Abnormal Labour

Question 1

What is the most common reason for poor progression in an otherwise normal labour

Answer 1

Inefficient uterine contraction

Question 2

What is the treatment of poor contractions

Answer 2

Rehydration
ARM
syntocinon

Question 3

When does labour become abnormal

Answer 3

When there is a lack of progression 
When there is fetal compromise
Malpresentation
Preterm labour
Uterine scar
Induced labour 
Requires intervention
Require anaestetic input

Question 4

Where is the tens machine targeted

Answer 4

T10-L1

S2-S4

Question 5

How is diamorphine administered

Answer 5

IM

Question 6

How is remifentanil administered

Answer 6

IV

Question 7

What are the possible complications of an epidural

Answer 7

Can slow progress of the second stage of labour
Hypotension
Dural puncture (1 percent)
Headache
Back pain
Atonic bladder (40 percent)

Question 8

When would you suspect failure to progress in the first stage if labour

Answer 8

Nulliparous - less than 2cm dilation in 4 hours

Parous - less than 2cm dilation in 4 hours or slowing progress

Question 9

What are the 3 factors that cna cause poor progression of labour

Answer 9

Power - poor or infrequent contractions
Passages - shape, trauma
Passenger - big baby, malposition, cephalopelvic disproportion

Question 10

What positions should the babies head be in

Answer 10

flexed

Question 11

What results when the babies head is extended

Answer 11

Brow or face presentation

Question 12

What are the risk factors for fetal hypoxia

Answer 12

Small baby
Preterm /post dates
Antepartum haemorrhage
Pre eclampsia
Diabetes
Meconium
Epidural analgesia
VBAC
PROM 
Sepsis
Induction

Question 13

What is a mornal baseline heart rate for a baby in labour

Answer 13

110-150bpm

Question 14

What is normal baseline variability

Answer 14

5-25 bpm

Question 15

What is a salutatory pattern

Answer 15

baseline variability more t than 25

Question 16

When assessing the CTG what four areas should be noted

Answer 16

Baseline fetal heart rate
baseline variability
Presence or absence of decelerations
Presence of accelerations

Question 17

What are normal decelerations

Answer 17

If there are none or if they are early ie at the peak of contraction

Question 18

What are abnormal decelerations

Answer 18

Variable (occurring with over 50 percent of contractions) or late decelerations

Question 19

What is the mnemonic for CTG interpretation

Answer 19

Determine 
Risk
Contractions
Baseline
R
Ate
Variability
Accelerations
Decelerations
Overall

Question 20

What is the only true way to find out if the fetus is distressed

Answer 20

fetal blood sampling

Question 21

How can fetal distress be managed

Answer 21

Change in maternal position
Fluids
Stop syntocinon
Scalp stimulation
Consider tocolysis- Terbutaline
Operative delivery

Question 22

How is fetal blood sampling interpreted

Answer 22

pH more than 7.25 = normal
7.2-7.25 = borderline, repeat in 30 min
less than 7.2 = abnormal = deliver

Question 23

What are the indications for an operative delivery

Answer 23

Standard = delay, fetal distress
Special = maternal cardiac disease, severe PET, eclampsia, intra partum haemorrhage, umbilical cord prolapse stage 2

Question 24

What is associated with the use of a ventouse cup

Answer 24

cephalohaematoma
retinal haemorrhage
failure

Question 25

what are the positives of a ventous

Answer 25

less anaesthesia

vaginal trauma and perineal pain is reduced

Question 26

What are the main indications for a caesarian

Answer 26

Previoud CS
Fetal distress
failure to progress in labour
breech
maternal request

Question 27

What are the downsides to c section

Answer 27

4 x increase inmaternal mortality

due to sepsis, haemorrhage, VTE, subfertility, trauma, TTN, complications in future pregnancy