abnormal labour Flashcards
what can go wrong in labour
malpresentation (non-vertex) malposition (OP or OT) preterm (<37 weeks) post-term (>42 weeks) obstruction fetal distress
what is the vertex bounded by
anterior and posterior fontanelles
parietal eminences
what is a complete breech
legs folded wit feet at the level of the baby’s bottom
what is a footling breech
one or both feet point down so the legs would emerge first
what is a frank breech
legs point up with feet by the baby’s head so the bottom emerges first
what are the different types of malpresentation
breech (3 types) transverse shoulder/arm face brow
what analgesia is available during labour
massage/relaxation techniques inhalation agents (entonox) TENS water immersion IM opiate analgesia eg morphine IV remifentanil regional anaesthesia
pros of epidural anaesthesia
complete pain relief in 95%
does not impair uterine activity
complications of epidural anaesthesia
hypotension dural puncture headache high block atonic bladder
complications of obstructed labour
sepsis uterine rupture obstructed AKI PPH fistula formation fetal asphyxia neonatal sepsis
how can progress in labour be assessed
cervical dilatation
descent of presenting part
signs of obstruction
what are signs of obstruction
moulding caput anuria haematuria vulval oedema
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
what are the 3 P’s in failure to progress
power
passage
passenger
what is recorded on the partogram
fetal heart amniotic fluid cervical dilation descent contractions obstruction (moulding) maternal observations
what is involved in intra-partum fetal assessment
doppler auscultation of fetal heart
electronic fetal monitoring (CTG)
colour of amniotic fluid
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
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
