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Charis & Ellie VS Reproduction > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

What does presentation mean?

A

Part of foetus overlying maternal pelvic inlet

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2
Q

Vertix?

A

Area of foetal skull outlined by the anterior and posterior fontanelles and parietal eminences

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3
Q

Breech Presnetation is generally safest delivered by?

A

C section

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4
Q

Transverse or shoudler/arm presnetation delivery?

A

NOT vaginal
High risk of sever sepsis as uterus will keep contracting and then it will rupture and = death
If vaginal is attempted

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5
Q

Position of the foetal head is defined as?

A

Relationship of denominator to fixed points of maternal pelvis

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6
Q

Denominator of head defined as?

A

Most definable prominence at periphery of presenting part

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7
Q

Occipitoanterior position is though to be strange or normal?

A

Normal- back of babys head is at front

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8
Q

How can you tell if back of baby head is at fornt?

A

Anterior fontanelle looks bigger and is at back

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9
Q

2 exmaples of malposition?

A

Occipitoposterior (back of babys head at back)

Occipitotransverse (back of babys head in transverse plane)

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10
Q

Failure of labour to progress in stage 1?

A

Defined as <2cm dilation in 4 hours or slowing progress

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11
Q

Normal duration of 2nd stage primiparous?

a) epidural
b) No epidural

A

2 hours: no

3 hours: epi

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12
Q

Normal duration for 2nd stage of labour if multiparous?

a) Epidural
b) No epidural

A

1 hour: no epidural

2 hours: epidural

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13
Q

Failure of labour to progress is due to 3 Ps?

A

Powers
Passages
Passenger

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14
Q

Power:

A

Inadequate contractions in frequency and/or strength

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15
Q

Passages?

A

Short stature, trauma, shape of pelvi

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16
Q

Passenger?

A

Big baby, malosition

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17
Q

What does a partogram do?

A

Allows recognition of labour that is not progressing

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18
Q

Moulding menaing?

A

Bones overlapping so head fits through pelvis, signif moulding can be sign of cephalon-pelvic disproportion up to 2+ is normal

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19
Q

Caput is?

A

Diffuse swelling of scalp caused by presssure of scalp against dilated cervix in labour assoc with moulding

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20
Q

Descent of foetal head is recorded by?

A

Assessing at level of presenting part in cm above or below the ischial spine and marked as +1, +2, +3 below spines and -1, -2, -3 if above spine

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21
Q

What is liquor?

A

Amniotic fluid and if ruptured colour is recorded, meconium stained liquor can be sign of foetal distress

22
Q

Assessment of foetal wellbeing involves?

A

Low risk women: dopler monitoring at intervals
High risk women: CEFM with CTG screens for foetal hypoxia

CEFM= Continuous electronic foetal monitoring

23
Q

What is CTG

A

Cardiotocography

24
Q

Pneumonic for interpreting CTG?

A

DR C BRAVADO

25
Q

DR stands for in CTG interpretation?

A

Define risk

26
Q

C stands for in DR C BRAVADO?

A

Contractions
-Peaks at bottom of trace, small nox= 1 min, CTG only demonstrates contraction frequency, not strength, expect 3-5 contractions in 10 mins in established labour

27
Q

How many contractions per 10 mins in established labour o CTG?

A

3-5 in 10 minutes

28
Q

BRA in BRAVADO of CTG interpretation?

A

Baseline rate foetal baseline HR should be 110-160 BPM, look at average rate over 10 mins ignoring accelerations or decelerations, tachycardia

29
Q

What is tachycardia in foetu?

A

> 160 bpm, bradycardia is <110 bpm

30
Q

V in BRAVADO?

A

Varaibility
Good= 5-25 bom
<5bpm= reduced variability, which can be reduced by foetal sleep state but not for longer than 40 mins

31
Q

A in BRAVADO?

A

Accelerations

Increase in FHR by at least 15 bpm for 15s or more and assoc with foetal movement

32
Q

D in BRAVADO?

A

Decelerations

33
Q

O IN BRAVADO?

A

Overall impression/diagnosis

34
Q

2 important things to be aware of on CTG?

A

Terminal bradycardia

Decelerations

35
Q

What does operative vaginal delivery involve use of?

A

Forceps

Vacuum extraction/ventouse

36
Q

Indications for opertaive vaginal delivery?

A

Failure to progress in 2nd stage
Foetal distress
Maternal exhaustion

37
Q

Requirements for forceps delivery?

A 
Fully dilated 
OA position 
Ruptured membranes 
Cephalic presentation 
Engaged presenting part 
Pain relief 
Sphincter

FORCEPS acronym

38
Q

Main indications for C section?

A 
Prev C section 
Foetal distress 
Failure to progress in labour 
Breech presentation 
Maternal request
39
Q

Indications for induction of labour?

A 
Prolonged pregnancy (XS of 42 weeks) 
Pre-eclampsia 
Placental insufficiency and IUGR 
APH 
Rh isoimmunization 
Diabetes 
Chronic renal disease
40
Q

What allows you to determine likely outcome of induction of labour

A

BIshops score

41
Q

What are methods of induction of labour decided by?

A

Whether membranes are still intact and score on cervical assessment

42
Q

Examples of induction techniques?

A

-Stripping of membranes
-Artificial ROM
-Medical induction following artificial ROM with syntocinon
Medical induction by cervical ripening with prostaglandins
Mechanical cervical ripening using balloon catheter

43
Q

Types of pain management in labour?

A 
Narcotic analgesia 
Inhalation analgesia 
Epidural analgesia 
Pudendal nerve block 
Spinal anaesthesia 
General anaesthesia
44
Q

Examples of narcotic anaglesia?

A

Pethidine and morphine

-Helpful if unsuitable for regional analgesia

45
Q

What can narcotic analgesia cause?

A

Foetal resp depression

46
Q

Examples of inhalational analgesia?

A

Etonox (AKA gas and air)

Often in early labour but sometimes inadequate

47
Q

Epidural analgesia gives how much pain relief?

A

Usually complete pain relief

48
Q

When can epidural be commenced?

A

Established Labour usually

49
Q

SE of epidural?

A 
Can cause abnormal foetal HR 
Risk of Hypotension in mum 
Accidental dural puncture risk 
Postdural headache 
Atonic bladder 
High block can cause resp depression in mother
50
Q

What is pudendal nerve block often used for?

A

Operative vaginal delivery

51
Q

Spinal anaesthesia used for?

A

Operative delivery

52
Q

General anaesthesia used for?

A

Emergency

Charis & Ellie VS Reproduction (71 decks)

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