Abnormal labour Flashcards
too early
preterm birth <37 weeks of gestation
too late
beyond 42 weeks
induction of labour
too painful
requires anaesthetic input
too long
failure to progress
fetal distress can mean what
with every uterine contraction the blood supply to the fetus is cut off
leading to hypoxia/sepsis
inhalation agents meaning what
and for who
entonox for both high and low risk women
TENS is what
electrodes
IM opiate analgesia
SE
diamorphine
ECG changes, respiratory distress
what can be given as an intermediate between IM opiate analgesia and regional anaesthesia
IV remifentanil PCA
how effective is epidural anaesthetsia does it impair uterine activity what may it inhibit what does it consist of complications
complete pain relief in 95%
does not impair uterine activity
during stage 2
levobupivacaine +/- opiate
hypotension dural puncture headache back pain - mainly mechanical atonic bladder
what can an epidural anaesthetic lead to
puncture of the dura mate which leads to severe headaches due to CSF leak and photophobia - can’t stand up due to severe headaches
bladder and epidural anaethesia
interferes with the nerve supply to the bladder - ensure the bladder is not over distended
stages at which an epidural anaesthesia is given
test dose is given first
then it is regularly topped up
why can an epidural anaesthesia lead to misposition of the baby
relaxation of the pelvic floor so the head may not flex sufficiently so there may not be internal rotation
how is progress assessed in labour
cervical dilation
descent of the presenting part
signs of obstruction - caput/moulding
suspected delay in stage one for a nulliparous woman and a porous woman
nulli - <2cm dilatation in 4 hours
porous <2cm in 4 hours or slowing in progress
causes of failure to progress (3 ps)
powers - inadequate contractions: frequency and/or strength
passangers - short stature/trauma/shape
passenger - big baby, malposition
what does partogram assess
fetal heart amniotic fluid cervical dilatation descent contractions obstruction maternal observations
what are the different ways of fetal assessing intra partum
doppler auscultation of the fatal heart during stage 1 during and after a contraction, every 15 mins and during stage 2 every 5-10 mins
CTG
colour of amniotic fluid
risk factors for fetal hypoxia
what do they all require
small fetus preterm/post dates antepartum haemorrhage hypertension/ PET DM meconium epidural analgesia VBAC - vaginal birth after C sec PROM > 24 hours sepsis (temp >38c) induction/augmentation of labour
continuous monitoring of the fetal heart
what does VBAC have a risk of
uterus rupture
whats does PROM have a risk of
sepsis and baby is at risk of septic brain injury
how does induction lead to a risk for fetal hypoxia
hypersitmualated - more contractions - baby will be more stressed
acute causes of fetal distress
abruption vasa praevia cord prolapse uterine rupture feto-maternal haemorrhage uterine stimulation regional anaesthesia
sub acute causes for fetal distress and how is this assessed
hypoxia
using a CTG
what does a CTG monitor
baseline fetal heart rate
variability
accelerations/decelerations
what else does the CTG monster other than the fetal heart rate
contractions
checked every 10 mins
can’t tell the strength - only the number
bradychardic fetal heart causes
hypoxia
opiate analgesia
malposition of the baby
tachycardia fetal heart causes
fetal stress active baby maternal dehydration intra uterine sepsis maternal sepsis
exaggerated variability means what
loss of variability means what
hypoxia
opiate analgesia, sleep phase
early decelerations are caused by what
late decelerations are caused by what
physiological due to head compression
pathological - mark of fetal hypoxia
what are complicated variable decelerations due to
mainly due to cord compression
What things need to be assessed and documented when reviewing the CTG
baseline fetal heart rate
baseline variability
presence or absence of decelerations
presence of accelerations
how should a CTG be classed as
normal/non reassuring/abnormal
CTG interpretation
dr c bravado
determine risk contractions baseline r ate variability accelerations decelerations overall impressions
normal fetal heart rate
110-160bpm
management of fetal distress
change fetal position - take pressure off the aorta
IV fluids
stop syntocin and consider tocolysis (terbutaline 250 mcg s/c) to stop uterine contractions
scalp stimulation
maternal assessment
fetal blood sampling - check acid base status
scalp pH normal boderline and abnormal pH and actions
> 7.25 normal no action
7.20-7.25 boderline repeat in 30 mins
<7.20 abnormal deliver baby
indications for operative (or not) labour
delay - failure to progress to stage 2
fetal distress
maternal cardiac disease
severe PET/eclampsia
intra partum haemorrhage
umbilical cord prolapse stage 2
what is failure to progress during stage two during prim/multips
prims 3 hour with epidural and 2 without
multips 2 hour with epidural and 1 without
what are the risks of ventouse
good things
increased risk of failure
cephalohaematoma
retinal haemorrhage
maternal worry
anaesthesia decrease
vaginal trauma decrease
perineal pain decrease
main indications for C sec
previous CS fetal distress failure to progress in labour breech presentation maternal request
risk with C sec
4 x greater maternal mortality
morbidity with C sec
sepsis haemorrhage VTE trauma TTN sub fertility regret complications in future pregnancy
