Abnormal labour Flashcards
What kinds of breech are there?
Complete breech Footling breech Frank breech
What are the kinds of malpresentation?
- Breech
- Transverse
- Shoulder/arm
- Face
- Brow
What is abnormal labour?
- too early- preterm birth
- too late- induction of labour
- too painful- requires anaesthetic input
- too long- failure to progress
- too quick- hyperstimulation
- foetal distress- hypoxia/sepsis
- wrong part presenting
What analgesia can be used?
- support
- massage/relaxation techniques
- inhalational agents- entonox
- TENS (T10-L1, S2-S4)
- Water immersion
- IM opiate analgesia e.g. morphine
- IV remifentanil PCA
- regional anaesthesia
How often does epidural give complete pain relief?
95%
What are the complications with epidural anaesthesia?
May inhibit progress during stage 2
- hypotension 20%
- dural puncture 1%
- Headache
- high block
- atonic bladder 40%
Epidural anaesthesia ______ impair uterine activity
Epidural anaesthesia doesn’t impair uterine activity
What is given in epidural anesthesia?
Levobupivacaine +/- opiate
What are the risks of obstructed labour?
- sepsis
- uterine rupture
- obstructed AKI
- postpartum haemorrhage
- fistula formation
- foetal asphyxia
- neonatal sepsis
How do we assess progress in labour?
- cervical dilatation
- descent of presenting part
- signs of obstruction
What are the signs of obstruction
Moulding
Caput
Anuria
Haematuria
Vulval oedema
When would you suspect a delay in a stage 1 nulliparous woman?
<2cm dilatation in 4 hours
When would you suspect a delay in a stage 1 parous woman?
<2cm dilatation in 4 hours or slowing in progress
Describe the 3 Ps in failure to progress
Powers
inadequate contractions: frequency and/or strength
Passages
Short stature/trauma/shape
Passenger
- Big baby*
- malposition- relative cephalo-pelvic disproportion*
What is recorded on a partogram?
- Fetal heart
- Amniotic fluid
- cervical dilatation
- descent
- contractions
- Obstruction-moulding
- Maternal observations
Describe intra-partum fetal assessment?
Doppler auscultation of foetal heart
Stage 1: during and after a contraction, every 15 minutes
Stage 2: at least every 5 minutes during & after a contraction for 1 whole minute & check mat pulse at least every 15 minutes
Electronic foetal monitoring- cardiotocograph (CTG)
Colour of amniotic fluid
What are the risk factors for foetal hypoxia?
- small foetus
- preterm/post dates
- antepartum haemorrhage
- hypertension/pre-eclampsia
- diabetes
- meconium
- epidural anesthesia
- VBAC- vaginal birth after caesarean
- PROM >24hr- pre leabour rupture of membranes
- Sepsis (Temp >38)
- induction/augmentation of labour
What is the aetiology for acute foetal distress?
Abruption
Vasa praevia
Cord prolapse
Uterine rupture
Feto-maternal haemorrhage
Uterine hyperstimulation
Regional anaesthesia
What is the aetiology for chronic foetal distress?
Placental insufficiency
Fetal anaemia
What is assessed and documented in CTG?
Baseline fetal heart rate
Baseline variability
Presence or absence of decelerations
Presence of accelerations
What should CTG be classified as?
Normal/suspicious/pathological
What is gradually evolving hypoxia in labour characterised by?
- loss of accelerations
- repetitive deeper and wider decelerations
- rising fetal baseline heart rate
- loss of variability
What is the acronym for CTG interpretation?
D- etermine
R- isk
C- ontractions
B- aseline
R
A - TE
V- ariability
A- ccelerations
D- ecelerations
O- verall impression
Describe the management of foetal disease?
- change maternal position
- IV fluids
- stop syntocinon
- scalp stimulation
- consider tocolyisis- terbutaline 250mcg s/c- anticontraction meds
- maternal assessment- pulse/BP/abdomen/VE
- foetal blood sampling
- operative delivery
Describe the interpretation of fetal blood sampling
Scalp pH- >7.5 = normal
Scalp pH 7.20-7.25- borderline- repeat in 30 minutes
Scalp pH <7.20 - abnormal- deliver
What are the indications for operative vaginal delivery?
- delay (failure to progress to stage 2)
- fetal distress
- maternal cardiac disease
- severe PET/eclampsia
- intra-partum haemorrhage
- umbilical cord prolapse stage 2
What is the expected duration of stage 2 in a primiparous woman with an epidural?
3 hours
What is the expected duration of stage 2 in a multiparous woman with an epidural?
2 hr
What is ventouse associated with?
Increased;
failure
Cephalohaematoma
Retinal haemorrhage
Maternal worry
decreased;
Anaesthesia
Vaginal trauma
perineal pain
What are the main indications for CS?
- previous CS
- foetal distress
- failure to progress in labour
- breech presentation
- maternal request
What is the risk of maternal mortality associated with CS?
4 x greater
Describe the morbidity in CS?
Sepsis
Haemorrhage
VTE
Trauma
TTN- transient tachypnoea of the newborn
Subfertility
Regret
Complications in future pregnancy
