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Reproductive - Childbirth > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

What is malpresentation?

A

Presentation of the foetus other than the vertex

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2
Q

What is malposition? Give some examples.

A

The vertex has presented first but not in the right direction e.g. OP or OT

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3
Q

What is the management of each of the following malpositions: a) OP? b) OT?

A

a) can be delivered vaginally b) C-section required

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4
Q

Define preterm and post-term delivery?

A

Pre-term = < 37 weeks, post-term = > 42 weeks

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5
Q

What is the risk of having a post-term baby?

A

After term, the rates of stillbirth increase exponentially

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6
Q

What is the vertex bound by?

A

The anterior and posterior fontanelles and the 2 parietal eminences

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7
Q

What is used to assess a baby’s position during delivery?

A

Feeling the fontanelles on vaginal examination

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8
Q

How do you differentiate between the anterior and posterior fontanelles on palpation?

A

Anterior fontanelle is diamond shaped and the posterior fontanelle is triangle shaped

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9
Q

There are higher chances of having a normal vaginal delivery in who?

A

Women who have already had a normal vaginal delivery

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10
Q

Forceps and C-section delivery are more likely in who?

A

Women who have never had a baby before

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11
Q

What is the management of a cord prolapse?

A

Emergency C-section within 30 minutes

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12
Q

Malpresentation is only a problem when?

A

When the woman is in active labour, especially if the membranes have ruptured

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13
Q

What is the commonest type of malpresentation? What part is presenting first?

A

Breech - the baby’s bottom is the presenting part

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14
Q

Aside from a breech, what are some other type of malpresentation? What part is presenting first?

A

Transverse (shoulder presenting part), mentoanterior/mentoposterior (chin presenting part) or brow (face presenting first)

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15
Q

What is the management for each of the following presentations: a) mentoanterior? b) mentoposterior?

A

a) can be delivered vaginally b) C-section

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16
Q

If a woman is known to be carrying a breech baby they should be counselled about this. What should you explain to them?

A

That a breech presentation can result in foetal parts passing through an undilated cervix, which can cause larger structures such as the head to get stuck which can cause hypoxia

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17
Q

Describe the management of breech presentations?

A

Frank or complete breech babies can still be delivered vaginally, though most mothers opt for an elective C-section. A footling breech must be delivered by C-section (because there is nothing pressing on the cervix causing it to dilate)

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18
Q

Can an a) transverse presentation and b) brow presentation be delivered?

A

a) no b) no

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19
Q

If a malpresentation is suspected, how should the diagnosis be confirmed?

A

US

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20
Q

Describe the process of picking regional anaesthesia for delivery?

A

Epidural is usually used, it is good since it can last through all of labour as it can be topped up. If under time pressure, a spinal anaesthetic takes 15 minutes and a GA even less.

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21
Q

In an epidural anaesthetic, what is injected?

A

A local anaesthetic and an opioid

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22
Q

The first dose of epidural is essentially a test run to ensure what?

A

Intrathecal injection has not occurred

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23
Q

What are some complications of epidural anaesthetic?

A

Hypotension, dural puncture, headache, atonic bladder

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24
Q

What are downsides to epidural use in labour?

A

Can inhibit and prolong stage 2 of labour, requires monitoring and IV access, reduces mobility

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25
Q

What are some complications of failure to progress?

A

Sepsis (maternal and neonatal), uterine rupture, obstructed AKI, PPH, foetal asphyxia

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26
Q

How is the progress of labour assessed?

A

Cervical dilatation, descent of presenting part, signs of obstruction

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27
Q

What are some signs of obstruction?

A

Moulding, caput, anuria, haematuria, vulval oedema

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28
Q

In a low risk delivery, when should vaginal examination be done?

A

Only when you need to or if there are signs of foetal distress

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29
Q

In a high risk delivery, when should vaginal examination be done?

A

Every 4 hours

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30
Q

In the first stage of labour, when do you suspect delay?

A

If there has been < 2cm dilatation in 4 hours in both nulliparous and parous women. Also if there is slowing in progress in a parous woman.

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31
Q

In the second stage of labour, when do you suspect delay?

A

Nulliparous: failure to deliver within 2 hours of active pushing / parous: failure to deliver within 1 hour of active pushing (add 1 hour to both if regional anaesthesia)

32
Q

What is the main cause of failure to progress due to power?

A

Inadequate contractions - frequency or strength

33
Q

What amount of contractions in 10 minutes is a) normal? b) hyperstimulation? c) inadequate?

A

a) 3-5 b) > 5 c) < 3

34
Q

In failure to progress, how is the power assessed?

A

By how much the uterine contractions are affecting the dilatation of the cervix

35
Q

What is the main cause of failure to progress due to passages? What are some causes for this?

A

Mismatch in the size between the pelvis and foetus / short stature or pelvic trauma

36
Q

What are some causes of failure to progress due to passenger?

A

Foetal size, presentation or position

37
Q

What is the first thing to do to manage failure to progress if it has not happened already?

A

Artificial rupture of membranes

38
Q

How is failure to progress managed in the first stage of labour?

A

IV syntocinon is given and vaginal exam done 4 hours later. If dilatation has not increased by at least 2cm then a C-section is indicated.

