Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Appreciating Complex Midwifery Care > Monitoring Complex Labour > Flashcards

Monitoring Complex Labour Flashcards

1
Q

What does MOTHERS stand for and what does it relate to?

A 
The indications for continuous monitoring
M = meconium
O = oxytocin
T = temperature
H = hyperstimulation
E = epidural
R = rate of progress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does Dr C Bravado stand for?

A 
DR - define risk
C - contractions
Bra - baseline rate
V - variability
A - accelerations
D - decelerations
O - overall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define complex labour

A

Anyone who doesn’t meet the criteria for labouring in a midwifery-led unit/ homebirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does CTG stand for?

A

Cardiotocograph - monitors the foetal HR and uterine contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does STAN stand for?

A

ST wave analysis - combines CTG monitoring with analysis of a foetal ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 3 classifications of a CTG trace?

A

Normal - all features reassuring
Suspicious - 1 feature non-reassuring and 2 features reassuring
Pathological - 1 feature pathological OR 2 features non-reassuring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 3 classification of the Dr C Bravado characteristics?

A

Reassuring, Non-reassuring, Abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the different between the 2 types of nervous system?

A

Somatic - voluntary

Autonomic - involuntary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the autonomic NS

A

Split into:
Sympathetic - fight or flight, increases HR, releases catecholamines
Parasympathetic - decreases HR, RR etc, releases acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a reassuring baseline rate?

A

100-160bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a non-reassuring baseline rate?

A

100-109bpm

160-180bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is an abnormal baseline rate?

A

<100 or >180bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a baseline bradycardia?

A

Baseline <110bpm for >10 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a baseline tachycardia?

A

Baseline >160bpm for >10 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 4 possible causes of abnormal baselines?

A
  1. Gestation
  2. Drugs
  3. Infection
  4. Hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What effect can the release of catecholamines have on the baseline?

A 
Increases baseline (in absence of maternal temp)
Caused by decreased oxygen levels in tissues and blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a reassuring variability?

A

5-25bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a non-reassuring variability?

A

<5 for >30 mins but <50 mins

>25 for >15 mins but <25 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an abnormal variability?

A

<5 for >50 mins

>25 for >25 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is cycling?

A

Periods of reduced variability while the baby is asleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some factors that affect variability?

A
  • Maternal opiates
  • Foetal hypoxia
  • Pre-existing foetal brain damage
  • Cardiac arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What 3 signs, when combines, are a sign of foetal hypoxia?

A

Reduced variability
Tachycardia
Decelerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the features of a sinusoidal pattern?

A
  • Baseline of 120-160bpm with regular sine-wave oscillations
  • Amplitude of 5-15 beats
  • 2-5 cycles per minute
  • Reduced/absent baseline variability
  • No accelerations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which is different about an atypical/ jagged sinusoidal pattern?

A

It always has a pathological cause (hypoxia/ foeto-maternal haemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are accelerations?

A
  • Increase of >15 beats for >15 secs
  • Related to the somatic NS
  • Occur most frequently during foetal activity
  • Sign that the baby is healthy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a deceleration?

A
  • A drop in FHR of >15 beats for >15 secs

- Drop of <15 beats with reduced variability may also be a concern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is an early deceleration?

A
  • Reassuring

- Nadir of deceleration in line with peak of contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What usually causes early decelerations?

A
  • Head compression causes increase in BP
  • High BP detected by baroreceptors which stimulate the parasympathetic NS
  • Vagus nerve releases acetylcholine which decreases FHR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is a late deceleration?

A
  • Mid to late contraction
  • Nadir >20 secs after peak of contraction
  • Similar to shape of contractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How are late decelerations classified?

A

> 50% contractions in <30 mins = non-reassuring

>50% contractions in >30 mins = abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are variable decelerations and how are they classified?

A
  • Vary in shape, form and timing

- Classified by the presence/ absence of concerning characteristics (CC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the characteristics of variable decelerations without concerning characteristics?

A
  • Last <60 secs
  • > 60 bpm
  • Classified by the presence of shouldering
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the characteristics of variable decelerations with concerning characteristics?

A
  • Last >60 secs
  • Reduced variability with deceleration
  • Failure to return to baseline
  • No shouldering
34
Q

What is shouldering?

A

FHR increases just before a deceleration

35
Q

How does blood flow between the placenta and the baby?

A
  • Oxygenated foetal blood flows from placenta to baby via thin walled veins
  • Deoxygenated foetal blood flows from placenta to baby via thick walled veins
36
Q

How does hypovolaemia affect FHR?

A
  • Increases FHR

- Increased FHR in presence of normalising BP causes decreased FHR

37
Q

What is hypovolaemia?

A

Decreased blood volume

38
Q

How does shouldering occur?

A
  1. Contraction occludes the vein
  2. Contraction occludes arteries
  3. Arteries spring open
  4. Vein opens
39
Q

What happens when the contraction occludes the vein?

A
  • Reduces blood flow to foetus
  • Blood flow to placenta is unchanged
  • Decreases BP and increases FHR (baroreceptors stimulate sympathetic NS)
40
Q

What happens when the contraction occludes the arteries?

A
  • Blood flow to and from baby equalises
  • Increased FHR and increased BP may cause haemorrhagic stroke so FHR is decreased (baroreceptors stimulate parasympathetic NS)
41
Q

What happens when the arteries spring open?

A
  • Blood flow to placenta is greater than the blood flow to the baby
  • BP decreases and FHR increases (baroreceptors stimulate sympathetic NS)
42
Q

What happens when the vein opens?

A
  • Blood flow to and from placenta equalises

- BP and FHR normalise

43
Q

How are variable decelerations classified?

