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Reproduction and Sexual Health > Abnormal Labour and Obstetric Emergencies > Flashcards

Abnormal Labour and Obstetric Emergencies Flashcards

1
Q

List different reasons why a labour may be classified as ‘abnormal’.

A
  • Malpresentation – non vertex
  • Malposition – OP or OT
  • Preterm <37 weeks
  • Post-term >42 weeks
  • Obstruction
  • Foetal distress
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2
Q

Name the boundaries of the vertex.

A

Anterior and posterior fontanelles and the parietal eminences

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3
Q

After how many weeks of pregnancy do the rates of stillbirth increase a lot?

A

After 37 weeks

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4
Q

What type of delivery is necessary if there is a cord prolapse?

A

C - section (think C for Cord

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5
Q

What baby position usually requires a c section?

A

BREECH

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6
Q

Describe complete breech position.

A

Legs crossed with babies feet and its bottom

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7
Q

Describe the footling breech position.

A

One or both feet point down so that the legs will come out first

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8
Q

Describe the frank breech position.

A

Legs are lifted up and touching the babies head so that the bottom comes out first

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9
Q

What does malpresentation mean simply?

A

When the baby is in any position that is not vertex

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10
Q

List the 4 main types of breech position.

A
  • Transverse
  • Shoulder-arm
  • Face (MA or MP)
  • Brow
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11
Q

What is MA position? What kind of delivery is required?

A

Menoanterior (mento is chin)

This can deliver anterior

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12
Q

What is MP position? What kind of delivery is required?

A

Menoposterior - the chin is posterior

This needs a c section

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13
Q

What type of situation can epidural not be given in?

A

Emergency

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14
Q

What type of analgesia must be given in an emergency?

A

GA or spinal

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15
Q

What is IV Remifentanil PCA?

A

A very short acting opiate that works quickly

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16
Q

What is Entonox also known as?

A

Gas and air

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17
Q

Is epidural good?

A

Yes, it provides pain relief for 95% of people

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18
Q

Epidural does not impair _______ ________?

A

Uterine activity

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19
Q

What may epidural inhibit?

A

Processes during the second stage of labour

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20
Q

What are the 2 components of epidural?

A

Levobupivacaine +/- Opiate

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21
Q

List the 5 main side effects of epidural.

A
  • Hypotension (20%)
  • Dural puncture (1%)
  • Headache
  • High block
  • Atonic bladder (40%)
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22
Q

What can dural puncture cause?

A

CSF leak

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23
Q

What is the main symptom of CSF leak?

A

AWFUL headache

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24
Q

What 3 things should be looked at when assessing the progress of labour in stage 3?

A
  • Cervical dilatation
  • Descent of presenting part
  • Signs of obstruction e.g moulding, caput, anuria, haematuria, vulval oedema
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25
Q

Describe moulding.

A

When fontanelles merge over each other and cannot be reduced, this is a sign of obstruction

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26
Q

Describe caput.

A

The fontanelles feel swollen, also a sign of obstruction

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27
Q

What 2 things would indicate a delay of pregnancy? (describe in terms of nulliparound and porous women)

A
  • Nulliparous - <2cm dilation in 4 hours

* Parous - <2cm dilation in 4 hours/slowing in progress

28
Q

What are the 3 P’s?

A

Power
Passage
Passenger

29
Q

Describe powers.

A

CONTRACTIONS

Inadequate contractions – frequency +/- strength

30
Q

Describe passage.

A

MATERNAL PELVIS

Short stature, trauma or shape

31
Q

Describe passengers.

A

BABY

  • Big baby
  • Malposition – relative cephalon-pelvic disproportion
32
Q

What is a partogram?

A

This is a graphic representation of the progress of labour

33
Q

What 7 things does a partogram take a recording of?

A
  • Foetal heart
  • Amniotic fluid
  • Cervical diltation
  • Dsecent
  • Contractions (frequency not intensity)
  • Obstruction
  • Maternal observations
34
Q

What 3 things should an intra-partum foetal assessment involve?

A
  • Doppler auscultation of fetal heart
  • Cartiotocograph (CTG) +/-STAN
  • Colour of amniotic fluid – normal is clear
35
Q

During stage 1 of labour, how often is doppler auscultation of the foetal heart done?

A
  • During and after a contraction

* Every 15 minutes

36
Q

During stage 2 of labour, how often is doppler auscultation of the foetal heart done?

