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Repro and Sexual Health > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

What binds the vertex?

A

Anterior and posterior fontanelles

Parietal eminences

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2
Q

What can cause an abnormal labour?

A 
Malpresentation; non-vertex 
Malposition; OP or OT
Preterm <37 weeks 
Post-term >42 weeks 
Obstruction 
Foetal distress
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3
Q

What are the 3 forms of breech?

A

Complete; legs folded with feet at the level of baby’s bottom
Footling breech; one or both feet point downwards so legs emerge first
Frank; legs point up with feet by babys head to bottom emerges first

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4
Q

What is the commonest variant of breech?

A

Frank

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5
Q

What are complications of breech?

A

Cord prolapse
Head entrapment
5% overall risk of foetal injury when breech delivered vaginally

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6
Q

What percentage of term babies are breech?

A

4%

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7
Q

What are the 3 forms of malpresentation?

A

Breech; 3 types
Transverse
Shoulder/arm

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8
Q

How can the head present if non-vertex?

A

Face presentation; if mental anterior can be delivered vaginally
Brow presentation; c/s

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9
Q

When is a birth termed preterm?

A

<37 weeks

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10
Q

Why can hyperstimulation resulting in a quick labour result in foetal distress?

A

If there is no gap between contractions, the placental vascular tree won’t have time to refill and therefore foetal hypoxia/ distress can occur

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11
Q

What forms of analgesia are available for labouring women?

A 
Support 
Massage/ relaxation 
Inhalation; entonox 
TENS (T10-L1, S2-4) 
Water immersion 
IM opiate analgesia; diamorph 
IV remifentanil PCA
Regional
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12
Q

When is IV remifentanil PCA utilised?

A

Gives short lasting bolus at peak of contraction

Good for women whose labours are progressing too quickly for a regional anaesthesia

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13
Q

Why is labour painful?

A

Compression of para-cervical nerves

Myometrial hypoxia

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14
Q

What issues can an epidural have on labour progression?

A

May inhibit progress during stage 2

Does NOT impair uterine activity

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15
Q

Complications of epidural anaesthesia?

A 
Hypotension 
Dural puncture
Headache
High block; resp depression 
Atonic bladder
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16
Q

What is injected in through an epidural?

A

Low conc LA with opioid; 10-15ml bupivacaine with fentanyl

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17
Q

What is the purpose of the 1st test dose?

A

To endure that inadvertent intrathecal injection has not occured

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18
Q

What are the risks of an obstructed labour?

A 
Sepsis; lots of vaginal exams 
Uterine rupture; multiparous women 
Obstructed AKI
PPH
Fistula formation 
Foetal asphyxia
Neonatal sepsis
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19
Q

How is progress assessed in labour?

A

Cervical dilation

Descent of presenting part

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20
Q

What are signs of an obstructed labour?

A 
Excessive moulding 
Caput 
Anuria
Haematuria
Vulval oedema
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21
Q

What is considered failure to progress in stage 1 of active labour?

A

Nulliparous and parous; <2cm in 4 hours

Parous women really should be a little quicker than this

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22
Q

When can you perform an instrumental delivery?

A

0 or + station

10cm dilated

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23
Q

What are the 3 Ps of failure to progress?

A

Power
Passage
Passenger

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24
Q

What can result in reduced power causing failure to progress?

A

Inadequate contractions; frequency +/- strength

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25
Q

What can result in an inadequate passage for a baby resulting in failure to progress?

A

Short stature of mother
Trauma
Shape; not gynaecoid (anthropoid or android)

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26
Q

What problems with the baby can result in failure to progress?

A

Macrosomia

Malposition

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27
Q

How many contractions are expected per 10 mins?

A

3 to 4

Duration of 40-50 seconds

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28
Q

What is the smallest diameter of the foetal head?

A

Suboccipito-bregmatic = 9.5cm

Submentobregmatic; 9.5cm

29
Q

What is the biggest diameter at the pelvic inlet and outlet respectively?

A

Inlet; transverse diameter = 13.5cm

Outlet; AP diameter; 13.5cm

30
Q

What are the different measurements for a vertex, OP, deflexed OP, brow and face presentation?

A 
Vertex; suboccipito-bregmatic = 9.5 cm 
OP; suboccipito-frontal = 10 cm 
Deflexed OP; occipitofrontal = 11.5cm 
Brow = occipitomental 13cm 
Face; submentobregmatic = 9.5cm
31
Q

What is the commonest reason why babies don’t progress?

A

Suboptimal flexion of the head

32
Q

What does the partogram measure?

A 
Foetal HR
Amniotic fluid
Cervical dilatation 
Descent 
Contractions 
Obstruction = moulding 
Maternal observations
33
Q

What can be given in the 1st stage of labour to assist with failure to progress?

A

IVI syntocinon

34
Q

When is the foetal heart measured in stage 1 of labour?

