Abnormal labour Flashcards
List things that can go wrong in labour
Malpresentation Malposition Pre term Post term Foetal distress Obstruction Too long Too painful
What is malpresentation
Wrong part of the foetus’ body presenting first ie not the vertex
List variations of malpresentation
Breech - complete, footling, frank Transverse Shoulder/arm Face Brow
List methods analgesia in labour
peer support massage therapy water immersion TENS IM opioid IV remifentanyl Regional anaesthesia
How long does remifentanyl last in the body
not long, very short t1/2
What are the benefits of epidural anaesthesia
very effective
can top it up
does not impair uterine activity
What are the complications of epidural anaesthesia
may inhibit progression in stage 2 hypotension dura puncture - severe headache high block - phrenic nerve and breathing atonic bladder
What are consequences of obstructed labour
sepsis uterine rupture post partum haemorrhage obstructed AKI fistula formation foetal asphyxia neonatal sepsis
what is assessed in labour progression
Cervical dilatation
descent of the presenting part
Signs of obstruction
What are signs of obstruction and what do they mean
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
What defines delay in stage of labour in a nulliparous women
<2cm dilatation in 4 hours
What defines delay in stage of labour in a parous women
<2cm dilatation in 4 hours or slowing in progression
What are the 3 P’s in failure to progress
Power: inadequate contractions
Passage: pelvic trauma, shape, small mother
Passenger: foetal macrosomia, malpositioning
What is a partogram and what does it record
A graphic representation of the progress of labour Measures: foetal heart amniotic fluid cervical dilatation descent contractions obstruction maternal observations
what is monitored to identify foetal distress
Doppler auscultation of foetal heart
electronic foetal monitoring - CTG
amniotic fluid
Risk factors for foetal hypoxia
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
List acute causes of foetal distress
placental abruption vasa previa cord prolapse uterine rupture foeto-maternal haemorrhage uterine hyperstimulation regional anaesthesia
List chronic causes of foetal distress
Placental insufficiency
Foetal anaemia
What is assessed in CTG
Contraction frequency in 10 min Baseline foetal HR (110-150bpm) Baseline variability (5-25bpm) Accelerations Decelerations
How is DR C BRAVADO used in CTG interpretation
Determine Risk Contrations Baseline RAte Variability Accelerations Decelerations Overall impression
How do you manage foetal distress
change maternal position IV fluids stop syntocin scalp stimulation consider tocolysis - anti contraction drug maternal assessment foetal blood sampling operative delivery
What is terbutaline
Anti contraction drug
Beta agonist
what is foetal blood sampling
Pin prick from foetal scalp to test pH/acidity of foetal blood
Foetal blood pH >7.25
normal?
yes
Foetal pH 7.20-7.25
Normal?
Borderline
repeat in 30 min
Foetal pH <7.20
Normal?
No, abnormal
deliver the baby
What are indications for operative vaginal delivery
failure to progress in stage 2 foetal distress maternal cardiac disease severe PET/eclampsia intrapartum haemorrhage cord prolapse
What are indications for c-section
previous c-section foetal distress failure to progress breech malpresentation maternal request
what must you ensure before instrumental delivery
must ensure that cervix is fully dilated before
define cord presentation
presence of umbilical cord between the foetal presenting part and the cervix with or without ruptured membranes
define cord prolapse
umbilical cord descends through the cervix alongside or past the presenting foetal part in the presence of ruptured membranes
cord prolapse is always revealed outside the introitus, true or false
false, it may be concealed within the vagina
complications of cord prolapse
foetal hypoxia
bradycardia
foetal demise
