Abnormal Labour Flashcards
examples of what can go wrong in labour?
mlapresentation (non-vertex e.g breech) malposition (OP or OT) pre-term (<37 weeks) post term (>42 weeks) obstruction fetal distress
what bounds the vertex?
bounded by the anterior and posterior fontanelles and the parietal eminences
types of breech?
complete = legs folded with feet at level of bottom
footling = one or both feet point down so the legs will engage first
frank (most common) = legs point up with feet y the babys head so the bottom engages first
complications of breech?
cord collapse
foetal head prolapse
other types of malpresentation?
transverse
shoulder/arm
face
brow
complications of post term?
malpositioning of baby (back to back with mum)
more likely to need C section
sepsis
analgesia techniques in labour?
support massage/relaxation techniques inhalaiton agents (entonox) TENS water immersion IM opiate (morphine) IV remifentanil PCA (good for fast moving labour who cant have nerve block etc) regional anaesthesia (epidural etc)
what is an epidural and what are the benefits?
levobupivacine +/- opiate
gives complete pain relief in 95%
does not impair uterine activity
complications of epidural?
may inhibit progress during stage 2 labour
hypotension (mainly) - due to vasodilation
dural puncture (will cause crashing, horrible headache)
headache
high block (anaesthesia rises too high up and can impair breathing)
atonic bladder
what does needle go through in epidural?
skin fat supraspinous ligament interspinous ligament ligamentum flavum
what risks come along with obstructed labour?
sepsis
uterine rupture (common in previous C section)
obstructed AKI (baby head pushing down obstructs urine tracts)
postpartum haemorrhage
fistula formation (between vagina and rectum/bladder)
foetal asphyxia
neonatal sepsis
how is progress in labour assessed?
cervical dilation (0-10cm) descent of presenting part any signs of obstruction (moulding, caput, anuria, haematuria, vulval oedema)
normal progression of cervical dilation in nulliparous women?
2cm in 4 hours
anything less is abnormal
normal progression of cervical dilation in parous women?
2cm in 4 hours
anything less or slowing in progress is abnormal
normal number of contractions?
3-4 in 10 mins
what are the 3 Ps which can impact progression of labour?
powers
- contractions (frequency and/or strength)
passages
- short stature/trauma/shape of pelvis
passenger
- big baby
- malposition (relative cephalo-pelvic disproportion)
one of the most common reasons for problem with progression of labour?
non-flexion of the foetal head so widest part is trying to pass through pelvis
what is the partogram and what does it measure?
graphic representation of progress of labour commence as soon as in established labour - fetal heart - amniotic fluid - cervical dilation - descent - contractions - obstructions - maternal obs
what may be given to help labour progress?
oxytocin infusion
when is doppler auscultation of the foetal heart used?
stage 1
- during and after contraction every 15 mins for a whole minute
stage 2
- at least every 5 mins during and after a contraction for 1 min and check maternal pulse at least every 15 mins
other monitoring during labour?
electronic foetal monitoring (cardiotocograph - CTG)
colour of amniotic fluid (e.g green can indicate maeconium)
risk factors for fetal hypoxia?
small foetus pre-term/post term antepartum haemorrhage hypertension/pre-eclampsia diabetes meconium epidural analgesia VBAC (vaginal birth after caesarean) continuous PROM >24hrs (premature rupture of membranes) sepsis (temp >38) induction/augmentation of labour
acute causes of fetal distress?
abruption vasa praevia cord prolapse uterine rupture feto-maternal haemorrhage uterine hyperstimulation regional anaesthesia
chronic causes of fetal distress?
placental insufficiency
fetal anaemia
normal neonatal baseline HR at term?
110-150
- accelerates when baby is moving about
- decelerates at times, e.g when head descends into pelvis, during contraction
- deceleration after contraction (late) can indicate hypoxia
- variable decelerations can indicate cord compression
normal variability in HR in term neonate?
5-25 bpm
higher or lower indicates hypoxia
what 4 features should be commented on in CTG assessment?
baseline foetal HR baseline variability presence or absence of decelerations presence of accelerations CTG should be classed as normal/suspicious/pathological
characteristics of hypoxia in baby?
loss of accelerations
repetitive deeper and wider decelerations
rising foetal baseline heart rate
loss of variability
acronym for CTG interpretation?
DR C BRAVADO
- determine
- risk
- contractions
- baseline
- R
- ate (rate)
- variability
- accelerations
- decelerations
- overall impression
definition of pathological CTG?
2+ abnormal features
how is foetal distress managed?
change maternal position IV fluids stop syntocinon scalp stimulation consider tocolysis (terbutaline 250mcg S/C) maternal assessment (pulse, BP, abdo, VE) fetal blood sampling operative delivery
interpretation of foetal blood sampling?
normal - scalp pH >7.25 - no action needed borderline - scalp pH = 7.2-7.25 - repeat test in 30 mins abnormal - scalp pH = <7.2 - deliver baby immediately
indications for operative vaginal delivery?
delay (failure to progress to stage 2) fetal distress special indications - maternal cardiac disease - severe PET/eclampsia - intra-partum haemorrhage - umbilical cord prolapse stage 2
normal duration of stage 2 in first and multiple babies?
first - no epidural = 2 hrs - epidural = 3 hrs multiple - no epidural = 1 hr - epidural = 2 hrs
what are the risks with use of ventouse in operational vaginal delivery?
failure cephalohaematoma retinal haemorrhage maternal worry but - reduced vaginal trauma and perineal pain
main indications for C section?
previous CS fetal distress failure to progress to labour breech presentation maternal request
