Abnormal Labour Flashcards
What is the most common reason for poor progression in an otherwise normal labour
Inefficient uterine contraction
What is the treatment of poor contractions
Rehydration
ARM
syntocinon
When does labour become abnormal
When there is a lack of progression When there is fetal compromise Malpresentation Preterm labour Uterine scar Induced labour Requires intervention Require anaestetic input
Where is the tens machine targeted
T10-L1
S2-S4
How is diamorphine administered
IM
How is remifentanil administered
IV
What are the possible complications of an epidural
Can slow progress of the second stage of labour Hypotension Dural puncture (1 percent) Headache Back pain Atonic bladder (40 percent)
When would you suspect failure to progress in the first stage if labour
Nulliparous - less than 2cm dilation in 4 hours
Parous - less than 2cm dilation in 4 hours or slowing progress
What are the 3 factors that cna cause poor progression of labour
Power - poor or infrequent contractions
Passages - shape, trauma
Passenger - big baby, malposition, cephalopelvic disproportion
What positions should the babies head be in
flexed
What results when the babies head is extended
Brow or face presentation
What are the risk factors for fetal hypoxia
Small baby Preterm /post dates Antepartum haemorrhage Pre eclampsia Diabetes Meconium Epidural analgesia VBAC PROM Sepsis Induction
What is a mornal baseline heart rate for a baby in labour
110-150bpm
What is normal baseline variability
5-25 bpm
What is a salutatory pattern
baseline variability more t than 25
When assessing the CTG what four areas should be noted
Baseline fetal heart rate
baseline variability
Presence or absence of decelerations
Presence of accelerations
What are normal decelerations
If there are none or if they are early ie at the peak of contraction
What are abnormal decelerations
Variable (occurring with over 50 percent of contractions) or late decelerations
What is the mnemonic for CTG interpretation
Determine Risk Contractions Baseline R Ate Variability Accelerations Decelerations Overall
What is the only true way to find out if the fetus is distressed
fetal blood sampling
How can fetal distress be managed
Change in maternal position Fluids Stop syntocinon Scalp stimulation Consider tocolysis- Terbutaline Operative delivery
How is fetal blood sampling interpreted
pH more than 7.25 = normal
7.2-7.25 = borderline, repeat in 30 min
less than 7.2 = abnormal = deliver
What are the indications for an operative delivery
Standard = delay, fetal distress Special = maternal cardiac disease, severe PET, eclampsia, intra partum haemorrhage, umbilical cord prolapse stage 2
What is associated with the use of a ventouse cup
cephalohaematoma
retinal haemorrhage
failure
what are the positives of a ventous
less anaesthesia
vaginal trauma and perineal pain is reduced
What are the main indications for a caesarian
Previoud CS Fetal distress failure to progress in labour breech maternal request
What are the downsides to c section
4 x increase inmaternal mortality
due to sepsis, haemorrhage, VTE, subfertility, trauma, TTN, complications in future pregnancy
