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REPRO > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

What is meant by malpresentation?

A
  • non-vertex

- commonly breech

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2
Q

What is meant by malposition?

A
  • OP or OT

- ABNORMAL position of the head

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3
Q

What is pre-term and post-term baby?

A
  • pre-term: <37 wks

- post-term: >42 wks

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4
Q

How many percent of deliveries are c-sections in sCOTLAND?

A
  • 30%
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5
Q

What are the diff. types of breech?

A
  • Complete breech (feet folded at baby’s bottom)
  • Footling breech
  • frank breech (bottom first- legs point up to head)
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6
Q

What are the risks of a breech baby?

A
  • cord prolapse are common, esp. in pre-term
  • skinny baby
  • delivery through a non-fully dilated cervix ; head entrapment —-C-SECTION
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7
Q

When is vaginal delivery NOT possible at all?

A
  • when bby’s arm comes first
  • commonly seen in twins
  • pre-term baby
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8
Q

What is meant by brow presentation?

A
  • bby’s chin is untucked
  • slightly extended backwards (not as sharp as the face presentation)
  • —- if chin is at the back; bby won’t deliver
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9
Q

How may labour be abnormal?

A 
Too early - preterm birth
Too late – induction of labour
Too painful - requires anaesthetic input
Too long - failure to progress
Too quick- hyperstimulation; fetal hypoxia ! ----uterine contractions on baby 
Fetal distress - hypoxia/sepsis
Wrong part presenting
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10
Q

What forms of analgesia is used for labour?

A
  • support (other people- females)
  • massage techniques
  • TENS (transcutaneous electrical nerve stimulation)—–electric pads on lower thoracic and lumbar
  • water immersion
  • IM opiate analgesia (at peak of contrxn; good for fast labour)
  • IV Remifentanil PCA
  • regional anaesthesia
  • entonox (inhalation agents)
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11
Q

Benefits of Epidural anaethesia?

Name one.

A
  • can be topped up during LONG period of labour
  • 95% effective
  • no uterine activity impairment
  • Levobupivacaine +/- Opiate
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12
Q

Complications of epidural anesthesia?

A

Hypotension (20%)
Dural puncture (1%)
—>Headache
High block (excessive block; respiratory distress)

Atonic bladder (40%)

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13
Q

Risks of Obstructed labour?

A
  1. sepsis
  2. uterine rupture (as uterus thins with every pregnancy; or previous c-section)
  3. obstructed AKI
  4. postpartum haemorrhage
  5. fistula formation (fetal head pressing on surrounding structures)
  6. fetal asphyxia
  7. neonatal sepsis
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14
Q

Extent of cervical dilatation?

A

-0-10cm

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15
Q

Who usually progresses faster with their deliveries?

A
  • Parous women
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16
Q

Expected contractions in 10mins?

A

3-4

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17
Q

What is indicative of delay in delivery?

A
  • <2cm dilatation in 4hrs in Stage 1 for Parous women (same with Nulliparous)
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18
Q

How may passages pose a problem in delivery?

A
  • short stature
  • trauma
  • shape
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19
Q

What factors to consider for the “passenger”?

A
  • bigbaby

- malposition

20
Q

List the change in fetal head orientation as it descends the pelvis?

A
  1. DESCENT: Head engages and in OCCIPUT TRANSVERSE position
  2. FLEXION: whilst descending through the pelvis; head flexes (chin-to-chest); still in OCCIPUT TRANSVERSE position; anterior fontanelle hard to feel
  3. INTERNAL ROTATION: occiput rotates anteriorly; head is now oblique or may be in OA
  4. Extension of head (not touching chest)
  5. shoulder to rotate to AP position
    - –foetal head returns to TRANSVERSE position
21
Q

What is the MAIN deterrent in the delivery of the baby?

A
  • flexion of the fetal head
22
Q

What is set as 0 for measuring the descent of the fetus?

A
  • ischial spine

- below = +1 , +2…

23
Q
  • bby feels big
  • labor all day
  • at 6 cm for 4 hrs
    —-only -1 descent if baby
    What is the course of action?
A
  • offer c-section
24
Q

What is involved in the intra-partum fetal assessment?

A
  • color of amniotic fluid
  • CTG
  • Doppler Auscultation
25
Q

When to monitor fetal heart during Stage 1 and 2?

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 mins
26
Q

Acute causes of fetal distress?

A 
Abruption
Vasa Praevia
Cord Prolapse- deceleration
Uterine Rupture
Feto-maternal Haemorrhage
Uterine Hyperstimulation
Regional Anaesthesia
27
Q

Chronic causes of fetal distress?

A

Placental insufficiency

- fetal anemia

28
Q

What do Late decelerations indicate?

A
  • bby is hypoxic
29
Q

How does complicated variable decelerations appear?

A
  • deep and broad deceleration

- –

30
Q

What should CTG be classified as?

A
  • normal/ suspicious/ pathological
31
Q

How does hypoxia appear on CTG?

A
  • loss of accelerations
  • Repetitive deeper and wider decelerations
  • Rising fetal baseline heart rate
  • Loss of variability
32
Q

Management of fetal distress

A
  • Change maternal position
  • IV Fluids
    -Stop syntocinon
    -Scalp stimulation
    -Consider tocolysis— Terbutaline 250 micrograms s/c
    -Maternal assessment - Pulse / BP / Abdomen / VE
    Fetal blood sampling
    Operative Delivery (Category 1 delivery)
33
Q

How is fetal blood sampling done?

A
  • edoscope through the vagina into the uterus; is used to obtain blood sample from the baby’s scalp
34
Q

What is operative vaginal delivery?

When can it be done?

A
  • the delivery of the bby PV; with the aid fof forceps/ vaccum by the operator
  • if baby is at or below the ischial spine
35
Q

When is forcep delivery indicated?

A

“Standard” Indications: Delay (failure to progress stage 2)

OR
Fetal distress

36
Q

Special indications for forcep use?

A

Maternal cardiac disease
Severe PET / Eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse Stage 2

37
Q

Ventouse is a.w :

A
  • INCREASED: failure/ cephalohematoma/ retinal hemorrhage/ maternal worry
  • DECREASED: anaesthesia/ vaginal trauma/ perineal pain
38
Q

Main indications of C-section?

A 
previous CS
fetal distress
failure to progress in labour
breech presentation
maternal request
39
Q

Risk of C-section?

A
  • 4x GREATER maternal mortality a.w CS
40
Q

Why is there a huge risk with c-section

A

sepsis, haemorrhage, VTE, trauma, TTN (transient tachypnea of newborn- fluid in lungs) , subfertility, regret, complications in future pregnancy

41
Q

Best head position for the baby to smoothly delivered?

A
  • if the head is well flexed; with chin tucked into the chest
  • —–smallest diameter of 9.5cm
42
Q

What 3 things are considered for assessing the progress in labour?

A
  • cervical dilatation
  • descent of presenting part
  • signs of obstruct.
43
Q

What are the signs of obstruction?

A
  • moulding
  • caput
  • anuria
  • hematuria
  • vulval edema
44
Q

How is the power of the labour affected?

A
  • inadequate contractions
  • frequency
  • and/or strength
45
Q

If the result from the fetal blood sampling is <7.2 ph; what does it mean?

A
  • means HYPOXIA!
    so DELIVER!

—-DON’T deliver if >7.2 ph

46
Q

Signs of fetal asphyxia?

A
  • abnormal HR
  • pathological CTG readings
  • green-meconium stained amniotic fluid
  • LOW blood- fetal scalp ph (<7.5) = fetal hypoxia!!!

REPRO (55 decks)

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