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REPRODUCTION & GYNAECOLOGY > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

What can cause an abnormal labour?

A
  • Malpresentation: Not the head coming first
  • Malposition: Occipito-Posterior or Occipito-Transverse
  • Pre-term <37wks
  • Post-term >42 wks
  • Obstruction
  • Foetal distress
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2
Q

What are the different types of breech presentation?

A

Complete Breech - both legs under foetus, born first
Footling Breech - one foot presents
Frank Breech - feet up by baby’s head, bottom presents first

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3
Q

Other than breech, how can a baby present in the wrong way?

A

Transverse
Shoulder/arm
Face
Brow

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4
Q

What methods of analgesia are used in pregnancy?

A
  • Supportive partner/ family member/ friend
  • Massage / relaxation techniques
  • Gas and Air (Entonox)
  • TENS (Lower thoracic and sacral nerves stimulated)
  • Water immersion
  • IM Morphine
  • IV Remifentanil
  • Regional anaesthesia
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5
Q

How effective are epidurals in labour?

A

complete pain relief in 95%

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6
Q

Women can have an epidural and still experience contractions that allow them to push in pregnancy. TRUE/FALSE?

A

TRUE

- uterine muscle not affected by anaethesia

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7
Q

Why may an epidural inhibit progress during stage 2 of labour?

A
  • Numbs and relaxes the pelvic floor

- Pelvic floor muscles are needed to provide resistance to baby’s head causing it to flex before birth

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8
Q

What else is usually injected alongside local anaesthetic in an epidural?

A

Opiate

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9
Q

What are the main complications of an epidural?

A

Hypotension (20%)
Dural puncture (1%)
Headache (due to dural puncture - worst day after birth)
High block (may cause resp. depression => SOB)
Atonic bladder (women don’t know when bladder is full)

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10
Q

What becomes a higher risk if a labour is obstructive?

A
  • Maternal OR neonatal sepsis
  • uterine rupture (especially if prev. C-section)
  • obstructed AKI (if foetal head is compressing ureters)
  • PPH (uterus works so hard in obstructed labour that it gives up and does not constrict blood vessels after)
  • fistula formation (recto-vaginal)
  • foetal asphyxia
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11
Q

How can progress during labour be assessed?

A
  • Cervical dilatation
  • Descent of presenting part
  • Signs of obstruction: moulding, caput, vulval oedema
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12
Q

What measurements of cervical dilatation would make you consider delayed labour?

A

<2cm dilation in 4 hours

OR if labour is slowing in progress in a lady who has had children before

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13
Q

Station is measured in relation to what landmark in the mother?

A

Ischial spines

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14
Q

What are the 3 Ps considered when a labour shows Failure to Progress?

A

Powers: Inadequate contractions

Passages: Short stature / Pelvis Shape

Passenger: Big baby, Malposition/ malpresentation

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15
Q

What is assessed on a partogram?

A
  • Foetal Heart Rate
  • Amniotic Fluid
  • Cervical Dilatation
  • Descent
  • Contractions
  • Obstruction - Moulding/caput
  • Maternal Observations (BP, pulse)
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16
Q

How often should a doppler be used to assess foetal heart rate in the 1st and 2nd stages of labour?

A

1st Stage
- Measure during and after a contraction (Every 15 mins)

2nd Stage:

  • every 5 mins
  • AND during and after a contraction for 1 whole minute
  • check maternal pulse at least every 15 mins
17
Q

How else can the foetus be assessed during labour?

A
  • Electronic Fetal Monitoring -Cardiotocograph (CTG)

- Colour of amniotic fluid

18
Q

What factors can increase the risk of foetal hypoxia?

A
  • Small fetus
  • Preterm / Post Dates
  • Antepartum haemorrhage
  • Hypertension / Pre-eclampsia
  • Diabetes
  • Meconium
  • Epidural analgesia
  • Sepsis
  • IOL
19
Q

What acute causes are there for foetal distress?

A
  • Abruption
  • Vasa Praevia
  • Cord Prolapse
  • Uterine Rupture
  • Feto-maternal Haemorrhage
  • Uterine Hyperstimulation
  • Regional Anaesthesia
20
Q

If a baby is presenting breech, what complication are they at increased risk of?

A
  • Cord prolapse

- due to feet presenting first => space around feet for cord to prolapse

21
Q

What are the chronic causes of foetal distress?

A

Placental insufficiency

Foetal anaemia

22
Q

What features of a CTG should be assessed on review?

A
  • baseline fetal heart rate
  • variability
  • presence/absence of decelerations
  • presence of accelerations
23
Q

How should a CTG be classified?

A
  • normal
  • suspicious
  • pathological
24
Q

What CTG changes may indicate foetal hypoxia has evolved in labour?

A
  • loss of accelerations
  • Repetitive deeper and wider decelerations
  • Rising fetal baseline heart rate
  • Loss of variability
25
Q

What mneumonic is used to interpret a CTG?

A

“Dr C Bravado”

D ETERMINE
R ISK 
C ONTRACTIONS
B ASELINE
R
A TE
V ARIABILITY
A CCELERATIONS
D ECELERATIONS
O VERALL IMPRESSION
26
Q

HOw should foetal distress be managed?

A
  • Change maternal position
  • IV Fluids
  • Stop oxytocin
  • Scalp stimulation
  • Beta Agonist- Terbutaline
  • Maternal assessment - Pulse / BP / Abdomen / VE
  • Foetal blood sampling (check not too acidic => <7.2)
  • Operative Delivery?
27
Q

When is an instrumental delivery normally indicated?

A

If woman is at full dilatation

  • Labour Delay (failure to progress stage 2)
  • Foetal distress
28
Q

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

A
  • Maternal cardiac disease (due to valsalva manoeuvres in obstructive labour)
  • Severe PET / Eclampsia
  • Intra-partum haemorrhage
  • Umbilical cord prolapse Stage 2
29
Q

How long would be considered a delay in labour?

A

first baby - 2hrs (3 if epidural)

subsequent baby - 1hr (2 if epidural)

30
Q

What is ventouse delivery and what does this increase the risk of?

A

Ventouse = cup-shaped suction device (vacuum delivery)

Higher risk of:

  • Failure
  • cephalohaematoma
  • retinal haemorrhage
  • maternal worry
31
Q

What are the main indications for a C-section?

A 
previous CS
foetal distress
failure to progress in labour
breech presentation
maternal request
32
Q

Maternal mortality is increased how much in C-section?

A

4 X greater maternal mortality

33
Q

What complications of C-section increase morbidity in the mother?

A
  • sepsis
  • haemorrhage
  • VTE
  • trauma
  • subfertility
  • complications in future pregnancy

REPRODUCTION & GYNAECOLOGY (58 decks)

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