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Reproduction and sexual health > Abnormal labour > Flashcards

Abnormal labour Flashcards

1
Q

List things that can go wrong in labour

A 
Malpresentation 
Malposition 
Pre term 
Post term 
Foetal distress 
Obstruction 
Too long 
Too painful
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2
Q

What is malpresentation

A

Wrong part of the foetus’ body presenting first ie not the vertex

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3
Q

List variations of malpresentation

A 
Breech - complete, footling, frank 
Transverse 
Shoulder/arm 
Face 
Brow
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4
Q

List methods analgesia in labour

A 
peer support 
massage therapy 
water immersion 
TENS 
IM opioid 
IV remifentanyl 
Regional anaesthesia
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5
Q

How long does remifentanyl last in the body

A

not long, very short t1/2

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6
Q

What are the benefits of epidural anaesthesia

A

very effective
can top it up
does not impair uterine activity

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7
Q

What are the complications of epidural anaesthesia

A 
may inhibit progression in stage 2 
hypotension 
dura puncture - severe headache 
high block - phrenic nerve and breathing 
atonic bladder
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8
Q

What are consequences of obstructed labour

A 
sepsis 
uterine rupture 
post partum haemorrhage 
obstructed AKI 
fistula formation 
foetal asphyxia 
neonatal sepsis
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9
Q

what is assessed in labour progression

A

Cervical dilatation
descent of the presenting part
Signs of obstruction

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10
Q

What are signs of obstruction and what do they mean

A 
Moulding - sliding of foetal skull bones over eachother 
Caput - oedematous squidgy skull
Anuria - stopped peeing 
Haematuria - blood in urine 
Vulval oedema
Dry vagina 
Negative station
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11
Q

What defines delay in stage of labour in a nulliparous women

A

<2cm dilatation in 4 hours

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12
Q

What defines delay in stage of labour in a parous women

A

<2cm dilatation in 4 hours or slowing in progression

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13
Q

What are the 3 P’s in failure to progress

A

Power: inadequate contractions
Passage: pelvic trauma, shape, small mother
Passenger: foetal macrosomia, malpositioning

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14
Q

What is a partogram and what does it record

A 
A graphic representation of the progress of labour 
Measures: 
foetal heart 
amniotic fluid 
cervical dilatation 
descent 
contractions 
obstruction 
maternal observations
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15
Q

what is monitored to identify foetal distress

A

Doppler auscultation of foetal heart
electronic foetal monitoring - CTG
amniotic fluid

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16
Q

Risk factors for foetal hypoxia

A 
smal foetus 
pre term / post dates
antepartum haemorrhage  
HTN/PET 
DM 
Meconium 
epidural anaesthesia 
vaginal birth after c-section (VBAC)
Premature rupture of membranes >24 hours 
sepsis t>38 degrees 
IOL/augmentation of labour
17
Q

List acute causes of foetal distress

A 
placental abruption 
vasa previa 
cord prolapse 
uterine rupture 
foeto-maternal haemorrhage 
uterine hyperstimulation 
regional anaesthesia
18
Q

List chronic causes of foetal distress

A

Placental insufficiency

Foetal anaemia

19
Q

What is assessed in CTG

A 
Contraction frequency in 10 min
Baseline foetal HR (110-150bpm)
Baseline variability (5-25bpm)
Accelerations 
Decelerations
20
Q

How is DR C BRAVADO used in CTG interpretation

A 
Determine Risk 
Contrations 
Baseline RAte 
Variability 
Accelerations 
Decelerations 
Overall impression
21
Q

How do you manage foetal distress

A 
change maternal position 
IV fluids 
stop syntocin 
scalp stimulation 
consider tocolysis - anti contraction drug 
maternal assessment 
foetal blood sampling 
operative delivery
22
Q

What is terbutaline

A

Anti contraction drug

Beta agonist

23
Q

what is foetal blood sampling

A

Pin prick from foetal scalp to test pH/acidity of foetal blood

24
Q

Foetal blood pH >7.25

normal?

A

yes

25
Q

Foetal pH 7.20-7.25

Normal?

A

Borderline

repeat in 30 min

26
Q

Foetal pH <7.20

Normal?

A

No, abnormal

deliver the baby

27
Q

What are indications for operative vaginal delivery

A 
failure to progress in stage 2 
foetal distress
maternal cardiac disease 
severe PET/eclampsia 
intrapartum haemorrhage 
cord prolapse
28
Q

What are indications for c-section

A 
previous c-section 
foetal distress 
failure to progress 
breech malpresentation 
maternal request
29
Q

what must you ensure before instrumental delivery

A

must ensure that cervix is fully dilated before

30
Q

define cord presentation

A

presence of umbilical cord between the foetal presenting part and the cervix with or without ruptured membranes

31
Q

define cord prolapse

A

umbilical cord descends through the cervix alongside or past the presenting foetal part in the presence of ruptured membranes

32
Q

cord prolapse is always revealed outside the introitus, true or false

A

false, it may be concealed within the vagina

33
Q

complications of cord prolapse

A

foetal hypoxia
bradycardia
foetal demise

Reproduction and sexual health (46 decks)

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