Abnormal Labour

Question 1

give the 6 ways in which about ca be abnormal?

Answer 1

to early-preterm birth 
too late- induction of labour
too painful- anaesthetic input
too long- failure to progress
foetal distress- hypoxia, sepsis
requires intervention- operative delivery

Question 2

Analgesia

name the different types of analgesia available in labour? (7)

Answer 2

massage/relaxation
inhalation agents (Entonox, 50% nitrous oxide, 50% O2)
TENS- trans cutaneous electrical nerve stimulation for T10-L1, S2-S4
water immersion
IM opiate analgesia e.g. morphine
IV remifentanil PCA
Regional anaesthesia

Question 3

Epidural anaesthesia

• name of drug?
• advantages?
• complications?
• describe process of administration?

Answer 3

-Levobupivacaine +/- opiate

-very effective
does not impair uterine activity

-may inhibit progress during stage 2 
hypotension
Dural puncture
headache 
back pain 
Atonic bladder (descent of baby will stop if over-extended)

-catheter fed through the epidural space, through ligament flavum, into epidural space, there is a test dose prior to administration

Question 4

Failure to progress

• how is progress in labour assessed? (3)
• when is the 2nd stage entered?
• what indicates baby is stuck?
• when is there a “suspected delay” in stage 1?

Answer 4

-Cervical dilatation
Descent of presenting part
Signs of obstruction

• when the cervix is 10cm dilated
• molding
• when <2cm dilation in 4 hours/ slowing in progress (parous)

Question 5

What are the 3 P’s in failure to progress?

Answer 5

Powers
inadequate contractions: frequency and/or strength

Passages
short stature/trauma/shape

Passenger
Big baby
Malposition- relative céphalo-pelvic disproportion

Question 6

what is a partogram?

• when would one be started?
• what does it measure
• what drug can be given to increase power of contractions?

Answer 6

a graphic representation of the progress of labour

-as soon as woman enters labour ward

-Foetal heart 
amniotic fluid- colour ?meconium 
Cervical dilatation
Descent 
Contractions 
obstruction-moulding
Maternal obs- be aware of hypo/hypertension

-Syntoxin

Question 7

Components of intra-partum foetal assessment? (3)

Answer 7

Doppler auscultation of foetal heart
stage 1
(during & after contraction
every 15 mins)
stage 2
(every 5-10 mins)

Cardiotocograph

colour of amniotic fluid

Question 8

What are the risk factors for foetal hypoxia? (11)

Answer 8

small foetus 
preterm/post dates
antepartum haemorrhage
hypertension/preeclampsia 
DM
meconium 
epidural 
VBAC (vaginal birth after C section)
PROM > 24 hr
sepsis 
induction/augmented labour

Question 9

what are the causes Of foetal Distress:

• Acute? (7)
• subacute? (1)

Answer 9

-abruption 
vasa praevia
cord prolapse
uterine rupture
feto-maternal haemorrhage
uterine hyperstimulation
regional anaesthesia 

-hypoxia

Question 10

what to look for on a Cardiotocograph? (2)

• what is foetal bradycardia?
• what should they be classified as?

Answer 10

baseline HR?
accelerations?
(want to see 3 in 15 mins)
presence/absence decelerations?
(uniform and mirror contractions, physiological due to head compression UNLESS lag = hypoxia)
baseline variability?
(of decelerations mainly due to crop compression)

also look at contractions and their frequency

-A foetal HR less than 100

-normal
non-reassuring
abnormal

Question 11

CTG interpretation

-what pneumonic used?

Answer 11

DR C BRAVADO 
D- determine
R- risk
C- contractions
B- baseline
R/A- rate 
V- variability
A- accelerations 
D- decelerations 
O- overall impression

Question 12

Management of foetal distress:

what actions should be take in the event of foetal distress?

Answer 12

change maternal position (reduced aorta compression)
IV fluids
Stop syntocinon
Scalp stimulation
Consider tocolysis (terbutaline 250mcg s/c)
Maternal assessment (Pulse/BP/Abdomen/VE)
foetal blood sampling
Operative delivery

Question 13

How is foetal blood sampling carried out?
-what would your action be with the following results:
Scalp pH >7.25
Scalp pH 7.20-7.25
Scalp pH <7.20

Answer 13

incision is made into scalp while foetus still in womb and obtained through a capillary tube

-normal, no action
Borderline, Repeat 30 mins
abnormal, deliver

Question 14

Indications for operative delivery:

• standard?
• special indications?

Answer 14

-delay, i.e. failure to progress
Fetal distress

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

Question 15

When should an epidural be given in:

• 1st birth?
• 2nd+ birth?

Answer 15

• after 3 hrs in stage 2

- after 2 hrs in stage 2

Question 16

Give the advantages (3) and disadvantages (4) of ventouse delivery?

Answer 16

-disadv
failure
cephalohaematoma
retinal haemorrhage
Maternal worry

adv
reduced Anaesthesia
reduced Vaginal trauma
reduced perineal pain

Question 17

Caesarean section

• indications? (5)
• complications? (8)

Answer 17

-previous CS
Fetal distress
failure to progress in labour
Breech presentation
Maternal request 

-sepsis, haemorrhage, VTE, trauma, TTN, sub fertility, complications in future preg