Abnormal Labour Flashcards
What stage of labour may an Epidural inhibit?
Stage 2
What are complications of an epidural?
Hypotension Dural puncture Headache Back pain Atonic bladder
What 3 things are assessed during labour?
Cervical dilatation
Descent of presenting part
Signs of obstruction
What is Nulliparous?
<2cm dilation in 4 hours
What is Parous?
<2cm dilation in 4 hours or slowing of progress
What are the 3 P’s of failures to progress?
Powers - Inadequate contractions, frequency and/or strength
Passages - Short stature/Trauma/Shape
Passenger - Big baby, Malposition - relative cephalo-pelvic disproportion
How big is the Pelvic inlet?
Transverse = 13.5cm AP = 11cm
How big is the Mid-cavity?
Transverse = 12cm AP = 12cm
How big is the Pelvic inlet?
Transverse = 11cm AP = 13.5
What is noted down on a Partogram?
Fetal heart Amniotic fluid Cervical dilatation Descent Contractions Obstruction - moulding Maternal observations
When would you do a doppler auscultation of the fetal heart in stage 1?
Every 15 minutes
When would you do a doppler auscultation of the fetal heart in stage 2?
Every 5-10 mins
What else should be checked to assess the fetus?
Cardiotocograph (CTG) (+/- STAN)
Colour of amniotic fluid
What should be measured in a CTG assessment?
Baseline fetal heart rate
Baseline variability
Presence or absence of deceleration
Presence of accelerations
How should a CTG be classified?
Normal
Non-reassuring
Abnormal
What management can be down to a fetus in distress?
Change in maternal position IV fluids Stop syntocinon Scalp stimulation Consider tocolysis - Terbutaline 250 micrograms Maternal assessment - pulse/BP/Abdomen/VE Fetal blood sampling Operative delivery
What are the ranges for scalp pH?
Normal = >7.25 Borderline = 7.20-7.25 Abnormal = <7.20
What do you do when the scalp pH is borderline and abnormal?
Borderline = repeat test in 30 mins Abnormal = deliver the baby
What are standard indications for operative vaginal delivery?
Delay (failure to progress to stage 2)
Fetal distress
What are the special indications for operative vaginal delivery?
Maternal cardiac disease
Severe PET/Eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse Stage 2
What is Ventouse associated with?
Increased failure Increased cephalohaematoma Increased retinal haemorrhage Increased maternal worry Decreased anaesthesia Decreased vaginal trauma Decreased perineal pain
What are the main indications for carrying out a caesarean section?
Previous caeserean Fetal distress Failure to progress to labour Breech presentation Maternal request
What are complications with a caesarean?
4X maternal mortality Sepsis Haemorrhage VTE Trauma TTN Subfertility Regret Complications in future pregnancy
