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Reproduction Year 3 > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

what is classed as abnormal labour

A 
Too early- pre-term
Too late- induction of labour
Too painful- requires anaesthetic input
Too long- failure to progress
Fetal distress- hypoxia/sepsis
Requires intervention- operative birth
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2
Q

Describe the aetiology of labour pain

A

compression of para-cervical nerves

Myometrial hypoxia

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3
Q

what is in an epidural anaesthesia

A

Levobupivacaine +/- opiate

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4
Q

Why is an epidural anaesthetic useful

A

Does not impair uterine activity

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5
Q

Complications of an epidural

A 
Hypotension 
Atonic bladder (most common)
Dural puncture
Headache 
Back pain
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6
Q

How is progress in labour assessed

A

Cervical dilatation
Descent of presenting part
Signs of obstruction

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7
Q

when should you suspect a delay in stage

A 
if nulliparous (never given birth before) <2cm dilation in 4 hours 
If parous (given birth before) <2cm in 4 hours or slowing in progress
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8
Q

what should you think about when considering a cause for failure to progress

A

3 P’s

Power: inadequate contractions: frequency and/or strength
Passages: short stature/trauma/shape
Passenger: big baby/ malposition

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9
Q

what is commenced as part of assessing progress as soon as a woman enters the labour ward

A

The partogram

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10
Q

What tools are used to assess fetal well being

A

Doppler auscultation of fetal heart
Cardiotocograph
Colour of amniotic fluid

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11
Q

when is doppler auscultation of the fetal heart done

A

Stage 1: during and after a contraction
Every 15 mins
Stage 2: at least every 5 mins during + after a contraction

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12
Q

Risk factors for fetal hypoxia

A 
Small fetus
Preterm/ post dates
Antepartum haemorrhage 
Hypertension/ pre-eclampsia 
Diabetes
Epidural anaesthesia 
Induced labour
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13
Q

what is done if the baby has any risk factors for fetal hypoxia

A

continuous monitoring of the fetal heart

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14
Q

What are some acute causes of fetal distress

A

Abruption (premature separation of placenta from the uterus)
Vasa Praevia (babies blood vessels run near the internal opening of the uterus- risk of rupture)
Cord prolapse
Uterine rupture
Feto-maternal haemorrhage
Uterine hyperstimulation

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15
Q

subacute cause of fetal distress

A

hypoxia

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16
Q

what does a CTG record

A 
Contractions 
decelerations 
accelerations
variability
baseline HR
17
Q

Normal baseline fetal HR

A

110-150 bpm

tachycardia >150
bradycardia <110

18
Q

what is the normal variability in fetal HR

A

5-25 bpm

19
Q

how are CTG results classified

A

Normal
Suspicious
Pathological

20
Q

Management of fetal distress

A 
Change maternal position
IV fluids
Stop syntocinon (synthetic oxytocin)
Consider tocolysis- terbutaline 250micrograms (used to suppress premature labour)
Maternal assessment- BP, HR, Abdo exam
Fetal blood sampling 
Operative delivery
21
Q

Normal parameters of fetal blood sampling scalp pH

A

pH >7.25 = normal
pH 7.2-7.25 = boderline
pH <7.2 = Abnormal

22
Q

What would you do if fetal scalp pH was borderline ? (7.2-7.25)

A

repeat in 30 mins

23
Q

what would you do if fetal scalp pH was abnormal ? (<7.2)

A

deliver the baby

24
Q

what length of stage 2 labour duration is okay in a woman who has never given birth before

A

No epidural <2 hours

Epirdual <3 hours

25
Q

what length of stage 2 labour is okay in a woman who has given birth before

A

No epidural <1 hour

Epidural <2 hours

26
Q

what is ventouse

A

vacuum assisted vaginal delivery or vacuum extraction

27
Q

what is ventouse associated with

A

increased failure
increased cephalohaematoma
increased retinal haemorrhage
increased maternal worry

Decreased anaesthesia
Decreased vaginal trauma
Decreased perineal pain

28
Q

main indications for C-Section

A 
previous CS
Fetal distress
failure to progress in labour 
breech presentation 
maternal request
29
Q

why is there 4x greater risk of mortality associated with C-Section

A 
Greater incidence of 
sepsis
Haemorrhage 
Venous embolism 
Trauma
30
Q

What are the maternal indications for inducing labour

A

Pre-eclampsia
Poor obstetric history
Post dates

31
Q

what are the fetal indications for inducing labour

A

Suspected IUGR, Rhesus, isoimmunisation, antepartum haemorrhage

32
Q

Methods for inducing pregnancy

A

Prostaglandins- PGE2 Dinoprostone
Mechanical- membrane sweep, foley balloon, catheter
Amniotomy - artificial membrane rupture
IV syntocinon

Reproduction Year 3 (36 decks)

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