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Flashcards in Abnormal labour Deck (44):
1

too early

preterm birth <37 weeks of gestation

2

too late

beyond 42 weeks
induction of labour

3

too painful

requires anaesthetic input

4

too long

failure to progress

5

fetal distress can mean what

with every uterine contraction the blood supply to the fetus is cut off
leading to hypoxia/sepsis

6

inhalation agents meaning what
and for who

entonox for both high and low risk women

7

TENS is what

electrodes

8

IM opiate analgesia
SE

diamorphine
ECG changes, respiratory distress

9

what can be given as an intermediate between IM opiate analgesia and regional anaesthesia

IV remifentanil PCA

10

how effective is epidural anaesthetsia
does it impair uterine activity
what may it inhibit
what does it consist of
complications

complete pain relief in 95%

does not impair uterine activity

during stage 2

levobupivacaine +/- opiate

hypotension
dural puncture
headache
back pain - mainly mechanical
atonic bladder

11

what can an epidural anaesthetic lead to

puncture of the dura mate which leads to severe headaches due to CSF leak and photophobia - can't stand up due to severe headaches

12

bladder and epidural anaethesia

interferes with the nerve supply to the bladder - ensure the bladder is not over distended

13

stages at which an epidural anaesthesia is given

test dose is given first
then it is regularly topped up

14

why can an epidural anaesthesia lead to misposition of the baby

relaxation of the pelvic floor so the head may not flex sufficiently so there may not be internal rotation

15

how is progress assessed in labour

cervical dilation
descent of the presenting part
signs of obstruction - caput/moulding

16

suspected delay in stage one for a nulliparous woman and a porous woman

nulli - <2cm dilatation in 4 hours
porous <2cm in 4 hours or slowing in progress

17

causes of failure to progress (3 ps)

powers - inadequate contractions: frequency and/or strength

passangers - short stature/trauma/shape

passenger - big baby, malposition

18

what does partogram assess

fetal heart
amniotic fluid
cervical dilatation
descent
contractions
obstruction
maternal observations

19

what are the different ways of fetal assessing intra partum

doppler auscultation of the fatal heart during stage 1 during and after a contraction, every 15 mins and during stage 2 every 5-10 mins

CTG

colour of amniotic fluid

20

risk factors for fetal hypoxia
what do they all require

small fetus
preterm/post dates
antepartum haemorrhage
hypertension/ PET
DM
meconium
epidural analgesia
VBAC - vaginal birth after C sec
PROM > 24 hours
sepsis (temp >38c)
induction/augmentation of labour

continuous monitoring of the fetal heart

21

what does VBAC have a risk of

uterus rupture

22

whats does PROM have a risk of

sepsis and baby is at risk of septic brain injury

23

how does induction lead to a risk for fetal hypoxia

hypersitmualated - more contractions - baby will be more stressed

24

acute causes of fetal distress

abruption
vasa praevia
cord prolapse
uterine rupture
feto-maternal haemorrhage
uterine stimulation
regional anaesthesia

25

sub acute causes for fetal distress and how is this assessed

hypoxia
using a CTG

26

what does a CTG monitor

baseline fetal heart rate
variability
accelerations/decelerations

27

what else does the CTG monster other than the fetal heart rate

contractions
checked every 10 mins
can't tell the strength - only the number

28

bradychardic fetal heart causes

hypoxia
opiate analgesia
malposition of the baby

29

tachycardia fetal heart causes

fetal stress
active baby
maternal dehydration
intra uterine sepsis
maternal sepsis

30

exaggerated variability means what
loss of variability means what

hypoxia

opiate analgesia, sleep phase

31

early decelerations are caused by what
late decelerations are caused by what

physiological due to head compression

pathological - mark of fetal hypoxia

32

what are complicated variable decelerations due to

mainly due to cord compression

33

What things need to be assessed and documented when reviewing the CTG

baseline fetal heart rate
baseline variability
presence or absence of decelerations
presence of accelerations

34

how should a CTG be classed as

normal/non reassuring/abnormal

35

CTG interpretation
dr c bravado

determine
risk
contractions
baseline
r
ate
variability
accelerations
decelerations
overall impressions

36

normal fetal heart rate

110-160bpm

37

management of fetal distress

change fetal position - take pressure off the aorta

IV fluids

stop syntocin and consider tocolysis (terbutaline 250 mcg s/c) to stop uterine contractions

scalp stimulation

maternal assessment

fetal blood sampling - check acid base status

38

scalp pH normal boderline and abnormal pH and actions

>7.25 normal no action
7.20-7.25 boderline repeat in 30 mins
<7.20 abnormal deliver baby

39

indications for operative (or not) labour

delay - failure to progress to stage 2
fetal distress

maternal cardiac disease
severe PET/eclampsia
intra partum haemorrhage
umbilical cord prolapse stage 2

40

what is failure to progress during stage two during prim/multips

prims 3 hour with epidural and 2 without

multips 2 hour with epidural and 1 without

41

what are the risks of ventouse

good things

increased risk of failure
cephalohaematoma
retinal haemorrhage
maternal worry

anaesthesia decrease
vaginal trauma decrease
perineal pain decrease

42

main indications for C sec

previous CS
fetal distress
failure to progress in labour
breech presentation
maternal request

43

risk with C sec

4 x greater maternal mortality

44

morbidity with C sec

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