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Reproduction & Sexual Health > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

What is the vertex?

A

Part of the baby’s head bounded by the anterior and posterior fontanelles and the parietal eminences

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2
Q

What percentage of babies are breech?

A

25% at 28 weeks

3-4% at term

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3
Q

Name the three types of breech

A
  • Frank (legs up around head)
  • Footling (one or both feet point down)
  • Complete (legs folded at baby’s bottom)
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4
Q

Other than breech what other types of malpresentation are there

A

Transverse
Shoulder/arm
Face (hyperextension)
Brow (forehead first)

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5
Q

State the risk factors for breech presentation

A 
Preterm 
Praevia 
Twins 
Polyhydramios 
Oligohydramios
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6
Q

Name three management options for a breech baby

A
  • external cephalic version
  • planned vaginal birth
  • c-section
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7
Q

What are the risk of a planned vaginal birth in a breech baby?

A

Hypoxia/death
Head entrapment
Cord Prolapse

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8
Q

Describe the external cephalic version

A

Use gas and air, monitor foetal heart with CTG
Lift the baby’s bum and encourage the head to move
50% success rate, risk of 1 in 800 of causing distress
After 37 weeks it is much harder

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9
Q

What are the side effects of an epidural?

A 
Hypotension (fluid given beforehand) 
Dural puncture and CSF leak 
Headache 
High block 
Atonic bladder - may require catheterisation
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10
Q

State the risk of obstructed labour

A

Sepsis - ascending infection
Uterine rupture - previous c-section, multiparous
AKI - obstruction of ureters
PPH - long labour can cause atonic PPH
Fistual formation - local necrosis and disintegration
Fetal asphyxia
neonatal sepsis

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11
Q

What is classed as failure to progress?

A

<2cm/4 hours or slowing progress

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12
Q

In terms of the 3Ps what can cause failure of progress?

A

Power - inadequate contractions
Passage - short stature, trauma, shape (rickets)
Passenger - big baby and malposition

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13
Q

What is a partogram?

A

Graphic representation of the progress of labour

  • foetal heart
  • amniotic fluid
  • cervical dilatation
  • descent
  • contractions
  • obstruction
  • maternal observations
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14
Q

State the signs of obstruction

A 
Moulding 
Caput 
Anuria 
Haematuria 
Vulval oedema
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15
Q

Describe the largest diameter of the pelvic inlet and outlet

A

Inlet - transverse bigger
Mid-cavity - equal
Outlet - AP bigger

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16
Q

What is the commonest cause of slow progression?

A

Occipito-posterior presentation

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17
Q

When should a doppler auscultation be used in labour?

A

Stage 1 - during and after contraction, every 15 minutes

Stage 2 - at least every 5 minutes during and after for 1 minute and check maternal pulse every 15 minutes

18
Q

State the risk factors for fetal hypoxia

A
  • Small
  • Preterm (sepsis)
  • Post dates
  • Antepartum haemorrhage
  • Hypertension
  • Diabetes
  • Meconium (signs of distress)
  • Epidural (placenta blood supply may be compromised)
  • VBAC
  • PROM >24 hours
  • Sepsis
  • IOL
19
Q

State the acute causes of fetal hypoxia

A 
Uterine hyperstimulation 
Abruption 
Cord prolapse 
Uterine rupture 
Haemorrhage 
Anaesthesia 
Vasa praevia
20
Q

State the chronic causes of fetal hypoxia

A 
Placental insufficiency 
Fetal anaemia (rhesus or haemorrhage)
21
Q

What features can be seen on a CTG?

A 
Contractions 
Baseline heart rate 
Decelerations (dips)
Accelerations (peaks) 
Variability (5-25 bpm)
22
Q

What is the normal baseline heart rate?

A

110-150bpm

23
Q

Define accelerations

A

15 beats above baseline for at least 15 seconds - normal, associated with activity

24
Q

Define decelerations and name the three types

A

15 beats below the baseline for at least 15 seconds

  • early
  • variable
  • late
25
Q

What are early decelerations?

A

Increased vagal tone, common during labour and are physiological with contractions

26
Q

What are late decelerations?

A

Onset is after the peak of contraction, suggests reduced placental perfusion and hypoxia

27
Q

What are variable decelerations?

A

Common and are associated with cord compression, represents compensatory change due to baroreceptors

28
Q

How does hypoxia look on CTG?

A
  • loss of accelerations
  • repetitive deeper and wider decelerations
  • rising baseline
  • loss of variability
29
Q

What is the pneumonic for assessing CTG?

A 
DR BRAVADO 
Determine 
Risks 
Baseline 
R
Ate 
Variability 
Accelerations 
Decelerations 
Overall impression
30
Q

How can suspected fetal hypoxia be managed?

A 
Change maternal position 
IV Fluids 
Stop snytocin 
Scalp stimulation should cause an acceleration 
Terbulaine - slows contractions 
Maternal assessment 
Surgical/instrumental delivery
31
Q

How is fetal blood sampled?

A

Capillary sample from baby’s scalp

32
Q

What do specific pH’s mean on fetal blood sampling?

A

> 7.25 - normal
7.2-7.25 - borderline, repeat in 30 mins
<7.2 metabolic acidosis - deliver

33
Q

Name two standard indications for instrumental delivery

A

Delay (failure to progress stage 2)

Fetal monitoring concern

34
Q

What are the ‘special’ indications for instrumental delivery?

A

Maternal cardiac disease
Severe PET/eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse

35
Q

How long should stage 2 last?

A

Prims - 2 hours, 3 hours with epidural

Multi - 1 hour, 2 hours with epidural

36
Q

What percentage of women have a C section?

A

30%

37
Q

At what gestational age should a C-section be carried out?

A

39 weeks - lower risk of ADHD and autism

38
Q

What are the indications for c-section?

A
  • previous c section
  • fetal distress
  • failure to progress in labour
  • breech presentation
  • maternal request
39
Q

What are the morbidities associated with C section?

A

4 times greater than SVD

Sepsis, haemorrhage, VTE, trauma, TTN, sub fertility, complications in future, cut to baby

40
Q

What is given to all women before a c-section and why?

A

PPI - ranitidine to reduce risk of aspiration

41
Q

What blood tests are done prior to a c-section?

A

Hb, G and S, ABO, clotting factors (low platelets/PET)

Reproduction & Sexual Health (36 decks)

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