abnormal labour

Question 1

what can this be due to

Answer 1

faults in powers, passages or passengers

Question 2

what features of the passenger can make it abnormal

Answer 2

presentation and size

Question 3

what presentations of fetus require C section

Answer 3

transverse and brow

Question 4

what can happen if the fetus presentation is face or OP

Answer 4

fail to progress

Question 5

what can be due to passages

Answer 5

cephalopelvic disproportion- if diametes are unfavourable and/or head is big

Question 6

where do contractions start

Answer 6

fundus

Question 7

when is it a problem with the powers

Answer 7

uterine dysfunction- lack of cervical dilatation over 2h and weak contractions

Question 8

what can the contractions be divided into

Answer 8

hypotonic- decr resting tone, low contraction peak. normotonic- but too infreq or may be coupled

Question 9

if the membranes are intact what can you try

Answer 9

amniotomy

Question 10

if cervical dilatation is

Answer 10

oxytocin

Question 11

management prolonged latent

Answer 11

no treatment or rupture of membranes

Question 12

management prolonged active

Answer 12

rupture membranes or oxytocin

Question 13

what is shoulder dystocia

Answer 13

inability to deliver shoulders after head delivered- gentle downward traction fails

Question 14

what can occur with shoulder dystocia

Answer 14

PPH, perineal tears, brachial plexus injury- Erbs palsy

Question 15

what is the danger in shoulder dystocia

Answer 15

asphyxia, cord squashed

Question 16

associations shoulder dystocia

Answer 16

large/postdate baby, induced/oxytocin, prolonged labour-1st or 2nd stage, assisted vaginal delivery, prev shoulder dystocia

Question 17

management dystocia

Answer 17

McRoberts position, apply suprapubic pressure 30s, rotate by 180so post shoulder now lies ant, episiotomy, get mother into all fours position, maternal symphiosotomy, cleidotomy (cutting through clavicles)

Question 18

what is prolapsed cord

Answer 18

descent of the cord through the cervix either alongside (occulta) or in front of (overt) the presenting part in presence of ruptured membranes

Question 19

why is prolapsed cord an emergency

Answer 19

as cord compression causes asphyxia

Question 20

risk factors cord prolapse

Answer 20

2nd twin, footling breech, shoulder presentation, polyhydramnios, unengaged head, transverse lie, male

Question 21

management prolapse if cord presentation noted before rupture of membranes

Answer 21

c section

Question 22

when could cord prolapse occur iatrogenically

Answer 22

rupture of membranes, external cephalic version

Question 23

signs prolapse

Answer 23

obvious if at the inoitrus, if not- bradycardia and variable decels- needs to do vaginal exam

Question 24

management prolapse

Answer 24

keep the cord in vagina, stop presenting part from occluding cord. displace presenting part by putting a hand in vagina and push up, place woman head down. catheter and saline into bladder. tocolytics.

Question 25

what tocolytics can be used in cord prolapse

Answer 25

terbutaline 0.25 SC- decreases contractions and helps bradycardia

Question 26

choice of delivery in prolapse

Answer 26

immediate C section. if cervix is fully dilated and presenting part is low in pelvis- forceps or breech extraction so that birth is

Question 27

what does the paediatrician do once baby is born after prolapse

Answer 27

paired cord sampes for PH and base excess