress in second stage
nullparous - >2 hours or >3 epidural // multiparous - >1 hours or >2 epidural
causes failure to progress
big head // feotal distress // uterine rupture // obstruction // malpresentation
symptoms obstruction in labour
vulva oedema // moulding // anuria // haematuria // caput
types of malpresentation
breech // brow (worst) // face // transverse
types of breech
complete = baby legs crossed // footing = 1 foot down // frank = bum first with legs at head
RF breech
uterus malformation eg fibroids // placenta praevia // poly or oligo hydramnios // fetal abnormality // premature
mx breech
<36 wks = wait // 36 (np)-37 (mp) weeks = external cephalic version // term = c section usually
contraindications external cephalic version
C section required // APH within 7 days // abnormal CTG // uterine anomaly // ruptured membrane // multiple pregnancy
methods of operative vaginal delivery
vacuum or forceps
indication operative vaginal delivery
fetal or maternal distress second stage // failure to progress second stage (epidural) // control head in breech
requirement for forceps
fully dilated
complications ventouse or forceps
Failure, cephalohaeatoma, retinal haemorrhage, maternal worry
injury to baby head after delivery
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)
indications c section
cephalopelvic disproportion (eg transverse) // placenta praevia grade 3-4 // pre-eclampsia // post dates // IUGR // detal distress // cord prolapse // failure to progress // herpes // cervical cancer
category of C section
cat 1 = emergency // cat 2 = emergency not life threatening // cat 3 = stable but urgent // cat 4 = elective
causes cat 1 C secition
uterine rupture // placental abruption // cord prolapse // fetal hypoxia or bradycardia
time from for cat 1 c section
within 30 mins
time from for cat 2 c section
75 minutes
when is vaginal birth ok after C section
> 37 weeks with single previous C section
contraindications vaginal birth after C section
previous uterine rupture or classic C section (longitudinal)
what is umbilical cord prolapse
cord descending ahead of presenting part of fetus
RF cord prolapse
premature // multiparous // polyhydramnios // twins // cephalopelvic disproportion eg breech, transverse
commonest cause cord prolapse
ARM
complication cord prolapse
cord compression or spasm –> hypoxia + death
mx cord prolapse pre delivery
push fetus back in // if cord past introtois do not touch // get women on all 4s // tocolytics // fill bladder
delivery cord prolapse
c section // maybe vaginal if fully dilates and head is low
RF shoulder dystocia
macrosomnia // BMI // DM // prolonged labour
mx for shoulder dystocia
McRoberts (bring mum thigh to abdomen) // epsiotomy
complication shoulder dystocia
PPH, tear // brachial plexus injury, neonatal death
when is episiotomy indicated
after crowning to protect anal sphincter
