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Reproduction Week 4 2018/19 > 7: Abnormal labour > Flashcards

7: Abnormal labour Flashcards

(51 cards)

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1
Q

In general terms, what can go wrong in the course of labour?

A

Too early

Too late

Too quick - hyperstimulation

Too slow - failure to progress

Too painful

Malpresentation and/or malposition

Foetal distress

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2
Q

What percentage of women have a normal vaginal delivery?

A

60%

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3
Q

What percentage of women have a forceps delivery?

A

15%

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4
Q

What percentage of women have Caesarean sections?

A

25%

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5
Q

What is malpresentation?

A

A non-vertex delivery

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6
Q

What is the vertex?

A

Space between the anterior/posterior fontanelles and parietal eminences

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7
Q

What is malposition?

A

Non occipito-anterior position

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8
Q

What is the definition of pre-term labour?

A

< 37 weeks

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9
Q

What is the definition of post-term delivery?

A

> 42 weeks

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10
Q

Beyond 42 weeks, the risk of what increases exponentially?

A

Stillbirth

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11
Q

What is a Category 1 Caesarean section?

A

C section within 30 minutes of diagnosis

Everyone is bleeped to come and help

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12
Q

In which malpresentation does the baby’s feet emerge first?

A

Breech

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13
Q

What is the risk of a breech birth?

How can this be avoided?

A

Head gets stuck –> foetal hypoxia

Caesarean section

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14
Q

Apart from breech, what are some other types of malpresentation?

A

Transverse

Shoulder / Arm

Face

Brow

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15
Q

Which terms are used to describe the position of face presentations?

A

Mento-anterior

Mento-posterior

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16
Q

Which analgesia is used in obstetric emergencies?

A

Spinal or general anaesthetic

because they’re quickest acting - spinal is ideal

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17
Q

In general terms, what does failure to progress mean?

A

Baby isn’t coming out

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18
Q

If the cervix dilates less than ___ in 4 hours, there is failure to progress

A

< 2cm in 4hrs

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19
Q

What is the station of a baby?

A

Position of lowest bit of presenting part compared to ISCHIAL SPINES

negative numbers - above spines - not engaged - bad

positive numbers - below spines - good

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20
Q

What is the name of the synthetic oxytocin used to stimulate uterine contractions?

A

Syntocinon

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21
Q

What tool can be used to view the course of labour?

22
Q

How is fetal distress monitored?

Study These Flashcards
A

Doppler ultrasound for heart rate

CTG for heart rate

Colour of amniotic fluid

23
Q

What pattern of foetal heart rate, relative to contractions, indicates foetal distress?

Study These Flashcards
A

Late decelerations

Foetal heart rate decreases at the onset of a contraction (something to do with their head being compressed)

If that occurs late on in a contraction, it means that the body is reflexively trying to keep HR up due to poor oxygenation - baby is hypoxic

24
Q

What are the three Ps influencing the success of vaginal delivery?

Study These Flashcards
A

Power

Passage

Passenger

25
What does foetal distress mean?
**Foetal hypoxia** characteristic CTG patterns
26
What conditions **cause** foetal distress?
**Placental abruption** **Cord prolapse** **Uterine rupture** **Antepartum haemorrhage** **Foetal anaemia**
27
Are early decelerations on CTG normal?
Yes Baby's head squashed by uterus during contractions causing vagal bradycardia
28
Are **late decelerations** on CTG normal?
**No** **Indicates foetal hypoxia, because the body is reflexively trying to keep foetal HR up for as long as possible**
29
What is the **mnemonic** used for interpreting CTGs?
**DR C BRAVADO**
30
What does **DR C BRAVADO** stand for in terms of CTGs?
**DR** - determine risk **C** - contractions **BRA** - baseline rate **V** - variability **A** - accelerations **D** - decelerations **O** - overall impression
31
What is **CTG**?
**Cardiotocography** Measurement of foetal heart rate AND uterine contractions, allowing you to compare them
32
How do you **determine the risk** of a patient before looking at their CTG?
**From history**
33
The **\_\_\_** and **\_\_\_** of contractions increase during the course of labour.
**number** and **duration** of contractions
34
What is a **normal foetal heart rate**?
**120 - 160bpm** faster than adults
35
Is **increase in foetal heart rate on examination** normal?
**Yes** **Normal sympathetic response** It's an example of **variability**, which is a reassuring sign on CTG
36
What is **variability** in terms of a CTG?
**Fluctuations in foetal heart rate** **Normal and desired, given they're not too extreme**
37
**(Accelerations / decelerations)** on a CTG are **normal.**
**accelerations are normal**
38
What kind of **decelerations** are **benign** on a CTG?
**Early decelerations** **Mixed decelerations**
39
What kind of **decelerations** are a sign of **foetal distress?**
**Late decelerations**
40
What maternal measurements should you do in suspected foetal distress?
**BP** **HR**
41
Where can you take blood from to determine if a foetus is hypoxic?
**Scalp capillaries** via vaginal exam **Umbilical cord** on delivery
42
What are two tools used in **assisted vaginal delivery?**
**Forceps** **Ventouse suction**
43
Say there is **failure to progress** in pregnancy (without epidural anaesthesia). How long would you try for a spontaneous vertex delivery before attempting assisted vaginal delivery in a **a) primagravida** **b) multiparous woman?**
**a) 2 hours** **b) 1 hour**
44
What type of pain relief **prolongs labour**?
**Epidural anaesthesia**
45
Between **forceps** and **Ventouse delivery**, which is more successful?
**Forceps** Suction cups tend to fall off
46
Which **placental problems** are more likely in subsequent Caesarean sections?
**Placenta accreta** **Placental abruption**
47
What are the **reversible causes** of **cardiac arrest?**
**FOUR Hs:** hypoxia, hypovolaemia, hyper/hypokalaemia, hypothermia **FOUR Ts:** tension pneumothorax, tamponade, thrombosis, toxins
48
Which type of drug should you consider using if uterine contractions are causing foetal distress in premature labour?
**Tocolytic drugs** e.g terbutaline, they terminate contractions for up to 48h
49
What are the **four Ts** of reversible cardiac arrest?
**Tension pneumothorax** **Cardiac tamponade** **Thrombosis** **Toxins**
50
What are the **four Hs** of reversible cardiac arrest?
**Hypovolaemia** **Hypoxia** **Hyper/hypokalaemia** **Hypothermia**
51
Why may a pregnant woman become **shocked** if she is lying on her back?
**Compression of aorta/IVC** If a pregnant woman needs CPR, immediate C section is often lifesaving because otherwise she can't lie flat

Reproduction Week 4 2018/19 (9 decks)

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