Abnormal Labour Flashcards
List factors that determine labour as abnormal
Too early Too late Too painful Too long Foetal distress Intervention required (operative)
What causes transient hypoxia in a baby during labour?
Uterine contractions (interrupt placental blood supply)
List options for providing analgesia during labour
Support, massage/relaxation techniques Paracetamol Entonox (laughing gas) TENS Water immersion IM diamorphine IV remifentanil Epidural anaesthesia
Epidural anaesthesia impairs uterine activity. True/False?
False
May inhibit progress during stage 2 labour, however
What vertebral level is the epidural anaesthetic injected into?
L3/L4 space
List potential complications of epidural anaesthesia
Hypotension Dural puncture Headache Backache Atonic bladder
What counts as delay in stage 1 labour?
Nulliparous woman: less than 2cm dilation in 4 hours
Parous woman: less than 2cm dilation in 4 hours OR slowing in progress
What are the 3 P’s that affect progression of labour?
Power (inadequate contractions)
Passage (shape/state of pelvis)
Passenger (big baby, malposition)
Going down the pelvis, the transverse diameter increases/decreases and the anteroposterior diameter increases/decreases
Going down the pelvis, the transverse diameter decreases and the anteroposterior diameter increases
What is a partogram?
Graphical representation of the progression of labour
What is assessed on a partogram?
Foetal heart rate Amniotic fluid Cervical dilation Descent Contractions Obstruction (moulding/caput) Maternal vital signs
How often is the foetal heart auscultated during labour?
Stage 1: during + after a contraction/every 15 mins
Stage 2: every 5-10 mins
Meconium (foetal stool) can be a sign of what?
Foetal distress
What is a CTG used for?
Assess foetal heart
You can only assess frequency of contractions on a CTG, not strength. True/False?
True
What is a normal foetal heart rate?
110-165 bpm
What 4 features are assessed on a CTG?
What is the mnemonic for remembering this?
Heart rate, variability, accelerations, decelerations Mnemonic: Determine Risk Contractions Baseline R Ate Variability Accelerations Decelerations Overall impression
Outline management of foetal distress in labour
Change maternal position IV fluids Stop syntocinon Consider tocolysis Foetal blood sampling (hypoxia) Operative delivery
What is a normal pH to obtain upon foetal blood sampling?
pH greater than 7.25
What are the main indications for cesarean section?
Previous CS Foetal distress Failure to progress in labour Breech presentation Maternal request
