Abnormal Labour Flashcards
Reasons for abnormal labour
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
complications of breech presentation
cord prolapse
body gets out through the cervix but the baby head gets stuck
head entrapment in the abdomen - does not come into pelvis
types of malpresentation
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)
after how many weeks do you induce labour
42 weeks - if normal baby
what analgesia is used in labour
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)
what are come complications of epidural anaesthetic
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)
what drugs are used in an epidural
Levobupivavaine +/- opiate
what are the risks for failure to progress in labour (obstructed labour)
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
how do you asses progress in labour
cervical dilation
descent of presenting part (compare to level of ischial spine)
signs of obstruction (moulding, caput (swelling of skull), anuria, haematuria, vulval oedema)
failure to progress in Nulliparous labour (first baby)
<2cm dilation in 4 hours
failure to progress in porous labour (had babies before)
<2cm dilation in 4 hours or slowing in progress
what are the 3Ps in labour which could be causing failure to progress
Powers:
(inadequate contractions, frequency or strength) should be 3-4 every 10 mins
Passages:
(short stature, trauma, shape of pelvis)
Passenger:
(big baby, malposition)
what is a partogram
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
what is intra-partum fetal assessment
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
what are the risk factors for fetal hypoxia
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
what is cord prolapse
cord comes first - gets crushed as uterus contracts
causes of chronic fetal distress
placental insufficiency
fetal anaemia (rare)
causes of acute fetal distress
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
what a normal CTG baseline fetal heart rate rate at term
110-150
what is a fetal tachycardia
> 150
what is a fetal bradycardia
<110
what a normal variability in fetal heart rate and what does it show
5-25 bpm (varies within 1-25 bpm around 110-150bpm)
shows the baby is well oxygenated
if reduced 0 baby is hypoxic
when is it normal to have a deceleration in fetal heart rate
as head enters the pelvis
after a contraction
most common type of decelerations
variable
sometimes happens before contractions, sometimes happens after
how do you asses CTG
Baseline rate variability accelerations decelerations overall impression
classified as:
normal
suspicious
pathological
characteristics of hypoxia in labour
loss of accelerations
repetitive deeper and wider decelerations
rising fetal baseline heart rate
loss of variability
DRCBRAVADO for CTG interpretation
Determine Risk Contractions Baseline Rate Variability Accelerations Decelerations Overall impression
how do you manage fetal distress
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
normal fetal blood sampling PH
> 7.25
<7.2 is abnormal - need to deliver
indications for instrumental delivery (forceps)
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
rates of CS in tayside
30%
indications for CS
previous CS fetal distress failure to progress breech presentation maternal request
what is the maternal mortality associated with CS
4x greater mortality
causes of maternal death with CS
sepsis haemorrhage VTE trauma TTN (transient tachypnea of the newborn) subfertility regret complications in future pregnancy
complications with CS
sepsis haemorrhage VTE trauma TTN subfertility regret complications in future pregnancy
what is a late deceleration
a deceleration that occurs after a contraction
what is an early deceleration
a deceleration that occurs before a contraction
