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Abnormal Labour Flashcards

1
Q

what is malpresentation of a baby

A

non vertex:

  • breech (frank, footling, complete)
  • transverse
  • shoulder/ arm
  • face
  • brow
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2
Q

what is malposition of a baby

A

abnormal position of the head- OP/ OT

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3
Q

what is pre term

A

<37 weeks

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4
Q

what is post term

A

> 42 weeks

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5
Q

when is malposition more likely

A

if baby too early/ late

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6
Q

what are the types of breech

A

complete- hip and knee flexed (cross legged)
footling - one/both feet coming first
frank (most common) - hips flexed, knees extended (legs up, bottom comes first)

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7
Q

what can happen if a very small baby starts to be delivered through a cervix that is not fully dilated

A

body goes through but head can get stuck

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8
Q

what does it mean if a babies arm is delivered first

A

baby in transverse lie, cannot be delivered need CS

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9
Q

can face/ brow presentations be delivered

A

brow means head at widest diameter- wont deliver

face will if chin at front

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10
Q

what classifies as abnormal labour

A 
Too early (<27wks( - preterm birth
Too late (>42wks)– induction of labour
Too painful - requires anaesthetic input
Too long - failure to progress
Too quick- hyperstimulation
Fetal distress - hypoxia/sepsis
Wrong part presenting
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11
Q

what pain relief options for mothers in childbirth

A 
support (better usually if not men)
massage/ relaxation techniques
inhalational agents- entonox
TENS machine
water immersion 
IM opiate analgesia (morphine)
IV remifentanil PCA
regional anaesthesia
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12
Q

what causes labour pain

A

compression of para cervical nerves

myometrial hypoxia

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13
Q

does an epidural impair uterine activity

A

no

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14
Q

what might an epidural inhibit

A

progress during stage 2

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15
Q

what is given in epidural anaesthesia

A

levobupivacaine +/- opiate

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16
Q

what are the possible complications of an epidural

A

hypotension (20%) due to vasodilation
dural puncture (1%)
headache
high block (blockage goes too high, can make it hard to breath)

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17
Q

is an epidural more effective than opiods

A

yes

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18
Q

do you always need IV access when given an epidural

A

yes

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19
Q

what are the risks in obstructed labour

A

sepsis (increased by vaginal exams)
uterine rupture (uterus thins, more common in women who have had previous section and if given syntocinon)
obstructed AKI (impaired renal drainage)
PPH
fistula formation
fetal asphyxia
neonatal sepsis

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20
Q

how do you assess progress in labour

A

dilation
descent of presenting part
signs of obstruction: moulding, caput, anuria, haematuria, vulval oedema

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21
Q

what dilation progressions indicate a suspected delay in 1st stage

A

nulliparous <2cm in 4 hours

parous <2cm in 4 pours or slowing in progress

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22
Q

should parous or nulliparous women usually progress faster in birth

A

parous

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23
Q

what is station measured in

A

fifths (where head is in relation to the ischial spines)

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24
Q

what are the three P’s of failure to progress

A

power:
- inadequate contractions (frequency and/ or strength)

passage:

  • short stature (under 5 ft)
  • trauma
  • shape

passenger:
- big baby
- malposition (relative cephalo-pelvic disproportion)

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25
Q

how many contractions are you aiming to have in 10 mins

A

3-4

26
Q

what are the widest parts of the pelvis

A

inlet- transverse diameter
mid cavity- AP = transverse
outlet= AP diameter

27
Q

what is the widest presentation of the babies head

A

brow- occipito-mental = 13 cm

28
Q

what is the narrowest presentation of the babies head

A

vertex (suboccipito-bregmatic = 9cm) and face (submento-bregmatic = 9cm)

29
Q

what does a partogram measure

A 
fetal heart
amniotic fluid
cervical dilation 
descent 
contractions 
obstruction (moulding) 
maternal obs- BP, HR, urinalysis
30
Q

what is the minimum expected dilation on a partogram

A

1cm every 2 hours

31
Q

what can be give to speed up a labour that is failing to progress

A

syntocinon

32
Q

what can be used to identify fetal distress

A

doppler ausculatation
electronic fetal monitoring- cardiotocograph
colour of amniotic fluid

33
Q

when is doppler auscultation of fetal heart done in stage 1 of labour

A

During and after a contraction

Every 15 minutes

34
Q

when is doppler auscultation of fetal heart done in stage 2 of labour

A

At least every 5 minutes
during & after a contraction for 1 whole minute
check Mat pulse at least every 15 mins

