Abnormal Labour Flashcards
what can cause an abnormal labour?
malpresentation - not head coming first
malposition - occipito-posterior or occipito-transverse
preterm (<37 weeks) or post term (>42)
obstruction
foetal distress
what are the different types of breech presentation?
complete breech = both legs under foetus, born first
footling breech = one foot presents
frank breech = feet up by babys head, bottom presents first
other than breech, how can a baby present in the wrong way?
transverse
shoulder / arm
face
brow
how effective are epidurals in labour?
complete pain relief in 95%
women can have an epidural and still experience contractions that allow them to push in pregnancy - true or false?
true - uterine muscles not affected by anaesthesia
why may an epidural inhibit progress during stage 2 of labour?
numbs and relaxes the pelvic floor
pelvic floor muscles are needed to provide resistance to babys head causing it to flex before birth
what else is usually injected alongside local anaesthetic in an epidural?
opiate
what are the main complications of an epidural?
hypotension (20%)
dural puncture (1%)
headache (due to dural puncture - worst day after birth)
high block (may cause resp depression - SOB)
atonic bladder (women don’t know when bladder is full)
what becomes a higher risk if a labour is obstructive?
maternal or neonatal sepsis
uterine rupture (esp if previous c-section)
obstructed AKI (if foetal head is compressing ureters)
PPH (uterus works so hard in obstructed labour that it gives up and does not constrict blood vessels after)
fistula formation (recto-vaginal)
foetal asphaxia
how can progress during labour be assessed?
cervical dilatation
descent of presenting part
signs of obstruction - moulding, caput, vulval oedema
what measurements of cervical dilatation would make you consider delayed labour?
<2cm dilation in 4 hours
OR if labour is slowing in progress in a lady who has had children before
station is measured in relation to what landmark in the mother?
ischial spines
what the 3 Ps considered when a labour shows failure to progress?
powers: inadequate contractions
passages: short stature / pelvis shape
passenger: big baby, malposition / malpresentation
what is assessed on a partogram?
foetal heart rate amniotic fluid cervical dilatation descent contractions obstructions - moulding / caput maternal observations (BP, pulse)
how often should a doppler be used to assess foetal heart rate in the 1st and 2nd stages of labour?
1st stage
- measure during and after contraction (every 15 mins)
2nd stage
- every 5 minutes
- and during and after a contraction for a 1 whole minute
- check maternal pulse at least every 15 minutes
how else can the foetus be assessed during labour?
electrical foetal monitoring
cardiotocograph (CTG)
colour of amniotic fluid
what factors can increase the risk of foetal hypoxia?
small foetus preterm / post dates antepatrum haemorrhage hypertension / pre-eclampsia diabetes meconium epidural analgesia sepsis IOL
what acute causes are there for foetal distress?
abruption vasa praevia cord prolapse uterine rupture feto-maternal haemorrhage uterine hyperstimulation regional anaesthesia
if a baby is presenting breech, what complication are they at increased risk of?
cord prolapse
due to feed presenting first -> space around feet for cord to prolapse
what are the chronic causes of foetal distress?
placental insufficiency
foetal anaemia
what features of a CTG should be assessed on review?
baseline foetal heart rate
variability
presence / absence of declerations
presence of accelerations
how should a CTG be classified?
normal
suspicious
pathological
what CTG changes may indicate foetal hypoxia has evolved in labour?
loss of accelerations
repetitive deeper and wider decelerations
rising foetal baseline HR
loss of variability
what mnemonic is used to interpret a CTG?
“Dr C Bravado”
D ETERMINE R ISK C ONTRACTIONS B ASELINE R A TE V ARIABILITY A CCELERATIONS D ECELERATIONS O VERALL IMPRESSION
