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Reproductive and sexual health > Abnormal labour > Flashcards

Abnormal labour Flashcards

1
Q

Contents of an epidural (2)

A

Levobupivacaine + opiate e.g. fentanyl

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2
Q

Site of insertion of epidural

A

Between L3 and L4 vertebrae

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3
Q

Which ligament lies directly above, and is pierced to gain entrance to, the epidural space?

A

Ligamentum flavum

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4
Q

Complications of epidural (5)

A 
Postural hypotension
Dural puncture
Headache
Back pain
Atonic bladder
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5
Q

Why is IV access needed for an epidural?

A

To give 500ml Hartmann solution (sodium lactate) at the outset, to help prevent hypotension

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6
Q

Why is Hartmann’s solution useful to correct hypovolaemia?

A

IV solution which is most closely isotonic with blood

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7
Q

Why might an epidural inhibit phase 2 of labour?

A

Might interfere with the woman’s desire to push

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8
Q

By what three criteria is the progress of labour assessed?

A

Cervical dilatation
Descent of the presenting part
Signs of obstruction

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9
Q

What is the desired rate of contraction after 3cm?

A

1cm/hour

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10
Q

When is delay suspected in stage 1?

A

Dilatation less than 2cm in 4 hours, or in parous women, less than 2cm in 4 hours or slowing in progress

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11
Q

What is the alert line on a partogram?

A

Line drawn illustrating 1cm/hour dilatation

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12
Q

When will the “action” line be intersected?

A

If the rate of cervical dilatation lags more than 2 hours behind expected

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13
Q

By what landmark is the descent of the presenting part measured?

A

Level of the ischial spines (0)

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14
Q

Uterine cause of failure to progress

A

Inadequate contraction frequency/strength

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15
Q

How might cephalopelvic disproportion occur? (2)

A

Macrosomia; small pelvis

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16
Q

In a well-flexed vertex presentation, what is the name of length of the presenting diameter?

A

Sub-occipitobregmatic (around 9.5)

17
Q

Signs of obstruction (2)

A

Moulding, caput formation

18
Q

How often should fetal heart doppler be carried out in a) 1st stage and b) second stage?

A

a) during and after contractions, for at least 1 minute every 15 minutes
b) every 5-10 minutes

19
Q

Which features of the CTG should be analysed? (4)

A

Heart rate
Baseline variability
Accelerations
Decelerations

20
Q

Normal foetal heart rate

A

110-160bpm

21
Q

Normal baseline variability

A

5-25bpm

22
Q

Which types of deceleration are physiological and which are indicative of foetal hypoxia?

A

Early decelerations are physiological. Late decelerations and variable decelerations are non-reassuring

23
Q

What causes late decelerations?

A

Placental insufficiency

24
Q

What is tocolysis? What drug can be used to achieve this?

A

Stops labour contractions. Terbutaline

25
Q

What are the cut-off for borderline and abnormal fetal blood pH?

A

Borderline is 7.2-.7.25, repeat in half hour.

Abnormal is less than 7.2

26
Q

Options for instrumental and operative delivery

A

Instrumental- forceps, Ventouse

C-section

27
Q

What is the major concern in VBAC patients?

A

Dehiscence of the uterine scar

28
Q

How long should stage 2 take in prims and multips? How is this extended for patients with epidural?

A

Prims- 2hours
Multips- 1 hour
Epidural extends by an hour

29
Q

What are the indications for instrumental delivery?

A

Delay and foetal distress

30
Q

Complications of ventouse (2)

A

Cephalohaematoma, retinal haemorrhage

31
Q

What factors are included in Bishop score? (5)

A 
Cervical position
Cervical consistency
Cervical effacement
Cervical dilatation
Foetal station
32
Q

How is labour usually induced?

A

Intra-vaginal prostaglandin pessary (ripens the cervix) followed by
Artificial membrane rupture

33
Q

If artificial membrane rupture does not stimulate labour, what drug can be given?

A

Syntocinon infusion (oxytocin), titrated to achieve regular contractions

34
Q

What is shoulder dystocia?

A

Inability to deliver the anterior shoulder of the fetus due to impaction on the symphysis pubis

35
Q

Complications of shoulder dystocia a) maternal b) foetal?

A

a) post-partum haemorrhage, perineal tears

b) brachial plexus injury, limb fractures, neonatal death due to asphyxia

36
Q

Risk factors for shoulder dystocia? (3)

A

Macrosomia
Prolonged labour
High maternal BMI

37
Q

Management of shoulder dystocia?

A

Call for help immediately

McRobert’s manouevre

38
Q

How is McRoberts manouevre performed? (4)

A

Hip abduction and flexion
Suprapubic pressure
Manual rotation of foetal shoulders
(+ episiotomy)

Reproductive and sexual health (65 decks)

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