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3 REPRO > abnormal labour > Flashcards

abnormal labour Flashcards

1
Q

what can go wrong in labour

A 
malpresentation (non-vertex)
malposition (OP or OT)
preterm (<37 weeks)
post-term (>42 weeks)
obstruction
fetal distress
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2
Q

what is the vertex bounded by

A

anterior and posterior fontanelles

parietal eminences

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3
Q

what is a complete breech

A

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

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4
Q

what is a footling breech

A

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

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5
Q

what is a frank breech

A

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

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6
Q

what are the different types of malpresentation

A 
breech (3 types)
transverse 
shoulder/arm 
face 
brow
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7
Q

what analgesia is available during labour

A 
massage/relaxation techniques 
inhalation agents (entonox)
TENS
water immersion
IM opiate analgesia eg morphine
IV remifentanil 
regional anaesthesia
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8
Q

pros of epidural anaesthesia

A

complete pain relief in 95%

does not impair uterine activity

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9
Q

complications of epidural anaesthesia

A 
hypotension
dural puncture
headache 
high block 
atonic bladder
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10
Q

complications of obstructed labour

A 
sepsis 
uterine rupture
obstructed AKI
PPH
fistula formation 
fetal asphyxia 
neonatal sepsis
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11
Q

how can progress in labour be assessed

A

cervical dilatation
descent of presenting part
signs of obstruction

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12
Q

what are signs of obstruction

A 
moulding 
caput 
anuria 
haematuria 
vulval oedema
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13
Q

definition of failure to progress in stage 1

A 
nulliparous = <2 cm dilation in 4 hours 
porous = <2 cm dilation in 4 hours or slowing in progress
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14
Q

what are the 3 P’s in failure to progress

A

power
passage
passenger

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15
Q

what is recorded on the partogram

A 
fetal heart 
amniotic fluid 
cervical dilation 
descent 
contractions 
obstruction (moulding)
maternal observations
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16
Q

what is involved in intra-partum fetal assessment

A

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

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17
Q

how often should the fetal heart rate be assessed

A

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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18
Q

what are risk factors for fetal hypoxia

A 
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
19
Q

what can cause acute fetal distress

A 
abruption
vasa praevia 
cord prolapse 
uterine rupture 
feto-maternal haemorrhage 
uterine hyperstimulation 
regional anaesthesia
20
Q

what can cause chronic fetal distress

A

placental insufficiency

fetal anaemia

21
Q

which features should be assessed when reviewing a CTG

A

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

22
Q

what is a normal/reassuring baseline fetal heart rate

A

100-160

23
Q

what is non-reassuring baseline variability

A

<5 for 30-90 minutes

24
Q

what is abnormal baseline fetal heart rate

A

> 180

<100

25
Q

what is abnormal baseline variability

A

<5 for over 90 minutes

26
Q

what kind of decelerations are abnormal

A

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

27
Q

what mnemonic is used to evaluate CTGs

A 
DR C BRAVADO
Define 
Risk 
Contractions 
Baseline 
RAte 
Variability 
Accelerations 
Decelerations 
Overall impression
28
Q

how to manage fetal distress

A 
change of maternal position
IV fluids 
stop syntocinon
scalp stimulation 
tocolysis 
maternal assessment 
fetal blood sampling 
operative delivery
29
Q

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

A

pH >7.25

no action

30
Q

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

A

pH 7.20-7.25

repeat in 30 minutes

31
Q

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

A

pH <7.20

deliver

32
Q

what are standard indications for operative vaginal delivery

A

delay (failure to progress to stage 2)

fetal distress

33
Q

what are special indications for operative vaginal delivery

A

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

34
Q

how long should stage 2 last with and without epidural

A

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

35
Q

pros of ventouse delivery

A

decreased anaesthesia
decreased vagina trauma
decreased perineal pain

36
Q

cons of ventouse delivery

A

increased failure
increased cephalohaematoma
increased retinal haemorrhage
increased maternal work

37
Q

what are the main indications for C-section

A 
previous CS
fetal distress 
failure to progress in labour
breech presentation 
maternal request
38
Q

what causes of morbidity are associated with CS

A 
sepsis 
haemorrhage 
VTE
trauma 
TTN
subfertility 
regret 
complications in future pregnancy
39
Q

what are obstetric emergencies

A 
cord prolapse 
shoulder dystocia 
uterine inversion 
uterine rupture 
APH
PPH
sepsis
PET/eclampsia
40
Q

causes of maternal collapse (4H 4T)

A 
hypovolaemia 
hypxoia 
hyperkalaemia/hypokalaemia 
hypothermia 
tablet or toxin 
tamponade 
tension pneumothorax 
thrombosis
41
Q

what is supine hypotension and how is it caused

A

hypotension caused by lying in a supine position

gravid uterus compresses the IVC and aorta, reducing venous return and CO by up to 40%

42
Q

how can supine hypotension be reversed

A

turn the woman into the left lateral position

43
Q

why is CPR less effective in pregnant women

A

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

44
Q

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

A

4 minutes

if no response delivery should be undertaken to assist maternal resuscitation

3 REPRO (40 decks)

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