Abnormal Labour Flashcards
What is malpresentation in terms of abnormal labour?
Presentation of the fetus other than the vertex
What is malposition in terms of abnormal labour?
When there is abnormal position of the vertex of the fetal head
Why are all women induced at 42 weeks?
Risk of stillbirth post-term
What are the three types of breech that may be seen at labour?
Complete breech
Footling breech
Frank breech
Give some risks of a vaginal breech delivery
Fetal trauma
Head entrapment leading to fetal hypoxia
What methods of analgesia can be used in abnormal labour?
Inhalational agents (entonox) TENS IM opiate analgesia IV remifentanil Epidural anaesthesia
Give some complications of epidural anaesthesia
Hypotension Dural puncture Headache High block (blocks the phrenic nerve) Atonic bladder
Give some potential causes of obstructed labour
Sepsis Uterine rupture Obstructed AKI PPH Fetal asphyxia
What is the best way to assess progress in labour?
Vaginal examination
When is a woman said to have failure to progress in labour?
<2cm dilation in 4 hours
Give some reasons for failing to progress in labour according to the three P’s
Power - inadequate contractions
Passages - short stature/trauma
Passenger - big baby/malposition
What is assessed on a partogram?
Fetal heart Amniotic fluid Cervical dilatation Descent Contractions Obstruction
When is CTG carried out during the first stage of labour?
During and after a contraction
Every 15 minutes
When is CTG carried out during the second stage of labour?
Every 5 minutes
After a contraction for 1 whole minute
Why is the fetal heart listened to after a contraction?
As it could show decelerations which are a sign of hypoxia
Give some risk factors for fetal hypoxia
Small fetus Antepartum haemorrhage Hypertension/pre-eclapsia Diabetes Meconium
What is measured on the CTG assessment?
Recording of contractions
Accelerations/decelerations
Variability
Baseline heart rate
What is the normal range for fetal heart rate?
110-150bpm
What should be assessed when reviewing the CTG?
Baseline fetal heart rate
Baseline variability
Presence/absence of decelerations
Presence of accelerations
Give some methods of managing fetal distress
Change maternal position IV fluids Scalp stimulation Tocolysis (too many contractions) Fetal blood sampling
What is measured on fetal blood sampling?
Scalp pH
When is scalp pH considered abnormal?
<7.2
Give some indications for performing an operative delivery
Failure to progress to stage 2
Fetal distress
Maternal cardiac disease
Severe PET
What surgical tools can be used for performing an operative delivery?
Ventouse
Forceps
Give some indications for performing a C-section
Previous C-section Fetal distress Failure to progress in labour Breech Maternal request
What is aortocaval compression?
When the gravid uterus compresses the IVC and aorta decreasing cardiac output and precipitating collapse
After how many minutes of no response to correctly performed CPR in a pregnant mother should a C-section be performed?
4 minutes