35
Q

what are the risk factors for fetal hypoxia

A 
small fetus (biggest risk)
preterm/ post dates 
antepartum haemorrhage 
HPTx/ PET
diabetes
meconium
epidural analgesia 
vaginal birth after caesatean 
premature rupture of membranes >24 hours 
sepsis (temp >38c)
induction/ augmentation of labour
36
Q

what do you need to do additionally when there are risk factors for fetal hypoxia

A

continuously monitor fetal heart

37
Q

what are the acute causes of fetal distress

A 
abruption 
vasa praevia 
cord prolapse 
uterine rupture 
feto-maternal haemorrhage 
uterine hyperstimulation 
regional anaesthesia
38
Q

what are the symptoms of fetal abruption

A

severe pain
bleeding
very acute
abnormal fetal HR

39
Q

what is vasa praevia

A

when the babies placental or umbilical blood vessels run across the entrance to the cervix

40
Q

what are the chronic causes of fetal distress

A

placental insufficiency

fetal anaemia

41
Q

how can CTG be done

A

abdominal tracing

fetal scalp electrode- needed sometimes if mother obese

42
Q

what does CTG tell you about contractions

A

frequency (not strength)

43
Q

what are normal fetal heart rates

A

110-150 bpm
tachycardia >150
bradycardia <110

44
Q

what is variability of fetal HR on CTG

A

(how wiggly the line is)

normal= changes of 5-25 bmp

45
Q

what are abnormally variabilities of fetal HR

A

saltatory: >25 bmp
reduced: <5 bmp
complete loss

all signs of hypoxia

46
Q

what are acceleration in fetal HR

A

increases
due to baby moving
want to see 15 bmp above baseline rate 2x in 10 mins

47
Q

what are decelerations of fetal HR and when are they normal/ abnormal

A

reduction in HR
early- occur with contractions- normal
late- follow the contraction- abnormal- sign of hypoxia
variable- most common type- can be complicated or uncomplicated (complicates associated with cord compression)

48
Q

what should you document when revieing a CTG

A

baseline fetal HR
baseline variability
presence/ absence of decelerations
presence of accelerations

classify as normal, suspicious or pathological

49
Q

hypoxia can evole gradually in labour- what is seen on a CTG

A

loss of accelerations
repetitive deeper and wider decelerations
rising fetal baseline HR
loss of variability

50
Q

what mnemonic for CTG interpretation

A 
DR C BRAVADO
determine risk 
contractions 
baseline rate 
variability 
accelerations 
decelerations 
overall impression (normal, suspicious, pathological)
51
Q

when is a CTG pathological

A

when more than 2 abnormal features

52
Q

what is the management for fetal distress

A 
change maternal position 
IV fluids
stop syntocinon
scalp stimulation 
consider tocolysis- terbutaline 250 micrograms s/c (stop/ reduce contractions) 
maternal assessment -pulse, BP, abdomen, VE
fetal blood sampling 
operative delivery
53
Q

how is fetal blood sampling done

A

pin prick of scalp via vaginal endoscopic tube

54
Q

what is normal/ abnormal fetal scalp blood pH

A 
>7.24= normal= no action needed
7.2-7.25= borderline= repeat in 30 mins 
<7.2= abnormal= deliver
55
Q

a what point in labour must a women be at in order to have an instrumental delivery

A

babies head below/ at ischial spines

cervix must be fully dilated

56
Q

what are the indications for an instrumental delivery

A

delay (failure to progress to stage 2)
fetal distress

special cases:

  • maternal cardiac disease
  • severe PET/ eclapmsia
  • intra-partum haemorrhage
  • umbilical cord prolapse in stage 2
57
Q

how long should stage 2 of labour last

A

prims: 2hrs no epidural, 3hrs with epidural
multips: 1 hr no epidural, 2 hrs with epidural

58
Q

what are the pros and cons of venoutous compared to forceps

A

ventouse (not used as mush in scotland, foceps used more):

  • increased failure
  • increased cephalohaematoma
  • increased retinal haemrorhage
  • increased maternal worry
  • decreased anaesthesia
  • decreased vaginal trauma
  • decreased perineal pain

long term outcomes the same, ventouse more traumatic to baby, forceps more traumatic for mother

59
Q

what are the main indications for a c section

A 
previous CS
fetal distress
failure to progress in labour
breech presentation
maternal request
60
Q

how many people in tayside get a cs

A

30%

61
Q

what are the risks of a c sections

A

4 X greater maternal mortality

Morbidity - sepsis, haemorrhage, VTE, trauma, transient tachypnoea of newborn, subfertility, regret, complications in future pregnancy

62
Q

how many women in tayside have a SVD

A

~60%

Reproduction (51 decks)

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