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Y3 OBS AND GYNAE > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

List factors that determine labour as abnormal

A 
Too early (preterm <37w)
Too late (induction >42w)
Too painful (anaesthetic input)
Too long (failure to progress)
Too quick (hyperstimulation)
Foetal distress (hypoxia/ sepsis)
Wrong part presentation
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2
Q

What is a normal presentation of the fetus during pregnancy?

A

Vertex presentation, where the occiput is the leading part (the part that first enters the birth canal)

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3
Q

List types of non vertex or malpresentations of the fetus during pregnancy

A 
Breech
Transverse
Shoulder/arm
Face
Brow
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4
Q

Define the three main types of breech presentation

A 
Complete breech (legs folded with feet at level of baby's bottom)
Footling breech (one or both feet point down so the legs would emerge first)
Frank breech (legs point up to the baby's head, so the bottom emerges first)
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5
Q

What causes transient hypoxia in a baby during labour?

A

Uterine contractions (interrupt placental blood supply)

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6
Q

List options for providing analgesia during labour

A 
Support, massage/relaxation techniques
Paracetamol
Entonox (inhalation)
TENS
Water immersion
IM diamorphine
IV remifentanil
Epidural anaesthesia
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7
Q

Epidural anaesthesia impairs uterine activity. True/False?

A

False

May inhibit progress during stage 2 labour, however

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8
Q

What vertebral level is the epidural anaesthetic injected into?

A

L3/L4 space

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9
Q

List complications of epidural anesthesia

A 
HYPOTENSION
Dural puncture
Headache
Backache
Atonic bladder
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10
Q

List aetiology of of obstructed labour

A 
Sepsis
Uterine rupture
Obstructed AKI
PPH
Fistula formation
Fetal asphyxia
Neonatal sepsis
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11
Q

How is progress assessed in labour?

A

Cervical dilatation
Descent of presenting part (station)
Signs of obstruction (moulding, caput, anuria, haematuria. vulval oedema)

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12
Q

What counts as delay in stage 1 labour?

A

Nulliparous woman: less than 2cm dilation in 4 hours

Parous woman: less than 2cm dilation in 4 hours OR slowing in progress

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13
Q

What are the 3 P’s that affect progression of labour?

A

Power (inadequate contractions, frequency/strength)
Passage (shape/state of pelvis, short stature, trauma)
Passenger (big baby, malposition)

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14
Q

Going down the pelvis, the transverse diameter increases/decreases and the anteroposterior diameter increases/decreases

A

Going down the pelvis, the transverse diameter decreases and the anteroposterior diameter increases

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15
Q

What is assessed on a partogram?

A 
Foetal heart rate
Amniotic fluid
Cervical dilation
Descent
Contractions
Obstruction (moulding/caput)
Maternal vital signs
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16
Q

How is the fetus assessed during labour?

A

Doppler auscultation of fetal heart
Cardiotocograph
Colour of amniotic fluid (clear, red, brown)

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17
Q

How often is the foetal heart auscultated during labour?

A

Stage 1: during + after a contraction/every 15 mins

Stage 2: every 5-10 mins

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18
Q

Meconium (foetal stool) can be a sign of what?

A

Foetal distress

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19
Q

List risk factors for fetal hypoxia

A 
Small fetus
Preterm/ post dates
APH
Hypertension/ PET
Diabetes, sepsis
Induction of labour, epidural anaesthesia
Meconium
Vaginal birth after c-section, preterm delivery
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20
Q

List acute causes of fetal hypoxia

A 
Abruption
Vasa praevia
Cord prolapse
Uterine rupture
Feto-maternal rupture
Uterine hyperstimulation
Regional anaesthesia
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21
Q

List chronic causes of fetal hypoxia

A

Placental insufficiency

Fetal anaemia

22
Q

What is uterine hyperstimulation?

A

Single contractions lasting 2 minutes or more OR a contraction frequency of five or more in 10 minutes

23
Q

What is a CTG used for?

A

Assess foetal heart

24
Q

You can only assess frequency of contractions on a CTG, not strength. True/False?

A

True

25
Q

What is a normal foetal heart rate?

