Abnormal Labour Flashcards
When are women induced in Tayside?
by 42 weeks- induce by 41+3 weeks
What is the benefit of using remifentanil compared to diamorphine?
remifentanil is very short-activing powerful opiate
What drugs are used in epidurals?
levobupivacaine +/- opiate
What are the complications assoicated with epidurals?
hypotension; dural puncture; HA; back pain; urinary retention
How is progress in labour assessed?
cervical dilatation; descent of presenting part; signs of obstruction
What is defined as failure to prgress in the first stage in nulliparous?
<2cm in 4 hours
What is failure to progress in the 1st sgae in a parous woman?
<2cm in 4 hours or slowing in progress
What are the causes of failure to progress generally?
3P’s: power
passage
passenger
What are the power causes of failure to progress?
inadequate contractions- frequency and/or strength
What are the passage causes of afilure to progress?
short stature/ traum (to pelvis); shape
What are the passenger causes of failure to progress?
big baby; malposition
What is the usual presenting diameter of the fetal head?
9.5cm
What is assessed on the partogram?
fetal heart; liquor; cervical dilatation; descent; contractions; obstruction-moulding; maternal obs
How often should doppler auscultation of the fetal heart be done in stage 1?
during and after a contraction every 15 minutes for 1 minute
How often should doppler auscultation of the fetal heart be done in stage 2?
at least every 5 minutes during and after a contraction for 1 whole pulse
How often should the maternal pulse be checked suring stage 2?
every 15 mins
What are the risk factors for fetal hypoxia?
small fetus; preterm/post dates; antepartum haemorrhage; HT/pre-eclampsia; DM; meconium; epidural analgesia; VBAC; PROM >24hrs; sepsis; induction/augmentation of labour
What should be done if there is a risk factor for fetal hypoxia present?
continuous monitoring of fetal heart
What are teh acute causes of fetal distress?
abruption; vasa praevia; cord prolapse; uterine rupture; feto-maternal haemorrhage; uterine hyperstimulation; regional anaesthesia;
What mnemonic should be used when looking at CTGs?
DR C BRAVADO risk contractions baseline HR variability accelerations decelerations overall
What is an early deceleration?
trough of the deceleleration correlates with the peak of the contraction
What is a late decel?
decel is after contraction
What is the management of fetal distress?
change maternal position; IV fluids; stop syntocinon; scalp stimulation; consider tocolysis; maternal assessment; fetal blood ssampling; operative delivery
What is the normal pH for fetal blood scamples?
> 7.25
What are the indications for instrumental delivery?
failure to progress in stage 2; fetal distress; maternal cardiac disease; severe pre-eclampsia; intra-partum haemorrhage; umbilical cord prolapse stage2
What is the upper limit of normal length of stage 2 for a prim with an epidural?
3 hours
What is the upper limit of normal length of stage 2 for prims without an epidural?
2hours
What is the upper limit of normal length of stage 2 for a multips with no epidural?
1 hour
What is the upper length of normal length of stage 2 for a multips with an epidural?
2 horus
What are the problems associated with ventouse?
higher- failure; cephalohaematoma; retinal haemorrhage; maternal worry
What are the benefits of ventouse?
less anaesthetisa; vaginal trauma and perineal pain
Is there a big difference between ventouse and forceps?
no difference in CS rates; apgars or long-term outcomes
What are the main indications for C/S?
previous C/S; fetal distress; failure to progress in labour; breech presentation; maternal request
What are hte complications of C/S?
sepsis; haemorrhage; CTE; trauma; TTH; subfertility; regret; complications in future pregnancy
What is the difference between mortality in C/S and SVD?
x4 maternal mortality
