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Reproduction > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

What can be used as analgesia in labour?

A 
Support
Massage / relaxation techniques
Inhalational agents - Entonox
TENS (T10-L1, S2-S4)
Water immersion 
IM opiate analgesia e.g. Morphine
IV Remifentanil PCA
Regional anaesthesia
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2
Q

How effective is an epidural?

A

Complete relief in 95%

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3
Q

What does an epidural do to labour?

A

Does not impair uterine activity, but may inhibit progress during stage 2

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4
Q

What is administered in an epidural?

A

Levobupivacaine +- Opiate

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5
Q

What are some complications of an epidural?

A 
HT (20%)
Dural puncture (1%)
Headache
Back pain
Atonic bladder (40%)
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6
Q

What is used to assess progress in labour?

A

Cervical dilatation
Descent of presenting part
Signs of obstruction

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7
Q

What is a nulliparous delay?

A

<2cm dilation in 4 hours

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8
Q

What is a parous delay?

A

<2cm dilation in 4 hours or slowing in progress

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9
Q

What is the marker for assessing descent of the presenting part?

A

Ischial spines (+-3 either way)

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10
Q

What is the attitude in pregnancy?

A

Flexion/extension of passenger

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11
Q

What is the widest diameter in a well-flexed fetus prior to birth?

A

Suboccipito-bregmatic (9.5cm)

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12
Q

What is a partogram?

A

A graphic representation of the progress of labour

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13
Q

When does a partogram commence?

A

As soon as woman enters labour ward

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14
Q

What is included in a partogram?

A 
FH
Amniotic fluid
Cervical dilatation
Descent
Contractions
Obstruction-moulding
Maternal observations
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15
Q

What is involved in an Intra-partum fetal assessment?

A

Dopper auscultation of FH
Cardiotocograph (+- STAN)
Colour of amniotic fluid

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16
Q

How is often is the fetal heart auscultated by Doppler during stage 1 of labour?

A

During and after every contraction

Every 15 mins

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17
Q

How is often is the fetal heart auscultated by Doppler during stage 2 of labour?

A

Every 5-10 mins

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18
Q

What are the risk factors for fetal hypoxia?

A 
Small fetus
Preterm / Post Dates
Antepartum haemorrhage
Hypertension / Pre-eclampsia
Diabetes
Meconium
Epidural analgesia
VBAC
PROM >24h
Sepsis (Temp > 38C)
Induction / Augmentation of labour
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19
Q

What are some acute causes of fetal distress?

A 
Abruption
Vasa Praevia
Cord Prolapse
Uterine Rupture
Feto-maternal Haemorrhage
Uterine Hyperstimulation
Regional Anaesthesia
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20
Q

What is a subacute cause of fetal distress?

A

Hypoxia

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21
Q

What is included in a CTG?

A 
Duration and quality of recording
Baseline HR
Variability
Accelerations
Decelerations
Recording of contractions
22
Q

What is a normal baseline HR on a CTG?

A

110-150bpm

23
Q

What is a tachycardia on a CTG?

A

> 150bpm

24
Q

What is a bradycardia on a CTG?

A

<110bpm

25
Q

What is a normal variability on a CTG?

A

5-25bpm

26
Q

What is a saltatory pattern of variability on a CTG?

A

> 25bpm

27
Q

What is a reduced variability on a CTG?

A

<5bpm

28
Q

How should a CTG be classified?

A

Normal
Non-reassuring
Abnormal

29
Q

What are the criteria for non-reassuring variable decelerations?

A

Dropping from baseline by 60bpm or less and taking 60 seconds or less to recover
Present for over 90 minutes
Occurring with over 50% of contractions
OR
Dropping from baseline by more than 60bpm or taking over 60 seconds to recover
Present for up to 30 minutes
Occurring with over 50% of contractions

30
Q

What are the criteria for non-reassuring late decelerations?

A

Present for up to 30 minutes

Occurring with over 50% of contractions

31
Q

What is the criteria for normal/reassuring decelerations?

A

None or early

32
Q

What is the criteria for baseline variability in abnormal CTGs?

A

Less than 5 for over 90 mins

33
Q

What is the criteria for baseline variability in non-reassuring CTGs?

A

Less than 5 for 30-90 mins

34
Q

What is the criteria for baseline variability in normal/reassuring CTGs?

A

5 or more

35
Q

What are the criteria for abnormal non-reassuring variable decelerations?

A

As for non-reassuring variable, and:
Still observed 30 mins after starting conservative measures
Occurring with over 50% of contractions

36
Q

What are the criteria for abnormal late decelerations?

A

Present for over 30 mins
Do not improve with conservative measures
Occuring with over 50% of contractions

37
Q

What is the criteria for abnormal bradycardia or a single prolonged deceleration?

A

Must last 3 minutes or more

38
Q

What is the acronym used in CTG interpretation?

A 
D ETERMINE
R ISK 
C ONTRACTIONS
B ASELINE
R
A TE
V ARIABILITY
A CCELERATIONS
D ECELERATIONS
O VERALL IMPRESSION
39
Q

What measures can be used to manage fetal distress?

A 
Change maternal position
IV Fluids
Stop syntocinon
Scalp stimulation
Consider tocolysis - Terbutaline 250 micrograms s/c
Maternal assessment - Pulse / BP / Abdomen / VE
Fetal blood sampling
Operative Delivery
40
Q

Where is fetal blood for sampling taken from?

A

Scalp

41
Q

If scalp pH is >7.25, how should this be interpreted and acted on?

A

Normal

No action

42
Q

If scalp pH is 7.20-7.25, how should this be interpreted and acted on?

A

Borderline

Repeat 30 mins

43
Q

If scalp pH is <7.20, how should this be interpreted and acted on?

A

Abnormal

Deliver

44
Q

What are standard indications for operative vaginal delivery?

A

Delay (failure to progress stage 2)

Fetal distress

45
Q

What are special indications for operative vaginal delivery?

A

Maternal cardiac disease
Severe PET/eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse stage 2

46
Q

What is the normal duration of stage 2 for prims and multips without an epidural?

A

2h and 1hr respectively

47
Q

How much longer does an epidural make stage 2 for both prims and multips?

A

1 hour

48
Q

Which complications are ventouse associated with?

A

Increased: failure, cephalohaematoma, retinal haemorrgage, maternal worry
Decreased anaesthesia, vaginal trauma, perineal pain

49
Q

What are the main indications for C-section?

A 
Previous CS
Fetal distress
Failure to progress in labour
Breech presentation
Maternal request
50
Q

By how much does CS increase maternal mortality?

A

4x

51
Q

What can cause morbidity in CS?

A 
Sepsis
Haemorrhage
VTE
Trauma
TTN
Subfertility
Regret
Complications in future pregnancy

Reproduction (40 decks)

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