A

110-165 bpm

26
Q

What 4 features are assessed on a CTG?

What is the mnemonic for remembering this?

A 
Heart rate, variability, accelerations, decelerations
Mnemonic:
Determine
Risk
Contractions
Baseline (120-160bpm)
RAte
Variability (<5bpm)
Accelerations
Decelerations (>15bpm)
Overall impression
27
Q

A CTG can be classified as…

A

Normal, suspicious or pathological

28
Q

Outline management of foetal distress in labour

A 
Change maternal position
IV fluids
Stop syntocinon
Scalp stimulation
Consider tocolysis (terbutaline to relax uterus)
Foetal blood sampling (hypoxia)
Maternal assessment (pulse, BP, abdomen, VE)
Operative delivery
29
Q

What is a normal pH to obtain upon foetal blood sampling? What pH level is abnormal and indicates delivery of the baby?

A

pH>7.25

pH<7.2

30
Q

What are the main indications for operative vaginal delivery?

A 
Delay (failure to progress stage 2)
Fetal distress
Maternal cardiac disease
Severe PET/ eclampsia
Intrapartum haemorrhage 
Umbilical cord prolapse
31
Q

What are the main indications for cesarean section?

A 
Previous CS
Foetal distress
Failure to progress in labour
Breech presentation
Maternal request
32
Q

List the main obstetric emergencies

A 
Cord prolapse
Shoulder dystocia
Uterine inversion
Uterine rupture
APH or PPH
Sepsis
Preclampsia, eclampsia
33
Q

List causes of maternal collapse

A 
Hypovolaemia
Hypoxia
Hyperkalaemia, hypokalaemia, metabolic
Hypothermia
Tablets or toxins
Tamponade
Tension pneumothorax
Thrombosis
Preclampsia
Amniotic fluid embolism
34
Q

Describe aortacaval compression and how it can lead to maternal collapse

A

From 20 weeks, uterus can compress IVC and aorta reducing venous return
Reduced CO leads to hypotension and collapse

35
Q

How is aortocaval compression reversed?

A

Turning women into left lateral position

36
Q

What is the management of maternal collapse when there is no response to CPR in 4 minutes?

A

Perimortem c-section to assist resuscitation

37
Q

The 3Ps are used to define causes of failure to progress in labour. In which cause can, synctoin be safely prescribed?

A

Power to initiate stronger contractions

38
Q

How do you calculate contractions on a CTG?

A

Assess number of peaks in one minute (10 big boxes)

39
Q

How do you calculate baseline HR on a CTG?

A

Look at the peaks for the line they cross

Ignore accelerations and deaccelerations

40
Q

What is a normal variability on a CTG?

A

5-25bpm

41
Q

How do you calculate variability on a CTG?

A

Look at how much the peaks and troughs differentiate from the baseline rate

42
Q

What is meant by an acceleration on a CTG?

A

Increase in baseline HR of greater than 15bpm for greater than 15 seconds
Sign of a healthy uterus

43
Q

What is meant by an deceleration on a CTG?

A

Decrease in baseline HR of greater than 15bpm for greater than 15 seconds

44
Q

Give the types of decelerations

A

Early (resolves when contraction ends)
Variable (no relationship to contractions)
Late (begin at peak and recover after contraction ends)
Prolonged (>2 minutes)

45
Q

What types of decelerations should we be worried about?

A

Variable (umbilical cord compression, normal in labour if <90 minutes)
Late (fetal hypoxia and acidosis!)
Prolonged (>3 minutes)

46
Q

If a CTG is abnormal, what is the next best management?

A

Fetal blood sampling

Consider emergency C-section

47
Q

What type of CTG pattern requires immediate C-section?

A

Sinusoidal pattern
Smooth regular wave-like pattern
Very rare!

48
Q

What is classed as a normal fetal blood sampling?

A

> 7,25

49
Q

What result in fetal blood sampling would indicate a need for emergency C-section?

A

<7.2

50
Q

What is the management for a fetal blood sampling with pH 7.2-7.25?

A

Repeat in 30 minutes

Y3 OBS AND GYNAE (44 decks)

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