Abnormal Labour and Obstetric Emergencies Flashcards
how many women achieve normal vaginal delivery?
60%
what is malpresentation?
abnormal postion of the foetus during delivery
what is malposition?
abnormal positions of the foetal head
OP or OT
what is the normal positioning of the foetal head during delivery?
ocippito-anterior
what are the three types of breech delivery?
complete- legs folded with feet at level of baby’s bottom
footling- one or both feet facing down so legs present first
frank- legs folded up the way to baby head so bottom emerges first
what forms of analgesia are avaible during labour?
entonox
TENS
water immersion
IM opiate e.g. morphine
regional anaesthesia
an epidural could inhibit progress of which stage of labour?
stage 2
what are complications of an epidural?
hypotension
headache
high block
atonic bladder
what can cause failure to progress in labour?
sespsis
uterine rupture
obstructed AKI
pospartum haemorrhage
foetal asphyxia
neonatal spesis
how is progress in labour assessed?
cervical dilation
descent of progressing part
signs of obstruction
what is suspected delay (stage 1)?
nuliparous <2cm dilation in 4 hours
parous <2cm dilation in 4 hours or slowing in progress
how is foetal distress identified?
Doppler auscultation
Electronic Foetal Monitoring Cardiotocograph (CTG)
colour of amniotic fluid
how often is doppler uaucultation carried out in stage 1 of labour?
during and after every contraction
every 15 mins
how often is doppler ausculation carried out in stage 2 of labour?
at least every 5 mins
during and after a contraction for 1 whole min
check maternal pulse at least every 15 mins
what indicates foetal hypoxia on doppler auscultation?
late decel
what is the normal range for bpm on CTG?
normal 110-150
variability 5-25 bpm
how are CTGs classified?
normal
suspicious
pathological
if you can’t interpret CTG what should be done?
get senior obstetrician input → really important not to miss anything
what is used to help interpret CTG?
DR C BRAVADO
Determine
Risk
Contractions
Baseline
Rate
Variability
Accelerations
Decelerations
Overall Impression
how is foetal distress managed?
change maternal position
IV fluids
stop syntocinon
sclap stimulation
foetal blood sampling
consider tocolysis
operative delivery
what are the ranges for foetal blood sampling (normal to abnormal)
normal >7.25
borderline 7.2-7.25
abnormal <7.2
what action should be taken if foetal blood sample comes back
1) normal
2) borderline
3) abnormal
1) none
2) repeat in 30 mins
3) deliver (emergency)
when would operative vaginal delivery be indicated?
delay (failure to progress to stage 2)
foetal distress
from 20 weeks gestation what can be affected when mum lies flat?
supine hyotension
(uterus compresses IVC and aorta reducign venous return and CO)
