Abnormal labour Flashcards
Contents of an epidural (2)
Levobupivacaine + opiate e.g. fentanyl
Site of insertion of epidural
Between L3 and L4 vertebrae
Which ligament lies directly above, and is pierced to gain entrance to, the epidural space?
Ligamentum flavum
Complications of epidural (5)
Postural hypotension Dural puncture Headache Back pain Atonic bladder
Why is IV access needed for an epidural?
To give 500ml Hartmann solution (sodium lactate) at the outset, to help prevent hypotension
Why is Hartmann’s solution useful to correct hypovolaemia?
IV solution which is most closely isotonic with blood
Why might an epidural inhibit phase 2 of labour?
Might interfere with the woman’s desire to push
By what three criteria is the progress of labour assessed?
Cervical dilatation
Descent of the presenting part
Signs of obstruction
What is the desired rate of contraction after 3cm?
1cm/hour
When is delay suspected in stage 1?
Dilatation less than 2cm in 4 hours, or in parous women, less than 2cm in 4 hours or slowing in progress
What is the alert line on a partogram?
Line drawn illustrating 1cm/hour dilatation
When will the “action” line be intersected?
If the rate of cervical dilatation lags more than 2 hours behind expected
By what landmark is the descent of the presenting part measured?
Level of the ischial spines (0)
Uterine cause of failure to progress
Inadequate contraction frequency/strength
How might cephalopelvic disproportion occur? (2)
Macrosomia; small pelvis
In a well-flexed vertex presentation, what is the name of length of the presenting diameter?
Sub-occipitobregmatic (around 9.5)
Signs of obstruction (2)
Moulding, caput formation
How often should fetal heart doppler be carried out in a) 1st stage and b) second stage?
a) during and after contractions, for at least 1 minute every 15 minutes
b) every 5-10 minutes
Which features of the CTG should be analysed? (4)
Heart rate
Baseline variability
Accelerations
Decelerations
Normal foetal heart rate
110-160bpm
Normal baseline variability
5-25bpm
Which types of deceleration are physiological and which are indicative of foetal hypoxia?
Early decelerations are physiological. Late decelerations and variable decelerations are non-reassuring
What causes late decelerations?
Placental insufficiency
What is tocolysis? What drug can be used to achieve this?
Stops labour contractions. Terbutaline
What are the cut-off for borderline and abnormal fetal blood pH?
Borderline is 7.2-.7.25, repeat in half hour.
Abnormal is less than 7.2
Options for instrumental and operative delivery
Instrumental- forceps, Ventouse
C-section
What is the major concern in VBAC patients?
Dehiscence of the uterine scar
How long should stage 2 take in prims and multips? How is this extended for patients with epidural?
Prims- 2hours
Multips- 1 hour
Epidural extends by an hour
What are the indications for instrumental delivery?
Delay and foetal distress
Complications of ventouse (2)
Cephalohaematoma, retinal haemorrhage
What factors are included in Bishop score? (5)
Cervical position Cervical consistency Cervical effacement Cervical dilatation Foetal station
How is labour usually induced?
Intra-vaginal prostaglandin pessary (ripens the cervix) followed by
Artificial membrane rupture
If artificial membrane rupture does not stimulate labour, what drug can be given?
Syntocinon infusion (oxytocin), titrated to achieve regular contractions
What is shoulder dystocia?
Inability to deliver the anterior shoulder of the fetus due to impaction on the symphysis pubis
Complications of shoulder dystocia a) maternal b) foetal?
a) post-partum haemorrhage, perineal tears
b) brachial plexus injury, limb fractures, neonatal death due to asphyxia
Risk factors for shoulder dystocia? (3)
Macrosomia
Prolonged labour
High maternal BMI
Management of shoulder dystocia?
Call for help immediately
McRobert’s manouevre
How is McRoberts manouevre performed? (4)
Hip abduction and flexion
Suprapubic pressure
Manual rotation of foetal shoulders
(+ episiotomy)
