Normal and Abnormal Labour Flashcards
What is malposition?
Abnormal positions of the vertex of the fetal head relative to the maternal pelvis
What is the normal position of the fetal head?
Occipitoanterior
What is the vertex of the fetal skull?
The vertex is the area midway between the anterior fontanel, the two parietal bones and the posterior fontanel. A vertex presentation occurs when this part of the fetal skull is leading the way.
Fit these terms to the arrows:
- The vertex
- The flexion point
- Anterior fontanelle
- Posterior fontanelle
- Parietal bone
- Parietal eminance
- Frontal bone
- Coronal suture
- Saggital suture
What is malpresentation?
Any presentation other than vertex
Name these types of presentation
- Complete breech - legs folded with feet at the bottom
- Footling breech - one or both feet point down and emerge first
- Frank breech - legs point up so bottom emerges first
What anatomical landmark is station 0?
Ischial spine
What is the definition of presentation
Which anatomical part of the fetus is closest to the pelvic inlet (leading)
What is the definition of attitude
Relationship of the fetal head to its own spine - should be flexed
What is the definition of position
The relation of the occipit to the maternal pelvis
What is the definition of lie
Relationship of the baby’s spine to the maternal spine
What does presence of muconium in the amniotic fluid indicate?
Fetal distress
What is the definiton of bradycardia on a CTG?
15 beats below the baseline for 3 minutes or more
What is the definition of a deceleration?
A drop of 15 beats or more below the baseline for more than 15 seconds
What are the indications for instrumental delivery?
- Maternal exhaustion
- Prolonged labour
- Co-morbidities that make pushing dangerous
- Fetal distress
- Malposition
What is the difference for future pregnancies between a lower and upper uterine segment incision?
Lower segment incision = can still have vaginal deliveries
Upper segment incision = must only deliver in future via c-section
What are the 3 Ps of abnormal labour?
- Passenger (doesn’t rotate/large baby etc)
- Passage (small pelvis)
- Power (tightenings not contrations/dehydration/epidurals etc)
What is considered full term?
37 weeks
What is the 1st stage of labour?
1st stage:
- Latent phase = cervical dilation up to 3-4cms
- Active phase = cervical dilation 4-10cm and contractions are regular and painful (about 4 in 10)
What is the second stage of labour?
Passage through birth canal to delivery of baby. An hour for passive descent and then actively push. Prims can have up to 4 hours be considered normal.
What is the 3rd stage of labour?
Delivery of baby to expulsion of placenta
What is syntocinon?
An IV infusion of synthetic oxytocin - to help labour progress
What should you do first if there is fetal distress?
Stimulate baby’s head/change Mum’s position etc to see if you can get a response and if not, take a fetal gas
When is thrombin given in obstetrics?
During PPH if the bleeding is becoming very watery and you’re worried about PPH
What uterotinic agents can be given in PPH?
- Syntocinon
- Mysoprostil
- Carboprost (be careful is asthmatics)
- Ergometrin (be very careful if patient is hypertensive)
+ 1g tranexamic acid (not uterotonic)
What are indications for induction of labour?
- Post dates
- Ruptured membranes
- Diabetic/hypertensive with poor control
- Static growth
What do you use instead of prostaglandins if a patient has had a previous c-section or is para 4+?
Cooks ballon
What does Dr C Bravado stand for?
DR = Determine Risk (low or increased)
C = Contractions (how many in 10)
BRA = Baseline RAte (is there a tachy or bradycardia or rising baseline)
V = Variability (normal, reduced or absent)
A = Accelerations (present or absent)
D = Decelerations (absent, early, variable or late)
O = overall assessment and written plan (reassuring or non-reassuring)
What is the expected rate of dilation?
2 cm every 4 hours
What are the risk factors for shoulder dystocia?
Previous shoulder dystocia
Diabetes
BMI > 30
Induced labour
Prolonged labour
Intrumental delivery
What drug can cause hyperstimulaton and issues with contractions which can lead to fetal distress
Syntocinon
