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3 Reproduction > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

Reasons for abnormal labour

A

malpresentation (non-vertex)

malposition (OP or OT)

Pre-term

Post-term

Obstruction

Fetal distress

too painful

too long - failure to progress

too quick - hyper stimulation

fetal distress - hypoxia/sepsis

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2
Q

complications of breech presentation

A

cord prolapse

body gets out through the cervix but the baby head gets stuck

head entrapment in the abdomen - does not come into pelvis

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3
Q

types of malpresentation

A

Breech (3 types- complete, footling or frank breech)

Transverse

Shoulder/arm

face (face is the same diameter as a well flexed vertex so should still deliver if anterior)

brow (brown is leading - gives v wide head diameter)

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4
Q

after how many weeks do you induce labour

A

42 weeks - if normal baby

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5
Q

what analgesia is used in labour

A 
Peer support 
Massage/relaxation techniques 
Inhalation agents - entonox 
TENS (transcutaneous enteric nerve stimulation) 
Water immersion 
IM opiate analgesia eg. morphine 
IV remifentanil 
Regional analgesia (epidural)
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6
Q

what are come complications of epidural anaesthetic

A

hypotension
dural puncture (gives headache next day)
headache
high block (can’t breath if it goes too high up)
atonic bladder (dont know when bladder is full)

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7
Q

what drugs are used in an epidural

A

Levobupivavaine +/- opiate

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8
Q

what are the risks for failure to progress in labour (obstructed labour)

A

Sepsis
Uterine rupture (less common in first baby, more likely if previous CS)
Obstructed AKI
Postpartum haemorrhage
Fistula formation (between vagina and rectum, or vagina and bladder)
Fetal asphyxia
Neonatal sepsis

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9
Q

how do you asses progress in labour

A

cervical dilation

descent of presenting part (compare to level of ischial spine)

signs of obstruction (moulding, caput (swelling of skull), anuria, haematuria, vulval oedema)

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10
Q

failure to progress in Nulliparous labour (first baby)

A

<2cm dilation in 4 hours

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11
Q

failure to progress in porous labour (had babies before)

A

<2cm dilation in 4 hours or slowing in progress

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12
Q

what are the 3Ps in labour which could be causing failure to progress

A

Powers:
(inadequate contractions, frequency or strength) should be 3-4 every 10 mins

Passages:
(short stature, trauma, shape of pelvis)

Passenger:
(big baby, malposition)

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13
Q

what is a partogram

A

graphic representation of the progress of labour

commence as soon as in established labour

records:

  • fetal heart
  • amniotic fluid
  • cervical dilation
  • descent
  • contractions
  • obstruction
  • maternal observations
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14
Q

what is intra-partum fetal assessment

A

Doppler auscultation of fetal heart

  • stage 1 - during and after contraction (every 15 mins)
  • stage 2 - at least every 5 minters during and after contraction for 1 whole minute, and check mat pulse every 15 mins

If complicated- Electronic fetal monitoring (cardiotocograph)

Look at colour of amniotic fluid

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15
Q

what are the risk factors for fetal hypoxia

A 
small fetus 
preterm/post dates 
antepartum haemorrhage 
hypertension/pre-eclampsia 
diabetes 
meconium 
epidural analgesia 
Vaginal birth after CS
Premature rupture of membranes >24 hours
Sepsis 
Induction of labour
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16
Q

what is cord prolapse

A

cord comes first - gets crushed as uterus contracts

17
Q

causes of chronic fetal distress

A

placental insufficiency

fetal anaemia (rare)

18
Q

causes of acute fetal distress

A 
placental abruption 
vasa praaevia (free fetal blood vessels near the opening of the uterus)
cord prolapse 
uterine rupture 
veto-maternal haemorrhage 
uterine hyper stimulation 
regional anaesthesia
19
Q

what a normal CTG baseline fetal heart rate rate at term

A

110-150

20
Q

what is a fetal tachycardia

A

> 150

21
Q

what is a fetal bradycardia

A

<110

22
Q

what a normal variability in fetal heart rate and what does it show

A

5-25 bpm (varies within 1-25 bpm around 110-150bpm)

shows the baby is well oxygenated

if reduced 0 baby is hypoxic

23
Q

when is it normal to have a deceleration in fetal heart rate

A

as head enters the pelvis

after a contraction

24
Q

most common type of decelerations

A

variable

sometimes happens before contractions, sometimes happens after

25
Q

how do you asses CTG

A 
Baseline rate 
variability 
accelerations 
decelerations 
overall impression

classified as:
normal
suspicious
pathological

26
Q

characteristics of hypoxia in labour

A

loss of accelerations

repetitive deeper and wider decelerations

rising fetal baseline heart rate

loss of variability

27
Q

DRCBRAVADO for CTG interpretation

A 
Determine 
Risk 
Contractions 
Baseline 
Rate 
Variability 
Accelerations 
Decelerations 
Overall impression
28
Q

how do you manage fetal distress

A

Change maternal position

IV fluids

Stop syntocinon

Sclap stimulation

Consider tocolysis (terbutaline) (labour suppressant)

Maternal assessment (pulse, BP, abdomen, VE)

Fetal blood sampling

operative delivery

29
Q

normal fetal blood sampling PH

A

> 7.25

<7.2 is abnormal - need to deliver

30
Q

indications for instrumental delivery (forceps)

A

Standard:

  • delay (failure to progress to stage 2)
  • fetal distress

special indications:

  • maternal cardiac disease
  • severe pre-ecplampsia/eclampsia
  • intrapartum haemorrhage
  • umbilical cord prolapse stage 2
31
Q

rates of CS in tayside

A

30%

32
Q

indications for CS

A 
previous CS
fetal distress 
failure to progress 
breech presentation 
maternal request
33
Q

what is the maternal mortality associated with CS

A

4x greater mortality

34
Q

causes of maternal death with CS

A 
sepsis 
haemorrhage 
VTE
trauma 
TTN (transient tachypnea of the newborn)
subfertility 
regret 
complications in future pregnancy
35
Q

complications with CS

A 
sepsis 
haemorrhage 
VTE
trauma 
TTN 
subfertility 
regret 
complications in future pregnancy
36
Q

what is a late deceleration

A

a deceleration that occurs after a contraction

37
Q

what is an early deceleration

A

a deceleration that occurs before a contraction

3 Reproduction (49 decks)

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