abnormal labour Flashcards
what does reduced fetal movements indicated
fetal distress + hypoxia
what is considered reduced fetal movements
<10 movements within 2 hours
when should fetl movements be established
24 weeks
risk factor reduced fetal movements
posture // distracted // anterior placenta or fetus // alcohol, opiates, benzos // obese // oligo or poly hydramnios // SGA
invx reduced fetal movements
doppler –> USS
invx reduced fetal movement >28 weeks
doppler, if no HB –> USS (+ abdo circumference + amniotic fluid volume)
invx reduced fetal movement 24-28 weeks
handheld doppler
invx reduced fetal movement <24 weeks
if movements felt previously –> doppler // if no movements previously –> refer
normal fetal pH bloods
from scalp // should be ph > 7.25
complications of preterm prelabour ROM
premature, infection, pulm hypoplasia // chorioamnionitis
invx PPROM
speculum –> amniotic fluid in posterior vagina // if no pooling –> test fluid for PAMG1 or IGF P1 // USS
mx PPROM
admit + oral erythro 10 days + steroids
when should PPROM be delivered
34 weeks
what is failure to progress in the 1st stage
> 3-8 hours to get to 4cm
what is primary arrest of the 1st stage
<2cm after 4 hours
what is failure to progress in second stage
nullparous - >2 hours or >3 epidural // multiparous - >1 hours or >2 epidural
causes failure to progress
big head // feotal distress // uterine rupture // obstruction // malpresentation
symptoms obstruction in labour
vulva oedema // moulding // anuria // haematuria // caput
types of malpresentation
breech // brow (worst) // face // transverse
types of breech
complete = baby legs crossed // footing = 1 foot down // frank = bum first with legs at head
RF breech
uterus malformation eg fibroids // placenta praevia // poly or oligo hydramnios // fetal abnormality // premature
mx breech
<36 wks = wait // 36 (np)-37 (mp) weeks = external cephalic version // term = c section usually
contraindications external cephalic version
C section required // APH within 7 days // abnormal CTG // uterine anomaly // ruptured membrane // multiple pregnancy
methods of operative vaginal delivery
vacuum or forceps
