Abnormal labour Flashcards by Aisha Mujahid

too early

preterm birth <37 weeks of gestation

How well did you know this?

Not at all

Perfectly

too late

beyond 42 weeks

induction of labour

How well did you know this?

Not at all

Perfectly

too painful

requires anaesthetic input

How well did you know this?

Not at all

Perfectly

too long

failure to progress

How well did you know this?

Not at all

Perfectly

fetal distress can mean what

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

How well did you know this?

Not at all

Perfectly

inhalation agents meaning what

and for who

entonox for both high and low risk women

How well did you know this?

Not at all

Perfectly

TENS is what

electrodes

How well did you know this?

Not at all

Perfectly

IM opiate analgesia

diamorphine

ECG changes, respiratory distress

How well did you know this?

Not at all

Perfectly

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

IV remifentanil PCA

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

bladder and epidural anaethesia

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

How well did you know this?

Not at all

Perfectly

stages at which an epidural anaesthesia is given

test dose is given first

then it is regularly topped up

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

how is progress assessed in labour

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

causes of failure to progress (3 ps)

powers - inadequate contractions: frequency and/or strength

passangers - short stature/trauma/shape

passenger - big baby, malposition

How well did you know this?

Not at all

Perfectly

what does partogram assess

fetal heart
amniotic fluid
cervical dilatation 
descent 
contractions 
obstruction 
maternal observations

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

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

what does VBAC have a risk of

uterus rupture

whats does PROM have a risk of

sepsis and baby is at risk of septic brain injury

how does induction lead to a risk for fetal hypoxia

hypersitmualated - more contractions - baby will be more stressed

acute causes of fetal distress

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

sub acute causes for fetal distress and how is this assessed

hypoxia | using a CTG

what does a CTG monitor

baseline fetal heart rate variability accelerations/decelerations

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

bradychardic fetal heart causes

hypoxia opiate analgesia malposition of the baby

tachycardia fetal heart causes

``` fetal stress active baby maternal dehydration intra uterine sepsis maternal sepsis ```

exaggerated variability means what | loss of variability means what

hypoxia opiate analgesia, sleep phase

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

physiological due to head compression pathological - mark of fetal hypoxia

what are complicated variable decelerations due to

mainly due to cord compression

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

how should a CTG be classed as

normal/non reassuring/abnormal

CTG interpretation | dr c bravado

``` determine risk contractions baseline r ate variability accelerations decelerations overall impressions ```

normal fetal heart rate

110-160bpm

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

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

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

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

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

main indications for C sec

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

risk with C sec

4 x greater maternal mortality

morbidity with C sec

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