A

During and after a contraction

Every 15 mins

35
Q

When is the foetal heart rate measured in stage 2 of labour?

A

At least every 5 mins during and after a contraction for 1 whole minute
Check mat pulse at least every 15 mins

36
Q

What is included within the intrapartum foetal assessment?

A

Foetal HR - either pinnards, doppler or CTG

Colour of amniotic fluid

37
Q

What are risk factors for foetal hypoxia?

A 
Small foetus
Pre-term/ post dates
Antepartum haemorrhage
Hypertension/ PET
Diabetes
Meconium
Epidural analgesia
VBAC
PROM >24 hrs 
Sepsis (temp >38) 
Induction/ augmentation of labour
38
Q

What is required if there are risk factors for foetal hypoxia?

A

CTG throughout labour

39
Q

What can cause acute foetal distress?

A 
Abruption 
Vasa praevia
Cord prolapse
Uterine rupture 
Foeto-maternal haemorrhage
Uterine hyperstimulation 
Regional analgesia
40
Q

What is vasa praevia?

A

A condition in which fetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue

41
Q

What can cause chronic foetal distress?

A

Placental insufficiency

Foetal anaemia

42
Q

Can a CTG monitor the strength of contractions?

A

NO; only the frequency

43
Q

What should be assessed when reviewing the CTG?

A

Baseline foetal heart rate
Baseline variability
Presence or absence of decelerations
Presence of accelerations

44
Q

What is a normal baseline foetal HR?

A

110-150
Tachy >150
Brady <110 (although only really worried when below 90)

45
Q

What is normal variability?

A

5-25 bmp
Reduced; <5
Saltatory >25
Complete loss = BAD

46
Q

What are normal foetal accelerations?

A

Really reassuring to see accelerations
Rise of 15 beats above baseline for at least 15 seconds
In a 40 min period; want to see 2 accelerations

47
Q

What is a normal deceleration?

A

Early with contractions but rise very quickly to baseline

48
Q

What is a worrying deceleration?

A

Late; after peak of contraction
Broad
Slow to recover to baseline HR

49
Q

How is a CTG classified?

A

Normal
Suspicious
Pathological

50
Q

What is hypoxia characterised by on a CTG?

A

Loss of accelerations
Repetitive deeper and wider decelerations
Rising foetal baseline HR
Loss of variability

51
Q

What is an acronym to CTG interpretation?

A 
Dr C Bravado 
Determine 
Risk 
Contractions 
Baseline 
R
Ate 
Variability 
Accelerations 
Decelerations 
Overall impression
52
Q

What makes a CTG pathological?

A

More than 2 abnormal features

53
Q

How is foetal distress managed?

A 
Change maternal position; left lateral 
IV fluids
Stop syntocinon
Scalp stimulation 
Consider tocolysis; terbutaline 250 mcg s/c 
Maternal assessment; pulse, BP, abdo, VE
Foetal blood sampling
Operative delivery; category 1
54
Q

How quickly must a category 1 delivery be performed in?

A

30 mins

55
Q

What is foetal blood sampling?

A

Prick from foetal scalp

Look at pH to determine if foetus is hypoxic and acidotic = BAD

56
Q

What is a normal foetal scalp pH?

A

> 7.25

57
Q

What is a borderline scalp pH?

A

7.20 - 7.25; repeat in 30 mins

58
Q

What is an abnormal foetal scalp pH?

A

<7.20; DELIVER

59
Q

What are the methods for an operative/ instrumental vaginal delivery?

A

Forceps

Vontouse

60
Q

What are the “standard” indications for an instrumental delivery?

A

Delay; failure to progress at stage 2

Foetal distress

61
Q

What are the “special” indications for an instrumental delivery?

A

Maternal cardiac disease; pushing may be dangerous
Severe PET/ eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse at stage 2

62
Q

What is the max time limit on the duration of stage 2 in a primigravida woman?

A

No epidural; 2hrs

Epidural; 3hrs

63
Q

What is the max time limit on the duration of stage 2 in a multip woman?

A

No epidural; 1hr

Epidural; 2hr

64
Q

What are the advantages of ventouse?

A

No anaesthesia needed
Reduced vaginal trauma
Reduced perineal pain

65
Q

What are the disadvantages of a ventouse?

A

Increased rates of failure
Increased risk of cephalohematoma
Increased risk of retinal haemorrhage
Increased maternal worry

66
Q

Difference between forceps and ventouse?

A

Forceps; more damage to mother
Ventouse; more damage to baby
BUT
No difference in c/s rates, apgar score or long term outcomes

67
Q

What are the main indications for a c/s?

A 
Previous c/s 
Foetal distress
Failure to progress
Breech 
Maternal request
68
Q

Risks assoc with c/s?

A 
Sepsis
Haemorrhage 
VTE
Trauma 
TTN 
Subfertility 
Regret
Complications in future pregnancy

Repro and Sexual Health (77 decks)

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