Abnormal Labour

Question 1

What are the pros and cons of an epidural?

What drugs are used?

What are the potential complications?

Answer 1

• Effective - complete pain relief in 95%
• Does not impair uterine activity
• May inhibit progress during stage 2
• Levobupivacaine +/- Opiate
• Complications:

Hypotension (20%)

Dural puncture (1%)

Headache

Back pain

Atonic bladder (40%)

Question 2

during stage 1 what would constitute “Failure to Progress” with regards to dilatation?

Answer 2

<2cm in 4 hours

Question 3

In a CTG what should be the normal baseline rate?

Answer 3

110-150

Question 4

In a CTG what should be the normal variablility?

Answer 4

5-25

Question 5

what are the different types of decellerations?

Answer 5

Early- same time as uterine contractions

Late- following uterine contractions

Variable- uncomplicated and complicated (drop by over 60bpm or last over 60 seconds)

Question 6

give baseline heart rates for normal/non-reassuring/ abnormal

Answer 6

100-160

161-180

<100, >180

Question 7

give variabilty for normal/non-reassuring/ abnormal

Answer 7

5-30

<5 for 30-90 minutes

<5 for 90 minutes

Question 8

when do decelarations becom abnormal

Answer 8

when they last for more than 30 minutes despite conservative management

or single prolonged decelarartion for more than 3 minutes

Question 9

management of foetal distress

Answer 9

Change maternal position

IV Fluids

Stop syntocinon

Scalp stimulation

Consider tocolysis - Terbutaline 250 micrograms s/c

Maternal assessment - Pulse / BP / Abdomen / VE

Fetal blood sampling

Operative Delivery

Question 10

what are the different ranges of foetal blood?

Answer 10