Abnormal Labour and Obstetric Emergencies

Question 1

how many women achieve normal vaginal delivery?

Answer 1

60%

Question 2

what is malpresentation?

Answer 2

abnormal postion of the foetus during delivery

Question 3

what is malposition?

Answer 3

abnormal positions of the foetal head

OP or OT

Question 4

what is the normal positioning of the foetal head during delivery?

Answer 4

ocippito-anterior

Question 5

what are the three types of breech delivery?

Answer 5

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

Question 6

what forms of analgesia are avaible during labour?

Answer 6

entonox

TENS

water immersion

IM opiate e.g. morphine

regional anaesthesia

Question 7

an epidural could inhibit progress of which stage of labour?

Answer 7

stage 2

Question 8

what are complications of an epidural?

Answer 8

hypotension

headache

high block

atonic bladder

Question 9

what can cause failure to progress in labour?

Answer 9

sespsis

uterine rupture

obstructed AKI

pospartum haemorrhage

foetal asphyxia

neonatal spesis

Question 10

how is progress in labour assessed?

Answer 10

cervical dilation

descent of progressing part

signs of obstruction

Question 11

what is suspected delay (stage 1)?

Answer 11

nuliparous <2cm dilation in 4 hours

parous <2cm dilation in 4 hours or slowing in progress

Question 12

how is foetal distress identified?

Answer 12

Doppler auscultation

Electronic Foetal Monitoring Cardiotocograph (CTG)

colour of amniotic fluid

Question 13

how often is doppler uaucultation carried out in stage 1 of labour?

Answer 13

during and after every contraction

every 15 mins

Question 14

how often is doppler ausculation carried out in stage 2 of labour?

Answer 14

at least every 5 mins

during and after a contraction for 1 whole min

check maternal pulse at least every 15 mins

Question 15

what indicates foetal hypoxia on doppler auscultation?

Answer 15

late decel

Question 16

what is the normal range for bpm on CTG?

Answer 16

normal 110-150

variability 5-25 bpm

Question 17

how are CTGs classified?

Answer 17

normal

suspicious

pathological

Question 18

if you can’t interpret CTG what should be done?

Answer 18

get senior obstetrician input → really important not to miss anything

Question 19

what is used to help interpret CTG?

Answer 19

DR C BRAVADO

Determine

Risk

Contractions

Baseline

Rate

Variability

Accelerations

Decelerations

Overall Impression

Question 20

how is foetal distress managed?

Answer 20

change maternal position

IV fluids

stop syntocinon

sclap stimulation

foetal blood sampling

consider tocolysis

operative delivery

Question 21

what are the ranges for foetal blood sampling (normal to abnormal)

Answer 21

normal >7.25

borderline 7.2-7.25

abnormal <7.2

Question 22

what action should be taken if foetal blood sample comes back

1) normal
2) borderline
3) abnormal

Answer 22

1) none
2) repeat in 30 mins
3) deliver (emergency)

Question 23

when would operative vaginal delivery be indicated?

Answer 23

delay (failure to progress to stage 2)

foetal distress

Question 24

from 20 weeks gestation what can be affected when mum lies flat?

Answer 24

supine hyotension

(uterus compresses IVC and aorta reducign venous return and CO)

Question 25

supine hypotension can precipitate what?

Answer 25

maternal collapse

(usually reversed by turning the woman into the left lateral position)

Question 26

what would a scalp pH of 7.1 on foetal blood sampling indicate?

Answer 26

emergency → deliver

Question 27

what breech presentation carries the highest risk?

Answer 27

footling

no pressure on cervix- foot will emerge then baby will get stuck