A
  • At least every 5 minutes during and after a contraction for 1 minute !
  • Check maternal pulse every 15 minutes too
37
Q

Why is it important to do constant monitoring of the foetal heart?

A

There are lots of causes of foetal hypoxia

38
Q

Outline ACUTE causes of foetal distress.

A
  • Abruption
  • Vasa Praevia
  • Cord Prolapse
  • Uterine Rupture
  • Foeto-maternal haemorrhage
  • Uterine hyperstimulation
  • Regional anaesthesia
39
Q

Outline CHRONIC causes of foetal distress.

A
  • Placental insufficiency

* Foetal anaemia

40
Q

Outline SUBACUTE causes of foetal distress.

A

Foetal hypoxia

41
Q

Early decelerations are physiological

A

TRUE

42
Q

Late decelerations are pathological

A

TRUE

43
Q

What are early decelerations due to?

A

Due to vagal maneuver – they are completely benign

44
Q

What are late decelerations a sign of?

A

HYPOXIA !!!

45
Q

Variable decelerations can be normal OR a sign on ….

A

Cord compression !!

46
Q

When assessing a CTG, there are 4 different categories which should be considered …

A
  • Baseline foetal heart rate
  • Baseline variability
  • Presence or absence of decelerations
  • Presence of accelerations
47
Q

CTG results are either – normal, suspicious or pathological. Outline what should be done for each.

A
  • Normal – leave this baby
  • Suspicious – observe and make any changes
  • Pathological - deliver as you think the baby is at risk of hypoxia
48
Q

What acronym is used in CTG analysis?

A

DR C BRAVADO

49
Q

DR C BRAVADO ….

A

D – determine
R – risk

C – contractions

B – baseline 
RA – rate 
V – variability 
A – accelerations 
D – decelerations 
O – overall impressions
50
Q

Outline the management of foetal distress.

A
  • Change maternal position
  • IV Fluids
  • Stop syntocinon
  • Scalp stimulation
  • Consider tocolysis - Terbutaline 250 micrograms s/c
  • Maternal assessment – pulse, BP, abdo exam, vaginal exam
  • Foetal blood sampling
  • Operative delivery
51
Q

Where is a foetal capillary sample taken from?

A

Babies scalp

52
Q

How many cm dilated does the mother have to be to be able to insert a cone and take a capillary sample from the babies head?

A

4 cm

53
Q

What pH required immediate delivery of the baby?

A

< 7.20

54
Q

What pH requires a repeat test in 30 mins?

A

7.20-7.25

55
Q

What is a ventrouse?

A

A vaccum extractor for use in assisting childbirth

56
Q

In Tayside, forceps are more commonly used than suction cups

A

TRUE

57
Q

List the 5 main indications for a c section.

A
  • Previous c-section
  • Foetal distress
  • Failure to progress in labour
  • Breech
  • Maternal request
58
Q

4x’s greater maternal mortality is associated with c-section

A

TRUE :(((((

59
Q

Shoulder dystocia - head comes out but anterior shoulder gets stuck between symphysis pubis

What is there a risk of?
What do you therefore have to do?

A

Hypoxia

Deliver the baby in 7 minutes !!!

60
Q

4 H’s and 4 T’s - reversible causes
+
Pre-eclampsia and amniotic fluid emoblism

What do all of the above cause?

A

Maternal collapse

61
Q

What are the 4 H’s that cause maternal collapse?

A
  • Hypovolaemia
  • Hypoxia
  • Hyperkalemia or hypokalemia/ metabolic
  • Hypothermia
62
Q

What are the 4 T’s that cause maternal collapse?

A
  • Tablets or toxins
  • Tamponade
  • Tension pneumothorax
  • Thrombosis
63
Q

What is aortocaval compression?

A

From 20 weeks gestation, in the supine position the gravid uterus can compress IVC and aorta reducing venous return

64
Q

What does aorticaval compression do to cardiac output?

A

Decreasing cardiac output by up to 40%, causing supine hypotension

65
Q

What is perimortem c section?

A

A resuscitative hysterotomy, also referred to as a perimortem Caesarean section (PMCS) or perimortem Caesarean delivery (PMCD), is a hysterotomy performed to resuscitate a woman in middle to late pregnancy who has entered cardiac arresst

Reproduction and Sexual Health (51 decks)

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