39
Q

How is failure to progress managed in the second stage of labour?

A

If the station is 0 or more then aim for operative vaginal delivery, if not then C-section

40
Q

Foetal distress is suspected based on what things?

A

Changes in heart rate, passage of meconium and decreased movements

41
Q

How is foetal heart rate monitoring in a) low risk pregnancies? b) high risk pregnancies?

A

a) Intermittent Doppler auscultation b) continuous CTG monitoring

42
Q

During the active phase of the 1st stage of labour, how often is Doppler auscultation of the foetal heart performed?

A

During and for 1 minute after every contraction or minimum every 15 minutes

43
Q

During the 2nd stage of labour, how often is Doppler auscultation of the foetal heart performed?

A

During and for 1 minute after every contraction or minimum every 5 minutes

44
Q

How are the results of intermittent Doppler auscultation of the foetal heart rate recorded?

A

Recorded as a single, average rate on the partogram

45
Q

During labour, the colour of the amniotic fluid is measured and recorded where?

A

On the partogram

46
Q

What colour should the amniotic fluid be?

A

Clear

47
Q

If the amniotic fluid is red, what does this suggest?

A

Presence of blood or clots e.g. antepartum haemorrhage

48
Q

If the amniotic fluid is brown/green, what does this suggest?

A

Meconium - this can be normal in late deliveries but can be a sign of foetal distress

49
Q

When you are auscultating the foetal heart after a contraction, what are you listening for?

A

The presence of late decelerations which are a sign of foetal hypoxia

50
Q

What are some acute aetiologies of foetal distress?

A

Antepartum haemorrhage (many causes), cord prolapse, uterine hyperstimulation, regional anaesthesia

51
Q

What are some chronic aetiologies of foetal distress?

A

Placental insufficiency or foetal anaemia

52
Q

What are some simple measures of management for foetal distress?

A

Change maternal position, IV fluids, stop syntocinon/consider tocolysis

53
Q

If tocolysis is to be given for foetal distress, what is used?

A

Terbutaline 250mcg SC

54
Q

When a CTG is pathological and delivery is not imminent, what is the best investigation to do? For this to be done, the cervix must be what?

A

Foetal blood sampling / 4cm+ dilated

55
Q

What are some last line management options for foetal distress?

A

Operative vaginal delivery or C-section

56
Q

If a foetal pH comes back as >7.25, what does this mean and what is the management?

A

Normal - no management

57
Q

If a foetal pH comes back as 7.2-7.25, what does this mean and what is the management?

A

Borderline, repeat test in 30 mins if no improvement

58
Q

If a foetal pH comes back as <7.2, what does this mean and what is the management?

A

Abnormal, deliver

59
Q

What are the main indications for operative vaginal delivery?

A

Failure to progress in the 2nd stage, contraindications to a prolonged 2nd stage (e.g. cardiac disease), maternal fatigue, suspected foetal compromise

60
Q

What are the two main options for operative vaginal delivery?

A

Ventouse or forceps

61
Q

What are the disadvantages to using a ventouse for operative vaginal delivery?

A

Increased failure rates, cephalohaematoma, retinal haemorrhage

62
Q

What are the advantages to using a ventouse for operative vaginal delivery?

A

Less anaesthesia needed, less perineal trauma

63
Q

With a forceps delivery, the baby is more likely to come out - why is a ventouse still considered over this?

A

Because forceps increase the diameter of the head and therefore are more painful

64
Q

What procedure is done in around 90% of operative vaginal deliveries?

A

Episiotomy

65
Q

PPH which occurs following an operative vaginal delivery is usually due to what?

A

Uterine atony or perineal trauma

66
Q

What harm may a forceps delivery cause to the baby?

A

May cause temporary marks on the baby’s face and can rarely cause a CNVII palsy

67
Q

What harm may a ventouse delivery cause to the baby?

A

Cause achignon - a swelling on the baby’s head which reduces in 48h

68
Q

What are the indications for emergency C-section?

A

Foetal compromise, cord prolapse, failure to progress despite use of syntocinon

69
Q

Why is there are increased risk of C-section babies having to go to the NICU?

A

They have breathing problems as the fluid is not expelled from the lungs as it would be in a vaginal delivery (transient tachypnoea of the newborn)

70
Q

The more C-sections a woman has, the risk of what increases in future pregnancies?

A

Placental problems

71
Q

Describe what happens in shoulder dystocia and how it should be managed?

A

The anterior shoulder gets stuck behind the symphysis pubis which causes hypoxia - you have 7 minutes to deliver the baby

72
Q

From 20 weeks, what effect can the gravid uterus have on the circulation in the supine position?

A

Compresses the IVC and aorta - reduces venous return causing supine hypotension

73
Q

Supine hypotension can precipitate what? How is this solved?

A

Maternal collapse / turning the woman to the left lateral position

74
Q

What must you do before performing CPR on a woman who is pregnant?

A

Displace the uterus or sit them up

75
Q

If there is no response to correctly performed CPR on a pregnant woman within 4 minutes of collapse, what is the management?

A

Delivery, to assist maternal resuscitation

Reproductive - Childbirth (9 decks)

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