Intrapartum Care - Childbirth

Question 1

what is diamorphine and how does it work?

Answer 1

opioid (heroin)

acts centrally on u opiate receptors in periaqueduct causing analgesia

Question 2

side effects of diamorphine?

Answer 2

constipation (only really in long term use)
resp depression
sedation
nausea
sweating
drowsiness
euphoria
pruritis (people can often be seen scratching there nose)
can cause mother to forget experience of childbirth

Question 3

how might diamorphine affect the foetus?

Answer 3

drowsiness (felt as reduced foetal movements which can also cause less accelerations on CTG)
neonatal respiratory distress at birth (would need to reverse effects of opiate with naloxone)

Question 4

what medication is used in an epidural?

Answer 4

levobupivacaine (basically lidocaine + opiate)

Question 5

how is an epidural administered?

Answer 5

injected into epidural scene via tuohy needle (has a curved end and allows a tube to be passed through into the epidural space (epidural cannula) to allow continuous infusion

Question 6

difference between epidural and spinal anaesthetic?

Answer 6

spinal anaesthetic = single injection into the subarachnoid space using normal needle, causes complete block of everything for around 3 hours
epidural = touhy needle, only supposed to block pain and temp

Question 7

how does epidural work?

Answer 7

regional anaesthetic works on nerve roots to uterus (T10-T12) and vagina (Pudendal nerve - S2, 3, 4)

Question 8

what special precautions are associated with the care of the mother with epidural?

Answer 8

should lean forward for administration (more space)
should be supported from the back after administration (cant really support themselves well)
give fluid to prevent hypotension (epidural causes vasodilation)
check BP every 5 mins
empty bladder first
catheterise after
continuous foetal monitoring

Question 9

risks in epidural?

Answer 9

too high level of block causing resp depression
dural puncture (causes crashing headache)
hypotension
loss of bladder control
nerve damage
failure to work
nausea
itchy skin
resp depression
infection
bleeding

Question 10

why is epidural a good choice?

Answer 10

doesnt reduce uterine contractile activity
lasts longer than diamorphine
can be given as continuous infusion
gives complete pain relief in 95%

Question 11

risks of hypotension after epidural and how is this managed?

Answer 11

can cause reduced blood flow to foetus leading to bradycardia and hypoxia
should avoid lying flat on back to maximise venous return
check BP every 5 mins
give IV fluids

Question 12

risks of dural puncture?

Answer 12

needle in epidural is larger than spinal anaesthetic so puncture by epidural is worse and can cause CSF leak
- presents with massive headache

Question 13

how is dural puncture managed?

Answer 13

blood patch

- taking internal blood and squirting it onto the area where the epidural was, the blood clots and seals the puncture

Question 14

how is progression of labour assessed?

Answer 14

bishops score
- dilation
- effacement (4cm in normal, 2cm in eary labour and shortens as labour progresses)
- station
- cervical consistency
- position
timing between contractions (>5 or <2 is abnormal)
engagement (full engaged when 3/5ths or less are palpable)
vaginal exam

Question 15

what is assessed on a partogram?

Answer 15

cervical dilation
foetal heart rate
contractions
duration of labour
vital signs

Question 16

how can failure to progress in labour be managed?

Answer 16

syntocinon (increases force of contractions)
- need to be aware if head is trapped as syntocinon would just push it further in and cause rupture
can use forceps if fully dilated (10cm)
can do C section

Question 17

signs of obstructed labour?

Answer 17

haematuria

a lot of caput and moulding