Abnormal Labour and Obstetric Emergencies Flashcards
how many women achieve a normal SVD?
60%
how many women need a forceps delivery?
15%
define malpresentation?
non-vertex
posterior fontanelle is shaped like…
a triangle
anterior fontanelle is shaped like…
a diamond
malposition is defined as…
OP or OT
pre-term delivery is defined as
37
post-term delivery is defined as >_ weeks
42
risk of stillbirth increases at >_ weeks
38
Tx cord prolapse
category 1 CS (within 30 mins)
describe a footling breech?
one or both feet point down
describe a frank breech?
legs point up with feet at baby’s head so bottom comes first
describe a complete breech
legs folded with feet at level of baby’s bottom
when would a malpresentation prompt a definite CS delivery?
active labour
membranes ruptured
what malpresentation of the face can still undergo a vaginal delivery? why?
mentoanterior
can still flex chin to chest
anesthesia used in CS? what anaesthetic is used in emergencies
spinal -15/20 mins
general - for emergencies
risks for obstructed labour
sepsis uterine rupture AKI (obstruction) PPH fistula fetal asphyxia neonatal sepsis
define obstructed labour
even though the uterus is contracting normally, the baby does not exit the pelvis during childbirth due to being physically blocked.
how do you assess progress in labour?
cervical dilatation via VE
descent of presenting part
signs of obstruction?
moulding caput (swollen fontanelles) anuria haematuria vulval oedema
failure to progress is defined as
failure of the cervix to dilate by 2cm in 4hrs
how many contractions do you want in labour per 10 mins?
3-5 in 10 mins
what problems with the baby can cause failure to progress?
big baby
malposition
components of intra-partum fetal assessment?
doppler auscultation of fetal heart every 15 mins
colour of AF
CTG
why is fetal HR checked for 1 whole min after a contraction?
late decelerations to check for hypoxia
risk factors for fetal hypoxia?
SGA pre/post term APH hypertensive problems diabetes meconium epidural sepsis IOL
a temp over _ degrees makes you worry about sepsis
38
acute causes of fetal distress
uterine hyperstimulation eg syntocinon PA vasa praevia cord prolapse uterine prolapse feto-maternal haemorrhage regional anaesthesia
chronic causes of fetal distress
placental insufficiency
fetal anaemia
normal FH rate?
110-150bpm
normal variability
5-25bpm
how should you deliver a baby in fetal distress?
whatever way is quickest
early decelerations are normal T or F
T
why does epidural anaesthesia carry a risk of fetal distress?
vasodilatation underperfuses babys placenta
define the DR C BRAVADO method of reading a CTG
Determine Risk Contractions Baseline RAte Variability Accelerations Decerations Overall impression
Tx of fetal distress
change maternal position IV fluids stop syntocinon scalp stimulation vitals abdo exam/VE FBS operative delivery
what is tocolysis? give an example of a tocolytic drug
medication that relaxes the uterus
terbutaline
when would you do fetal blood sampling?
if cervix >4cm dilated
not sure about CTG
Ix fetal distress
- CTG, VE, vitals, abdo exam
2. FBS
scalp pH under ___ on FBS is concerning
7.2
standard indications for assisted vaginal delivery?
delay
fetal distress
special indications for assisted vaginal delivery?
maternal cardiac disease
severe PET
IPH
cord prolapse stage 2
duration of stage 2 for prims without epidural? with epidural?
2h
3h
duration of stage 2 for multiparous women without epidural? with epidural?
1h
2h
what is a ventouse delivery?
vaginal delivery using suction
ventouse delivery is less safe than forceps or CS T or F
F
contraindications to FBS?
anaemic babies
low platelets
high bleeding risk
main indications for CS?
previous CS fetal distress failure to progress in labour breech presentation maternal request
main complications of CS?
sepsis haemorrhage VTE trauma hysterectomy if bleeding badly
what is shoulder dystocia
ant shoulder stuck under symphysis pubis which causes hypoxia
how long do you have to deliver a baby who is hypoxic from shoulder dystocia?
7
cause of uterine inversion?
iatrogenic from pulling on cord too hard
main causes of maternal collapse?
4Hs and 4T’s PLUS:
amniotic fluid embolism
pre-eclampsia
how can you resolve supine hypotension in a pregnant woman?
turn woman into left lateral position
pathophysiology of aortocaval compression
lying supine can compress IV and aorta causing reduced venous return
how long after performing CPR on a collapsed pregnant woman should you attempt delivery?
4 mins