A

<50% contractions for >30 mins = non-reassuring
>50% contractions for <30 mins = non-reassuring
>50% contractions for >30 mins = abnormal

44
Q

How likely is it that contractions will recover after prolonged decelerations?

A
  • 90% recover within 6 mins

- 95% recover within 9 mins

45
Q

What are the possible causes of prolonged decelerations?

A
  • Cord compression/ prolapse
  • Anaesthesia
  • Uterine rupture
  • Respiratory depression
  • Prolonged contractions/ hypercontractility
46
Q

What may indicate an OP position?

A

Coupling contractions

47
Q

What should be done if the CTG is suspicious or pathological?

A

Start conservative measures (fluids, reduce/stop synto, change position, offer tocolytic drugs)

48
Q

When is cEFM necessary?

A
  • P 2 x >120bpm or temp >38
  • Significant meconium
  • PV bleeding in labour
  • Hypertension
  • Delay in 1st/2nd stage
  • Oxytocin
49
Q

When is cEFM not necessary?

A

Women who have an epidural but no other risk factors

50
Q

How can subacute hypoxia be detected?

A

When the HR spends more time decelerating than at the baseline (baby’s pH drops by 0.01 every 2 mins during subacute hypoxia)

51
Q

What is the gradual evolution of hypoxia?

A

Normal CTG -> Decelerations -> Loss of accelerations -> Catecholamines released -> Raising baseline -> Reduced variability -> Baseline instability -> Terminal bradycardia -> Foetal demise

52
Q

What is aerobic metabolism?

A

Glucose/Fat/Protein + Oxygen -> CO2 + Water + ATP

CO2 + Water -> H+ + HCO3-

53
Q

How is pH measured?

A

The concentration of free H+ ions; most are buffered by Hb

54
Q

What is anaerobic metabolism?

A

Glycogen -> Glucose -> Energy (lactic acid produced as a by-product)

55
Q

What do significant and insignificant meconium look like?

A 
Significant = Dark green waters with lumps
Insignificant = Stained waters but not very thick
56
Q

If waters turn from clear to stained, what can this mean?

A
  • Sign that baby is stressed
    BUT
  • Can be normal with term babies as their vagus nerve is more developed
57
Q

How are placental lakes different in SGA babies?

A
  • Small baby = small placenta
  • Smaller placental lakes around villi
  • Less gaseous exchange between foetal and maternal blood
58
Q

How are placental lakes different in GDM babies?

A

Normal size villi but small placental lakes

59
Q

What is the indication for foetal blood sampling?

A

Pathological CTG with no response to foetal scalp stimulation

60
Q

What are some contraindications of FBS?

A
  • Prolonged bradycardia
  • 2nd stage
  • Not technically possible
  • Certain maternal/foetal conditions
  • Significant maternal pyrexia or sepsis
  • Prematurity
61
Q

What is the procedure for FBS?

A
  • Position woman in left lateral to avoid aortocaval compression
  • 2 samples optimum = use lowest result
  • Consider result, prev. results and whole clinical picture
  • If abnormal, seek consultant support
62
Q

What is the normal lactate and pH?

A

Lactate = <4.1mmol/l
pH = >7.25
Repeat in 1hr unless CTG abnormalities resolve or worsen

63
Q

What is borderline lactate and pH?

A

Lactate = 4.2-4.8mmol/l
pH = 7.21-7.24
Repeat in 30 mins

64
Q

What is abnormal lactate and pH?

A

Lactate = >4.9mmol/l
pH = <7.20
Deliver baby

65
Q

What are the issues with performing FBS?

A
  • Never been validated in humans
  • No evidence that is reduce the number of LSCS, instrumental deliveries or long-term neonatal outcome
  • Caput
  • Contamination with amniotic fluid/ mec
  • Lack of consistency in results
66
Q

Describe the process of paired cord sampling

A
  • Double clamp cord
  • 2 heparinised syringes
  • Sample artery and then vein at 45 degree angle
  • Expel excess air
  • Sample should be taken within 30 mins of delivery
  • Sample should be processed as soon as taken (within 10 mins)
67
Q

What is a normal arterial and venous pH?

A 
A = 7.04-7.39
V = 7.16-7.47
68
Q

What is a normal arterial and venous base deficit?

A 
A = -2.8 - 9.4mmol/l
V = -1.4 - 8.8mmol/l
69
Q

What is a normal arterial and venous pCO2?

A 
A = 37-80
V = 26-59
70
Q

What do levels of pH and base excess indicate?

A

Low pH, normal BE = respiratory acidaemia

Low pH, abnormal BE = combined respiratory and metabolic acidaemia

71
Q

What is respiratory acidaemia?

A

Accumulation of carbon dioxide through impaired gas exchange = low pH

72
Q

What is combined respiratory and metabolic acidaemia?

A

Accumulation of carbon dioxide through impaired gas exchange and the build up of lactate and H+ ions through anaerobic metabolism

73
Q

What is indicated if there’s a difference in pH acidaemia?

A

Large arterial-venous difference = likely to have occurred in 2nd stage, acute event or cord compression
Small arterial-venous difference = likely to be longstanding acidaemia

74
Q

What is a significant base excess?

A 
Arterial = >-12.0mmol/l
Venous = >-10.0mmol/l
75
Q

What is acidaemia?

A

Low blood pH

76
Q

What is acidosis?

A

Low blood and tissue pH

77
Q

What is base excess/deficit?

A

Measure of how much buffer has been used

78
Q

What is hypoxaemia?

A

Low oxygen tension in blood (low pO2)

79
Q

What is hypoxia?

A

Low oxygen levels in tissues

80
Q

What is metabolic acidosis?

A

Low blood pH and high BE due to accumulation of CO2 and H+ ions using up buffers

Appreciating Complex Midwifery Care (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions