Abnormal Labour Flashcards
What can be used as analgesia in labour?
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
How effective is an epidural?
Complete relief in 95%
What does an epidural do to labour?
Does not impair uterine activity, but may inhibit progress during stage 2
What is administered in an epidural?
Levobupivacaine +- Opiate
What are some complications of an epidural?
HT (20%) Dural puncture (1%) Headache Back pain Atonic bladder (40%)
What is used to assess progress in labour?
Cervical dilatation
Descent of presenting part
Signs of obstruction
What is a nulliparous delay?
<2cm dilation in 4 hours
What is a parous delay?
<2cm dilation in 4 hours or slowing in progress
What is the marker for assessing descent of the presenting part?
Ischial spines (+-3 either way)
What is the attitude in pregnancy?
Flexion/extension of passenger
What is the widest diameter in a well-flexed fetus prior to birth?
Suboccipito-bregmatic (9.5cm)
What is a partogram?
A graphic representation of the progress of labour
When does a partogram commence?
As soon as woman enters labour ward
What is included in a partogram?
FH Amniotic fluid Cervical dilatation Descent Contractions Obstruction-moulding Maternal observations
What is involved in an Intra-partum fetal assessment?
Dopper auscultation of FH
Cardiotocograph (+- STAN)
Colour of amniotic fluid
How is often is the fetal heart auscultated by Doppler during stage 1 of labour?
During and after every contraction
Every 15 mins
How is often is the fetal heart auscultated by Doppler during stage 2 of labour?
Every 5-10 mins
What are the risk factors for fetal hypoxia?
Small fetus Preterm / Post Dates Antepartum haemorrhage Hypertension / Pre-eclampsia Diabetes Meconium Epidural analgesia VBAC PROM >24h Sepsis (Temp > 38C) Induction / Augmentation of labour
What are some acute causes of fetal distress?
Abruption Vasa Praevia Cord Prolapse Uterine Rupture Feto-maternal Haemorrhage Uterine Hyperstimulation Regional Anaesthesia
What is a subacute cause of fetal distress?
Hypoxia
What is included in a CTG?
Duration and quality of recording Baseline HR Variability Accelerations Decelerations Recording of contractions
What is a normal baseline HR on a CTG?
110-150bpm
What is a tachycardia on a CTG?
> 150bpm
What is a bradycardia on a CTG?
<110bpm
What is a normal variability on a CTG?
5-25bpm
What is a saltatory pattern of variability on a CTG?
> 25bpm
What is a reduced variability on a CTG?
<5bpm
How should a CTG be classified?
Normal
Non-reassuring
Abnormal
What are the criteria for non-reassuring variable decelerations?
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
What are the criteria for non-reassuring late decelerations?
Present for up to 30 minutes
Occurring with over 50% of contractions
What is the criteria for normal/reassuring decelerations?
None or early
What is the criteria for baseline variability in abnormal CTGs?
Less than 5 for over 90 mins
What is the criteria for baseline variability in non-reassuring CTGs?
Less than 5 for 30-90 mins
What is the criteria for baseline variability in normal/reassuring CTGs?
5 or more
What are the criteria for abnormal non-reassuring variable decelerations?
As for non-reassuring variable, and:
Still observed 30 mins after starting conservative measures
Occurring with over 50% of contractions
What are the criteria for abnormal late decelerations?
Present for over 30 mins
Do not improve with conservative measures
Occuring with over 50% of contractions
What is the criteria for abnormal bradycardia or a single prolonged deceleration?
Must last 3 minutes or more
What is the acronym used in CTG interpretation?
D ETERMINE R ISK C ONTRACTIONS B ASELINE R A TE V ARIABILITY A CCELERATIONS D ECELERATIONS O VERALL IMPRESSION
What measures can be used to manage fetal distress?
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
Where is fetal blood for sampling taken from?
Scalp
If scalp pH is >7.25, how should this be interpreted and acted on?
Normal
No action
If scalp pH is 7.20-7.25, how should this be interpreted and acted on?
Borderline
Repeat 30 mins
If scalp pH is <7.20, how should this be interpreted and acted on?
Abnormal
Deliver
What are standard indications for operative vaginal delivery?
Delay (failure to progress stage 2)
Fetal distress
What are special indications for operative vaginal delivery?
Maternal cardiac disease
Severe PET/eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse stage 2
What is the normal duration of stage 2 for prims and multips without an epidural?
2h and 1hr respectively
How much longer does an epidural make stage 2 for both prims and multips?
1 hour
Which complications are ventouse associated with?
Increased: failure, cephalohaematoma, retinal haemorrgage, maternal worry
Decreased anaesthesia, vaginal trauma, perineal pain
What are the main indications for C-section?
Previous CS Fetal distress Failure to progress in labour Breech presentation Maternal request
By how much does CS increase maternal mortality?
4x
What can cause morbidity in CS?
Sepsis Haemorrhage VTE Trauma TTN Subfertility Regret Complications in future pregnancy
