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Repro > Abnormal labour > Flashcards

Abnormal labour Flashcards

1
Q

too early

A

preterm birth <37 weeks of gestation

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2
Q

too late

A

beyond 42 weeks

induction of labour

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3
Q

too painful

A

requires anaesthetic input

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4
Q

too long

A

failure to progress

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5
Q

fetal distress can mean what

A

with every uterine contraction the blood supply to the fetus is cut off
leading to hypoxia/sepsis

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6
Q

inhalation agents meaning what

and for who

A

entonox for both high and low risk women

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7
Q

TENS is what

A

electrodes

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8
Q

IM opiate analgesia

SE

A

diamorphine

ECG changes, respiratory distress

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9
Q

what can be given as an intermediate between IM opiate analgesia and regional anaesthesia

A

IV remifentanil PCA

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10
Q 
how effective is epidural anaesthetsia
does it impair uterine activity 
what may it inhibit 
what does it consist of
complications
A

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
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11
Q

what can an epidural anaesthetic lead to

A

puncture of the dura mate which leads to severe headaches due to CSF leak and photophobia - can’t stand up due to severe headaches

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12
Q

bladder and epidural anaethesia

A

interferes with the nerve supply to the bladder - ensure the bladder is not over distended

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13
Q

stages at which an epidural anaesthesia is given

A

test dose is given first

then it is regularly topped up

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14
Q

why can an epidural anaesthesia lead to misposition of the baby

A

relaxation of the pelvic floor so the head may not flex sufficiently so there may not be internal rotation

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15
Q

how is progress assessed in labour

A

cervical dilation
descent of the presenting part
signs of obstruction - caput/moulding

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16
Q

suspected delay in stage one for a nulliparous woman and a porous woman

A

nulli - <2cm dilatation in 4 hours

porous <2cm in 4 hours or slowing in progress

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17
Q

causes of failure to progress (3 ps)

A

powers - inadequate contractions: frequency and/or strength

passangers - short stature/trauma/shape

passenger - big baby, malposition

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18
Q

what does partogram assess

A 
fetal heart
amniotic fluid
cervical dilatation 
descent 
contractions 
obstruction 
maternal observations
19
Q

what are the different ways of fetal assessing intra partum

A

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

20
Q

risk factors for fetal hypoxia

what do they all require

A 
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

21
Q

what does VBAC have a risk of

A

uterus rupture

22
Q

whats does PROM have a risk of

A

sepsis and baby is at risk of septic brain injury

23
Q

how does induction lead to a risk for fetal hypoxia

A

hypersitmualated - more contractions - baby will be more stressed

24
Q

acute causes of fetal distress

A 
abruption 
vasa praevia
cord prolapse
uterine rupture
feto-maternal haemorrhage 
uterine stimulation 
regional anaesthesia
25
Q

sub acute causes for fetal distress and how is this assessed

A

hypoxia

using a CTG

26
Q

what does a CTG monitor

A

baseline fetal heart rate
variability
accelerations/decelerations

27
Q

what else does the CTG monster other than the fetal heart rate

A

contractions
checked every 10 mins
can’t tell the strength - only the number

28
Q

bradychardic fetal heart causes

A

hypoxia
opiate analgesia
malposition of the baby

29
Q

tachycardia fetal heart causes

A 
fetal stress
active baby
maternal dehydration
intra uterine sepsis
maternal sepsis
30
Q

exaggerated variability means what

loss of variability means what

A

hypoxia

opiate analgesia, sleep phase

31
Q

early decelerations are caused by what

late decelerations are caused by what

A

physiological due to head compression

pathological - mark of fetal hypoxia

32
Q

what are complicated variable decelerations due to

A

mainly due to cord compression

33
Q

What things need to be assessed and documented when reviewing the CTG

A

baseline fetal heart rate
baseline variability
presence or absence of decelerations
presence of accelerations

34
Q

how should a CTG be classed as

A

normal/non reassuring/abnormal

35
Q

CTG interpretation

dr c bravado

A 
determine
risk
contractions 
baseline 
r
ate
variability
accelerations
decelerations 
overall impressions
36
Q

normal fetal heart rate

A

110-160bpm

37
Q

management of fetal distress

A

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

38
Q

scalp pH normal boderline and abnormal pH and actions

A

> 7.25 normal no action
7.20-7.25 boderline repeat in 30 mins
<7.20 abnormal deliver baby

39
Q

indications for operative (or not) labour

A

delay - failure to progress to stage 2
fetal distress

maternal cardiac disease
severe PET/eclampsia
intra partum haemorrhage
umbilical cord prolapse stage 2

40
Q

what is failure to progress during stage two during prim/multips

A

prims 3 hour with epidural and 2 without

multips 2 hour with epidural and 1 without

41
Q

what are the risks of ventouse

good things

A

increased risk of failure
cephalohaematoma
retinal haemorrhage
maternal worry

anaesthesia decrease
vaginal trauma decrease
perineal pain decrease

42
Q

main indications for C sec

A 
previous CS
fetal distress
failure to progress in labour
breech presentation
maternal request
43
Q

risk with C sec

A

4 x greater maternal mortality

44
Q

morbidity with C sec

A 
sepsis 
haemorrhage 
VTE
trauma 
TTN
sub fertility 
regret
complications in future pregnancy

Repro (56 decks)

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