Abnormal Labour Flashcards
What different types of breech is there?
frank = legs up at head complete = legs curled footing = one foot presents
What can lead to obstruction in labour?
abnormally positioned body
small pelvis
problems with the birth canal
What complications can come from obstruction in labour?
sepsis uterine rupture obstructive AKI PPH fistula formation fetal asphixia neonatal sepsis
What are signs of obstruction?
moulding - oblong shape of baby's head caput - oedema of skull anuria haematuria vulval oedema
What constitutes failure to progress in stage 2 in a nulliparous woman?
2 hours = no epidural
3 hours = epidural
What constitutes failure to progress in stage 2 in a multiparous woman?
1 hour = no epidural
2 hours = epidural
What is a partogram?
graphic representation of progress of labour
What is shown in a partogram?
fetal heart amniotic fluid cervical dilation descent - in relation to ischial spines contractions - strong or weak obstructions maternal obs (BP + temp)
What analgesia is available?
etanox - nitrous oxide/gas and air
TENS - transcutaneous electrical nerve stimulation
Water Immersion
IM opiates - diamorphine or IM Remifentanil
Where are pads placed when using a TENS?
T10-4 and S2-4
What spinal levels does an epidural anaethetise?
T10-S5
What are the complications of an epidural?
hypotension dural puncture headache high block atonic bladder
What drugs are used in an epidural?
Levobupivacaine +/- opiate
What is the mode of action of an epidural?
reduced catecholamine secretion
How is the decent of the head marked?
+1, +2, +3 if below the ischial spines and -1, -2, -3 if above the spines
At what rate should the cervix efface from 0-3cm in multi and nulli parous women?
from 0 to 3cm in 6 hours in a multipara and 8hours in a nuliparous
How is foetal distress assessed?
stage 1: doppler auscultation of foetal heart during and after a contraction EVERY 15 MINS
stage 2: doppler auscultaiton of foetal heart at least EVERY 5 MINS during and after contraction for 1 MIN and check mothers pulse every 15 MINS
Apart from Doppler, how else is the foetus assessed?
Cardiotocograph (CTG)
colour of amniotic fluid
What are the risk factors for foetal hypoxia?
small foetus preterm/post date antepartum haemorrhage hypertension/preecclampsia diabetes meconium epidural analgesia vaginal birth after cesarean premature rupture of membranes >24hours sepsis - temp >38 induction/augmentation of labour
What acute causes can cause foetal hypoxia?
placental abruption cord prolapse uterine rupture fetomaternal haemorrhage vasa previa regional anaesthetic uterine hyperstimulation
What chronic causes can cause foetal hypoxia?
placental insufficiency
foetal aneamia
How can you manage foetal hypoxia?
change maternal positon IV fluids stop syntocinon consider tocolysis - terbutaline 250 micrograms fetal blood sampling delivery - catagory 1
What is the mnemonic for CTGs?
DR C BRaVADO
What does DR C BRaVADO stand for?
DR - determine rate C - contractions BRa - baseline rate V - variability A - accelerations D - decellerations O - overall impression
What is a good sign - accelerations or late decelerations?
accelerations
What does a reduction in variabiltiy mean?
WORRYING - hypoxia?
What are early decelerations?
mimic contractions
How is hypoxia seen on a CTG?
loss of accelerations
repetitive depper and wider decellerations
rising fetal baseline HR
loss of variability
What should the baseline rate be on a CTG?
100-16
What should the variability be on a CTG?
> 5
What is a normal scalp pH?
> 7.25
What does a scalp pH between 7.2-7.25 warrant?
repeat in 30 mins
What does a scalp pH below 7.2 warrant?
delivery
What indicates there should be an operative vaginal delivery?
failure to progress at stage 2 fetal distress maternal cardiac disease severe PET intrapartum haemorrhage umbillical cord prolapse stage 2
What are the pros of ventouse delivery?
decreases perineal pain
decreases vaginal trauma
no anaesthesia
What are the cons of ventouse delivery?
increase in failure
increase in cephalohaematoma and retinal haemorrhage
worries mother
What indicates there should be a c/section?
foetal distress previous c/section failure to progress in labour breech position maternal request
Is there a greater maternal mortality associated with a c/section?
YES - 4x
What are the maternal complications of a c/section?
sepsis haemorrhage VTE trauma TTN sub fertility regret complications in future pregnancies
