Abnormal Labour Flashcards
What are the boundaries of the vertex of the foetal skull?
Anterior and posterior fontanelles and the parietal eminences
What does malpresentation refer to?
Non-vertex birth position = breech, shoulder/arm, transverse, face brow
What are two examples of malposition?
Occipito-posterior and occipito-transverse
What gestation would be referred to as preterm?
<37 weeks
What gestation would be referred to as post-term?
> 42 weeks
What are the types of breech presentation?
Complete, footling and frank
What is the complete breech position?
Legs folded with feet at the level of the baby’s bottom
What is the footling breech position?
One or both feet point down so legs would emerge first
What is the frank breech position?
Legs point up with feet by baby’s head so bottom emerges first
What can abnormal labour refer to?
Too early or too late, too painful, too long or too quick, foetal distress or wrong part presenting
What are some analgesic options for during an abnormal labour?
Support and massage/relaxation techniques
Inhalation agents (entonox) or IM opiates
TENS = T10-L1, S2-4
IV remifentanil PCA or epidural
How effective is an epidural anaesthetic?
Complete pain relief on 95% and doesn’t impair uterine activity = may inhibit progress during stage 2
What drugs are given during an epidural anaesthetic?
Levobupivacaine +/- opiate
What are the complications of an epidural anaesthetic?
Hypotension (20%), dural puncture (1%), headache, high block, atonic bladder (40%)
What are the risks associated with an obstructed labour?
Sepsis, uterine rupture, obstructed AKI, postpartum haemorrhage, fistula formation, foetal asphyxia, neonatal sepsis
How is progress of labour assessed?
Cervical dilation, descent of presenting part, signs of obstruction
What are some signs of obstructed labour?
Moulding, caput, anuria, haematuria, vulval oedema
When would you suspect delay in stage 1 of labour?
<2cm dilation in 4hrs if nulliparous
<2cm dilation in 4hrs or slowing in progress if parous
What are the 3P’s used to assess failure to progress?
Powers = inadequate contractions (frequency/strength) Passage = short stature, trauma, shape Passenger = big baby, malposition (relative cephalo-pelvic disproportion)
What is a partogram?
Graphic representation of labour progress = commenced as soon as in established labour
What are some of the areas assessed in a partogram?
Maternal observations (e.g BP), descent, cervical dilation, foetal heart, amniotic fluid, contractions
What can be used to carry out intraoartum foetal assessment?
Doppler auscultation of foetal heart, electronic foetal monitoring (CTG), colour of amniotic fluid
How often should doppler auscultation of the foetal heart be done during labour?
Stage 1 = during and after every a contraction, every 15 minutes
Stage 2 = at least every 5 mins, during and after a contraction for 1 min
How often should maternal pulse be checked during the second stage of labour?
At least every 15 mins
What are the risk factors for foetal hypoxia?
Small foetus or preterm/post date Antepartum haemorrhage or sepsis (temp >38C) Hypertension or pre-eclampsia Diabetes, meconium or PROM >24hr Epidural anaesthetic or VBAC Induction or augmentation of labour
What are the acute causes of foetal distress?
Abruption, vasa praevia, cord prolapse, uterine rupture, foeto-maternal haemorrhage, uterine hyperstimulation, regional anaesthesia
What are the chronic causes of foetal distress?
Placental insufficiency, foetal anaemia
What is a CTG?
Recording of contractions = decelerations, accelerations, variability, baseline heart rate, duration and quality of recording
What four features should be documented during a CTG assessment?
Baseline foetal heart rate, baseline variability, presence or absence of decelerations, presence of accelerations
What can the results of a CTG be classed as?
Normal, suspicious or pathological
How do you interpret a CTG?
Determine risk = contractions, baseline, rate, variability, accelerations, decelerations, overall impression
What is the appearance of hypoxia on CTG?
Loss of accelerations, repetitive deeper and wider decelerations, rising foetal baseline heart rate, loss of variability
What is the management of foetal distress?
Change maternal positions and maternal assessment
IV fluids, scalp stimulation and stop syntocinon
Consider tocolysis = terbutaline 250mg
Foetal blood sampling and operative delivery
How does scalp pH from foetal blood sampling alter management?
pH >7.25 = normal result, no action needed
pH 7.2-7.25 = borderline, repeat sample in 30mins
pH <7.2 = abnormal result, deliver foetus
What are the standard indications for operative vaginal delivery?
Delay = failure to progress to stage 2
Foetal distress
What are the special indications for operative vaginal delivery?
Maternal cardiac disease, severe pre-eclampsia or eclampsia, intrapartum haemorrhage, stage 2 umbilical cord prolapse
What are the benefits of using the ventouse method of delivery?
Vacuum suction so reduces analgesia, vaginal trauma and perineal pain
What are the disadvantages of the ventouse delivery method?
Increased failure, cephalohaematoma, retinal haemorrhage, maternal worry
What are the indications for doing a C-section?
Previous C-section, foetal distress, failure for labour to progress, breech, maternal request
By how much does a C-section increase risk of maternal death?
Increases maternal mortality by 4x
What are some morbidities associated with C-section?
Sepsis, haemorrhage, VTE, trauma, TTN, subfertility, regret, complications for future pregnancy
