Abnormal Labour

Question 1

When are women induced in Tayside?

Answer 1

by 42 weeks- induce by 41+3 weeks

Question 2

What is the benefit of using remifentanil compared to diamorphine?

Answer 2

remifentanil is very short-activing powerful opiate

Question 3

What drugs are used in epidurals?

Answer 3

levobupivacaine +/- opiate

Question 4

What are the complications assoicated with epidurals?

Answer 4

hypotension; dural puncture; HA; back pain; urinary retention

Question 5

How is progress in labour assessed?

Answer 5

cervical dilatation; descent of presenting part; signs of obstruction

Question 6

What is defined as failure to prgress in the first stage in nulliparous?

Answer 6

<2cm in 4 hours

Question 7

What is failure to progress in the 1st sgae in a parous woman?

Answer 7

<2cm in 4 hours or slowing in progress

Question 8

What are the causes of failure to progress generally?

Answer 8

3P’s: power
passage
passenger

Question 9

What are the power causes of failure to progress?

Answer 9

inadequate contractions- frequency and/or strength

Question 10

What are the passage causes of afilure to progress?

Answer 10

short stature/ traum (to pelvis); shape

Question 11

What are the passenger causes of failure to progress?

Answer 11

big baby; malposition

Question 12

What is the usual presenting diameter of the fetal head?

Answer 12

9.5cm

Question 13

What is assessed on the partogram?

Answer 13

fetal heart; liquor; cervical dilatation; descent; contractions; obstruction-moulding; maternal obs

Question 14

How often should doppler auscultation of the fetal heart be done in stage 1?

Answer 14

during and after a contraction every 15 minutes for 1 minute

Question 15

How often should doppler auscultation of the fetal heart be done in stage 2?

Answer 15

at least every 5 minutes during and after a contraction for 1 whole pulse

Question 16

How often should the maternal pulse be checked suring stage 2?

Answer 16

every 15 mins

Question 17

What are the risk factors for fetal hypoxia?

Answer 17

small fetus; preterm/post dates; antepartum haemorrhage; HT/pre-eclampsia; DM; meconium; epidural analgesia; VBAC; PROM >24hrs; sepsis; induction/augmentation of labour

Question 18

What should be done if there is a risk factor for fetal hypoxia present?

Answer 18

continuous monitoring of fetal heart

Question 19

What are teh acute causes of fetal distress?

Answer 19

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

Question 20

What mnemonic should be used when looking at CTGs?

Answer 20

DR C BRAVADO
risk
contractions
baseline HR
variability
accelerations
decelerations
overall

Question 21

What is an early deceleration?

Answer 21

trough of the deceleleration correlates with the peak of the contraction

Question 22

What is a late decel?

Answer 22

decel is after contraction

Question 23

What is the management of fetal distress?

Answer 23

change maternal position; IV fluids; stop syntocinon; scalp stimulation; consider tocolysis; maternal assessment; fetal blood ssampling; operative delivery

Question 24

What is the normal pH for fetal blood scamples?

Answer 24

> 7.25

Question 25

What are the indications for instrumental delivery?

Answer 25

failure to progress in stage 2; fetal distress; maternal cardiac disease; severe pre-eclampsia; intra-partum haemorrhage; umbilical cord prolapse stage2

Question 26

What is the upper limit of normal length of stage 2 for a prim with an epidural?

Answer 26

3 hours

Question 27

What is the upper limit of normal length of stage 2 for prims without an epidural?

Answer 27

2hours

Question 28

What is the upper limit of normal length of stage 2 for a multips with no epidural?

Answer 28

1 hour

Question 29

What is the upper length of normal length of stage 2 for a multips with an epidural?

Answer 29

2 horus

Question 30

What are the problems associated with ventouse?

Answer 30

higher- failure; cephalohaematoma; retinal haemorrhage; maternal worry

Question 31

What are the benefits of ventouse?

Answer 31

less anaesthetisa; vaginal trauma and perineal pain

Question 32

Is there a big difference between ventouse and forceps?

Answer 32

no difference in CS rates; apgars or long-term outcomes

Question 33

What are the main indications for C/S?

Answer 33

previous C/S; fetal distress; failure to progress in labour; breech presentation; maternal request

Question 34

What are hte complications of C/S?

Answer 34

sepsis; haemorrhage; CTE; trauma; TTH; subfertility; regret; complications in future pregnancy

Question 35

What is the difference between mortality in C/S and SVD?

Answer 35

x4 maternal mortality