abnormal labour Flashcards by holly strachan

what can go wrong in labour

malpresentation (non-vertex)
malposition (OP or OT)
preterm (<37 weeks)
post-term (>42 weeks)
obstruction
fetal distress

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what is the vertex bounded by

anterior and posterior fontanelles

parietal eminences

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what is a complete breech

legs folded wit feet at the level of the baby’s bottom

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what is a footling breech

one or both feet point down so the legs would emerge first

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what is a frank breech

legs point up with feet by the baby’s head so the bottom emerges first

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what are the different types of malpresentation

breech (3 types)
transverse 
shoulder/arm 
face 
brow

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what analgesia is available during labour

massage/relaxation techniques 
inhalation agents (entonox)
TENS
water immersion
IM opiate analgesia eg morphine
IV remifentanil 
regional anaesthesia

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pros of epidural anaesthesia

complete pain relief in 95%

does not impair uterine activity

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complications of epidural anaesthesia

hypotension
dural puncture
headache 
high block 
atonic bladder

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complications of obstructed labour

sepsis 
uterine rupture
obstructed AKI
PPH
fistula formation 
fetal asphyxia 
neonatal sepsis

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how can progress in labour be assessed

cervical dilatation
descent of presenting part
signs of obstruction

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what are signs of obstruction

moulding 
caput 
anuria 
haematuria 
vulval oedema

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definition of failure to progress in stage 1

nulliparous = <2 cm dilation in 4 hours 
porous = <2 cm dilation in 4 hours or slowing in progress

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what are the 3 P’s in failure to progress

power
passage
passenger

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what is recorded on the partogram

fetal heart 
amniotic fluid 
cervical dilation 
descent 
contractions 
obstruction (moulding)
maternal observations

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what is involved in intra-partum fetal assessment

doppler auscultation of fetal heart
electronic fetal monitoring (CTG)
colour of amniotic fluid

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how often should the fetal heart rate be assessed

stage 1;
during and after a contraction
every 15 minutes
stage 2;
at least every 5 minutes during and after a contraction for 1 whole minute
*check maternal pulse at least every 15 minutes

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what are risk factors for fetal hypoxia

small fetus
preterm/post dates 
antepartum haemorrhage 
HTN/PET
DM
meconium
epidural analgesia 
vaginal birth after caesarean PROM >24 hr
sepsis (temp >38)
induction/augmentation of labour

what can cause acute fetal distress

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

what can cause chronic fetal distress

placental insufficiency

fetal anaemia

which features should be assessed when reviewing a CTG

baseline fetal heart rate
baseline variability
presence or absence of decelerations
presence of accelerations

what is a normal/reassuring baseline fetal heart rate

100-160

what is non-reassuring baseline variability

<5 for 30-90 minutes

what is abnormal baseline fetal heart rate

> 180

<100

what is abnormal baseline variability

<5 for over 90 minutes

what kind of decelerations are abnormal

non-reassuring variable decelerations late decelerations Brady cardia or single prolonged deceleration lasting 3 minutes or more

what mnemonic is used to evaluate CTGs

``` DR C BRAVADO Define Risk Contractions Baseline RAte Variability Accelerations Decelerations Overall impression ```

how to manage fetal distress

``` change of maternal position IV fluids stop syntocinon scalp stimulation tocolysis maternal assessment fetal blood sampling operative delivery ```

what is normal fetal blood sampling and what action should be taken

pH >7.25 | no action

what is borderline fetal blood sampling and what action should be take n

pH 7.20-7.25 | repeat in 30 minutes

what is abnormal fetal blood sampling and what action should be taken

pH <7.20 | deliver

what are standard indications for operative vaginal delivery

delay (failure to progress to stage 2) | fetal distress

what are special indications for operative vaginal delivery

maternal cardiac disease severe PET/eclampsia IPH umbilical cord prolapse in stage 2

how long should stage 2 last with and without epidural

prims 2 hours without; 3 hours with multips 1 hour without; 2 hours with

pros of ventouse delivery

decreased anaesthesia decreased vagina trauma decreased perineal pain

cons of ventouse delivery

increased failure increased cephalohaematoma increased retinal haemorrhage increased maternal work

what are the main indications for C-section

``` previous CS fetal distress failure to progress in labour breech presentation maternal request ```

what causes of morbidity are associated with CS

``` sepsis haemorrhage VTE trauma TTN subfertility regret complications in future pregnancy ```

what are obstetric emergencies

``` cord prolapse shoulder dystocia uterine inversion uterine rupture APH PPH sepsis PET/eclampsia ```

causes of maternal collapse (4H 4T)

``` hypovolaemia hypxoia hyperkalaemia/hypokalaemia hypothermia tablet or toxin tamponade tension pneumothorax thrombosis ```

what is supine hypotension and how is it caused

hypotension caused by lying in a supine position | gravid uterus compresses the IVC and aorta, reducing venous return and CO by up to 40%

how can supine hypotension be reversed

turn the woman into the left lateral position

why is CPR less effective in pregnant women

in non-pregnant women chest compression achieve around 30% of the normal CO in pregnant women, aortocaval compression reduces the CO to 10% that achieved in non-pregnant women

how long should CPR be carried out in response to maternal collapse

4 minutes | if no response delivery should be undertaken to assist maternal resuscitation