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Abnormal Labour Flashcards

1
Q

Reasons for abnormal labour

A
  1. Malpresentation: most commonly breech
  2. Malposition: OP or OT
  3. Pre term: <37wks
  4. Post term: >42wks
  5. Obstruction
  6. Fetal distress - hypoxia/sepsis
  7. Too painful - anaesthetic needed
  8. Too quick - hyperstimulation
  9. Too long - failure to progress
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2
Q

What complications commonly occurs with breech presentation?

A 
Cord prolapse (esp. if preterm) 
Head entrapment - baby might be delivered through a cervix that is not completely dilated causing the head to be trapped (esp if preterm and baby is small) 
Foetal injury at term
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3
Q

Types of malpresentation

A

Breech (3 types - complete, footling, frank)
Transverse
Shoulder/arm
Face
Brow - brow is leading, widest diameter, baby’s head won’t fit in pelvis

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4
Q

Aetiology of labour pain

A

Compression of para-cervical nerves

Myometrial hypoxia

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5
Q

Types of analgesia during labour

A 
Support
Massage / relaxation techniques
Inhalational agents - Entonox
TENS (T10-L1, S2-S4)
Water immersion 
IM opiate analgesia e.g. Morphine
IV Remifentanil PCA - infusion driven by a pump controlled by mother, given at peak of contraction during fast labour
Regional anaesthesia
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6
Q

Benefits of epidural anaethesia

A

Effective - complete pain relief in 95%

Does not impair uterine activity

Can be topped up during long periods

is not associated with a longer first stage of labour
does not increased the chance of a caesarean birth

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7
Q

Drawbacks of epidural anaesthesia

A 
May inhibit progress during stage 2
Requires IV access 
Reduced mobility
More intensive level of monitoring 
Increased chance of operative birth
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8
Q

Examples of epidural anaesthetic

A

Levobupivacaine +/- Opiate

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9
Q

Complications of epidural anaesthesia

A 
Hypotension (20%)
Dural puncture (1%)
Headache
High block - excess of anaesthetic, if it rises to high (ex. up to chest) mother will have difficulty breathing
Atonic bladder (40%)
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10
Q

What are the obstructed labour risks due to failure to progress?

A 
sepsis
uterine rupture
obstructed AKI 
postpartum haemorrhage
fistula formation
fetal asphyxia 
neonatal sepsis
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11
Q

Features used to asses progress in labour

A 
Cervical dilatation
Descent of presenting part 
Signs of obstruction- 
- moulding
-caput
- anuria
- haematuria
- vulval oedema
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12
Q

Suspected delay during Stage I of nulliparous women?

A

<2cm dilation in 4 hrs

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13
Q

Suspected delay during Stage I of parous women?

A

<2cm dilation in 4 hour or slowing in progress

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14
Q

Failure to progress in relation to the 3P’s

A

Power: inadequacy of contractions (frequency and/or strength, <3 to 4 contraction in 10 minutes)

Passages: Short stature/ Trauma/ Shape

Passenger: Big baby, malposition (cephalo-pelvic disproportion)

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15
Q

Position of baby’s head at pelvic inlet

A

transverse

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16
Q

Position of baby’s head within pelvis

A

Left/ Right OA

17
Q

Position of baby’s head at pelvic outlet

A

OA

18
Q

What information is given by a partogram?

A 
Fetal Heart
Amniotic Fluid
Cervical Dilatation
Descent
Contractions
Obstruction - Moulding
Maternal Observations
19
Q

What is given during labour to speed up progression?

A

Oxytocin infusion

20
Q

What is the most common form of Intra-partum Fetal Assesment?

A

Doppler auscultation of the heart:

Stage I:
every 15 min, during and after a contraction

Stage II:
At least every 5 mins during after a contraction for 1 full minute.
Check maternal pulse at least every 15 mins

21
Q

Other methods of intrapartum foetal assesment

A

Electronic Fetal Monitoring -Cardiotocograph (CTG)

Colour of amniotic fluid

22
Q

Risk factors for foetal hypoxia

A 
Small fetus
Preterm / Post Dates
Antepartum haemorrhage
Hypertension / Pre-eclampsia
Diabetes
Meconium
Epidural analgesia
VBAC
PROM >24h
Sepsis (Temp > 38C)
Induction / Augmentation of labour
23
Q

Aetiology of acute foetal distress

A 
Abruption
Vasa Praaevia
Cord Prolapse
Uterine Rupture
Feto-maternal Haemorrhage
Uterine Hyperstimulation
Regional Anaesthesia
24
Q

Aetiology of chronic foetal distress

A

Placental insufficiency

Fetal anaemia

25
Q

CTG assessment - what to monitor?

A

Baseline foetal heart rate (110-150bpm)
Baseline variability
Presence or absence of decelerations
Presence of accelerations

26
Q

Commonest kind of deceleration? Associated with?

A

Variable - quick to recover

Associated with cord compression

27
Q

Classifications of CTG

A

Normal
Suspicious
Pathological

28
Q

How does hypoxia appear on a CTG?

A

Loss of accelerations
Repetitive deeper and wider decelerations
Rising fetal baeline heart rate
Loss of variability

29
Q

How to interpret a CTG (pneumonic) - DR.C BRAVADO

A 
D ETERMINE
R ISK 
C ONTRACTIONS
B ASELINE
R
A TE
V ARIABILITY
A CCELERATIONS
D ECELERATIONS
O VERALL IMPRESSION
30
Q

Management of foetal distress

A

Change maternal position

IV Fluids

Stop syntocinon

Scalp stimulation

Consider tocolysis -
Terbutaline 250 micrograms s/c

Maternal assessment - Pulse / BP / Abdomen / VE

Fetal blood sampling

Operative Delivery (Category 1 delivery)

31
Q

What is foetal blood sampling?

A

Speculum/ scope with a light to look at foetal scalp during vaginal exam

Pin prick of foetal blood is taken from foetal scalp

32
Q

“standard” indications for operative vaginal delivery (only at full dilatation of cervix)

A

Delay (failure to progress to Stage II)

Foetal distress

33
Q

“special” indications or operative vaginal delivery (only at full dilatation of cervix)

A

Maternal cardiac disease Severe PET / Eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse Stage 2

34
Q

Ventouse is associated with ____?

A 
Increased: 
 failure
 cephalohaematoma
 retinal haemorrhage
 maternal worry

Reduced:
 Anaesthesia
 Vaginal trauma
 Perineal Pain

35
Q

Ventouse is associated with ____?

A 
Increased: 
 failure
 cephalohaematoma
 retinal haemorrhage
 maternal worry

Reduced:
 Anaesthesia
 Vaginal trauma
 Perineal Pain

36
Q

Main indications for C-sec

A 
Previous CS
Foetal distress
Failure to progress
Breech
Maternal request
37
Q

Complications of CS

A

4 X greater maternal mortality associated with CS

Morbidity - sepsis, haemorrhage, VTE, trauma, TTN, sub fertility, regret, complications in future pregnancy

Reproduction (32 decks)

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