Abnormal Labour Flashcards
what is classed as abnormal labour
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
Describe the aetiology of labour pain
compression of para-cervical nerves
Myometrial hypoxia
what is in an epidural anaesthesia
Levobupivacaine +/- opiate
Why is an epidural anaesthetic useful
Does not impair uterine activity
Complications of an epidural
Hypotension Atonic bladder (most common) Dural puncture Headache Back pain
How is progress in labour assessed
Cervical dilatation
Descent of presenting part
Signs of obstruction
when should you suspect a delay in stage
if nulliparous (never given birth before) <2cm dilation in 4 hours If parous (given birth before) <2cm in 4 hours or slowing in progress
what should you think about when considering a cause for failure to progress
3 P’s
Power: inadequate contractions: frequency and/or strength
Passages: short stature/trauma/shape
Passenger: big baby/ malposition
what is commenced as part of assessing progress as soon as a woman enters the labour ward
The partogram
What tools are used to assess fetal well being
Doppler auscultation of fetal heart
Cardiotocograph
Colour of amniotic fluid
when is doppler auscultation of the fetal heart done
Stage 1: during and after a contraction
Every 15 mins
Stage 2: at least every 5 mins during + after a contraction
Risk factors for fetal hypoxia
Small fetus Preterm/ post dates Antepartum haemorrhage Hypertension/ pre-eclampsia Diabetes Epidural anaesthesia Induced labour
what is done if the baby has any risk factors for fetal hypoxia
continuous monitoring of the fetal heart
What are some acute causes of fetal distress
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
subacute cause of fetal distress
hypoxia
what does a CTG record
Contractions decelerations accelerations variability baseline HR
Normal baseline fetal HR
110-150 bpm
tachycardia >150
bradycardia <110
what is the normal variability in fetal HR
5-25 bpm
how are CTG results classified
Normal
Suspicious
Pathological
Management of fetal distress
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
Normal parameters of fetal blood sampling scalp pH
pH >7.25 = normal
pH 7.2-7.25 = boderline
pH <7.2 = Abnormal
What would you do if fetal scalp pH was borderline ? (7.2-7.25)
repeat in 30 mins
what would you do if fetal scalp pH was abnormal ? (<7.2)
deliver the baby
what length of stage 2 labour duration is okay in a woman who has never given birth before
No epidural <2 hours
Epirdual <3 hours
what length of stage 2 labour is okay in a woman who has given birth before
No epidural <1 hour
Epidural <2 hours
what is ventouse
vacuum assisted vaginal delivery or vacuum extraction
what is ventouse associated with
increased failure
increased cephalohaematoma
increased retinal haemorrhage
increased maternal worry
Decreased anaesthesia
Decreased vaginal trauma
Decreased perineal pain
main indications for C-Section
previous CS Fetal distress failure to progress in labour breech presentation maternal request
why is there 4x greater risk of mortality associated with C-Section
Greater incidence of sepsis Haemorrhage Venous embolism Trauma
What are the maternal indications for inducing labour
Pre-eclampsia
Poor obstetric history
Post dates
what are the fetal indications for inducing labour
Suspected IUGR, Rhesus, isoimmunisation, antepartum haemorrhage
Methods for inducing pregnancy
Prostaglandins- PGE2 Dinoprostone
Mechanical- membrane sweep, foley balloon, catheter
Amniotomy - artificial membrane rupture
IV syntocinon
