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1. Reproduction > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

What different types of breech is there?

A 
frank = legs up at head
complete = legs curled
footing = one foot presents
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2
Q

What can lead to obstruction in labour?

A

abnormally positioned body
small pelvis
problems with the birth canal

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3
Q

What complications can come from obstruction in labour?

A 
sepsis
uterine rupture
obstructive AKI
PPH
fistula formation
fetal asphixia
neonatal sepsis
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4
Q

What are signs of obstruction?

A 
moulding - oblong shape of baby's head
caput - oedema of skull
anuria
haematuria
vulval oedema
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5
Q

What constitutes failure to progress in stage 2 in a nulliparous woman?

A

2 hours = no epidural

3 hours = epidural

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6
Q

What constitutes failure to progress in stage 2 in a multiparous woman?

A

1 hour = no epidural

2 hours = epidural

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7
Q

What is a partogram?

A

graphic representation of progress of labour

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8
Q

What is shown in a partogram?

A 
fetal heart
amniotic fluid
cervical dilation
descent - in relation to ischial spines 
contractions - strong or weak 
obstructions
maternal obs (BP + temp)
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9
Q

What analgesia is available?

A

etanox - nitrous oxide/gas and air
TENS - transcutaneous electrical nerve stimulation
Water Immersion
IM opiates - diamorphine or IM Remifentanil

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10
Q

Where are pads placed when using a TENS?

A

T10-4 and S2-4

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11
Q

What spinal levels does an epidural anaethetise?

A

T10-S5

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12
Q

What are the complications of an epidural?

A 
hypotension
dural puncture
headache
high block
atonic bladder
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13
Q

What drugs are used in an epidural?

A

Levobupivacaine +/- opiate

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14
Q

What is the mode of action of an epidural?

A

reduced catecholamine secretion

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15
Q

How is the decent of the head marked?

A

+1, +2, +3 if below the ischial spines and -1, -2, -3 if above the spines

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16
Q

At what rate should the cervix efface from 0-3cm in multi and nulli parous women?

A

from 0 to 3cm in 6 hours in a multipara and 8hours in a nuliparous

17
Q

How is foetal distress assessed?

A

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

18
Q

Apart from Doppler, how else is the foetus assessed?

A

Cardiotocograph (CTG)

colour of amniotic fluid

19
Q

What are the risk factors for foetal hypoxia?

A 
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
20
Q

What acute causes can cause foetal hypoxia?

A 
placental abruption
cord prolapse
uterine rupture
fetomaternal haemorrhage
vasa previa
regional anaesthetic 
uterine hyperstimulation
21
Q

What chronic causes can cause foetal hypoxia?

A

placental insufficiency

foetal aneamia

22
Q

How can you manage foetal hypoxia?

A 
change maternal positon
IV fluids
stop syntocinon 
consider tocolysis - terbutaline 250 micrograms
fetal blood sampling
delivery - catagory 1
23
Q

What is the mnemonic for CTGs?

A

DR C BRaVADO

24
Q

What does DR C BRaVADO stand for?

A 
DR - determine rate
C - contractions
BRa - baseline rate
V - variability
A - accelerations
D - decellerations
O - overall impression
25
Q

What is a good sign - accelerations or late decelerations?

A

accelerations

26
Q

What does a reduction in variabiltiy mean?

A

WORRYING - hypoxia?

27
Q

What are early decelerations?

A

mimic contractions

28
Q

How is hypoxia seen on a CTG?

A

loss of accelerations
repetitive depper and wider decellerations
rising fetal baseline HR
loss of variability

29
Q

What should the baseline rate be on a CTG?

A

100-16

30
Q

What should the variability be on a CTG?

A

> 5

31
Q

What is a normal scalp pH?

A

> 7.25

32
Q

What does a scalp pH between 7.2-7.25 warrant?

A

repeat in 30 mins

33
Q

What does a scalp pH below 7.2 warrant?

A

delivery

34
Q

What indicates there should be an operative vaginal delivery?

A 
failure to progress at stage 2
fetal distress
maternal cardiac disease
severe PET
intrapartum haemorrhage
umbillical cord prolapse stage 2
35
Q

What are the pros of ventouse delivery?

A

decreases perineal pain
decreases vaginal trauma
no anaesthesia

36
Q

What are the cons of ventouse delivery?

A

increase in failure
increase in cephalohaematoma and retinal haemorrhage
worries mother

37
Q

What indicates there should be a c/section?

A 
foetal distress
previous c/section
failure to progress in labour
breech position
maternal request
38
Q

Is there a greater maternal mortality associated with a c/section?

A

YES - 4x

39
Q

What are the maternal complications of a c/section?

A 
sepsis
haemorrhage
VTE
trauma
TTN
sub fertility
regret
complications in future pregnancies

1. Reproduction (50 decks)

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