Abnormal Labour Flashcards
What is meant by malpresentation?
- non-vertex
- commonly breech
What is meant by malposition?
- OP or OT
- ABNORMAL position of the head
What is pre-term and post-term baby?
- pre-term: <37 wks
- post-term: >42 wks
How many percent of deliveries are c-sections in sCOTLAND?
- 30%
What are the diff. types of breech?
- Complete breech (feet folded at baby’s bottom)
- Footling breech
- frank breech (bottom first- legs point up to head)
What are the risks of a breech baby?
- cord prolapse are common, esp. in pre-term
- skinny baby
- delivery through a non-fully dilated cervix ; head entrapment —-C-SECTION
When is vaginal delivery NOT possible at all?
- when bby’s arm comes first
- commonly seen in twins
- pre-term baby
What is meant by brow presentation?
- 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
How may labour be abnormal?
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
What forms of analgesia is used for labour?
- 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)
Benefits of Epidural anaethesia?
Name one.
- can be topped up during LONG period of labour
- 95% effective
- no uterine activity impairment
- Levobupivacaine +/- Opiate
Complications of epidural anesthesia?
Hypotension (20%)
Dural puncture (1%)
—>Headache
High block (excessive block; respiratory distress)
Atonic bladder (40%)
Risks of Obstructed labour?
- sepsis
- uterine rupture (as uterus thins with every pregnancy; or previous c-section)
- obstructed AKI
- postpartum haemorrhage
- fistula formation (fetal head pressing on surrounding structures)
- fetal asphyxia
- neonatal sepsis
Extent of cervical dilatation?
-0-10cm
Who usually progresses faster with their deliveries?
- Parous women
Expected contractions in 10mins?
3-4
What is indicative of delay in delivery?
- <2cm dilatation in 4hrs in Stage 1 for Parous women (same with Nulliparous)
How may passages pose a problem in delivery?
- short stature
- trauma
- shape
What factors to consider for the “passenger”?
- bigbaby
- malposition
List the change in fetal head orientation as it descends the pelvis?
- DESCENT: Head engages and in OCCIPUT TRANSVERSE position
- FLEXION: whilst descending through the pelvis; head flexes (chin-to-chest); still in OCCIPUT TRANSVERSE position; anterior fontanelle hard to feel
- INTERNAL ROTATION: occiput rotates anteriorly; head is now oblique or may be in OA
- Extension of head (not touching chest)
- shoulder to rotate to AP position
- –foetal head returns to TRANSVERSE position
What is the MAIN deterrent in the delivery of the baby?
- flexion of the fetal head
What is set as 0 for measuring the descent of the fetus?
- ischial spine
- below = +1 , +2…
- bby feels big
- labor all day
- at 6 cm for 4 hrs
—-only -1 descent if baby
What is the course of action?
- offer c-section
What is involved in the intra-partum fetal assessment?
- color of amniotic fluid
- CTG
- Doppler Auscultation
When to monitor fetal heart during Stage 1 and 2?
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
Acute causes of fetal distress?
Abruption Vasa Praevia Cord Prolapse- deceleration Uterine Rupture Feto-maternal Haemorrhage Uterine Hyperstimulation Regional Anaesthesia
Chronic causes of fetal distress?
Placental insufficiency
- fetal anemia
What do Late decelerations indicate?
- bby is hypoxic
How does complicated variable decelerations appear?
- deep and broad deceleration
- –
What should CTG be classified as?
- normal/ suspicious/ pathological
How does hypoxia appear on CTG?
- loss of accelerations
- Repetitive deeper and wider decelerations
- Rising fetal baseline heart rate
- Loss of variability
Management of fetal distress
- 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)
How is fetal blood sampling done?
- edoscope through the vagina into the uterus; is used to obtain blood sample from the baby’s scalp
What is operative vaginal delivery?
When can it be done?
- the delivery of the bby PV; with the aid fof forceps/ vaccum by the operator
- if baby is at or below the ischial spine
When is forcep delivery indicated?
“Standard” Indications: Delay (failure to progress stage 2)
OR
Fetal distress
Special indications for forcep use?
Maternal cardiac disease
Severe PET / Eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse Stage 2
Ventouse is a.w :
- INCREASED: failure/ cephalohematoma/ retinal hemorrhage/ maternal worry
- DECREASED: anaesthesia/ vaginal trauma/ perineal pain
Main indications of C-section?
previous CS fetal distress failure to progress in labour breech presentation maternal request
Risk of C-section?
- 4x GREATER maternal mortality a.w CS
Why is there a huge risk with c-section
sepsis, haemorrhage, VTE, trauma, TTN (transient tachypnea of newborn- fluid in lungs) , subfertility, regret, complications in future pregnancy
Best head position for the baby to smoothly delivered?
- if the head is well flexed; with chin tucked into the chest
- —–smallest diameter of 9.5cm
What 3 things are considered for assessing the progress in labour?
- cervical dilatation
- descent of presenting part
- signs of obstruct.
What are the signs of obstruction?
- moulding
- caput
- anuria
- hematuria
- vulval edema
How is the power of the labour affected?
- inadequate contractions
- frequency
- and/or strength
If the result from the fetal blood sampling is <7.2 ph; what does it mean?
- means HYPOXIA!
so DELIVER!
—-DON’T deliver if >7.2 ph
Signs of fetal asphyxia?
- abnormal HR
- pathological CTG readings
- green-meconium stained amniotic fluid
- LOW blood- fetal scalp ph (<7.5) = fetal hypoxia!!!
