Abnormal Labour Flashcards by Aaron Duff

What can be used as analgesia in labour?

Support
Massage / relaxation techniques
Inhalational agents - Entonox
TENS (T10-L1, S2-S4)
Water immersion 
IM opiate analgesia e.g. Morphine
IV Remifentanil PCA
Regional anaesthesia

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How effective is an epidural?

Complete relief in 95%

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What does an epidural do to labour?

Does not impair uterine activity, but may inhibit progress during stage 2

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What is administered in an epidural?

Levobupivacaine +- Opiate

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What are some complications of an epidural?

HT (20%)
Dural puncture (1%)
Headache
Back pain
Atonic bladder (40%)

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What is used to assess progress in labour?

Cervical dilatation
Descent of presenting part
Signs of obstruction

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What is a nulliparous delay?

<2cm dilation in 4 hours

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What is a parous delay?

<2cm dilation in 4 hours or slowing in progress

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What is the marker for assessing descent of the presenting part?

Ischial spines (+-3 either way)

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What is the attitude in pregnancy?

Flexion/extension of passenger

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What is the widest diameter in a well-flexed fetus prior to birth?

Suboccipito-bregmatic (9.5cm)

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What is a partogram?

A graphic representation of the progress of labour

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When does a partogram commence?

As soon as woman enters labour ward

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What is included in a partogram?

FH
Amniotic fluid
Cervical dilatation
Descent
Contractions
Obstruction-moulding
Maternal observations

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What is involved in an Intra-partum fetal assessment?

Dopper auscultation of FH
Cardiotocograph (+- STAN)
Colour of amniotic fluid

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How is often is the fetal heart auscultated by Doppler during stage 1 of labour?

During and after every contraction

Every 15 mins

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How is often is the fetal heart auscultated by Doppler during stage 2 of labour?

Every 5-10 mins

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What are the risk factors for fetal hypoxia?

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

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What are some acute causes of fetal distress?

Abruption
Vasa Praevia
Cord Prolapse
Uterine Rupture
Feto-maternal Haemorrhage
Uterine Hyperstimulation
Regional Anaesthesia

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What is a subacute cause of fetal distress?

Hypoxia

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What is included in a CTG?

Duration and quality of recording
Baseline HR
Variability
Accelerations
Decelerations
Recording of contractions

What is a normal baseline HR on a CTG?

110-150bpm

What is a tachycardia on a CTG?

> 150bpm

What is a bradycardia on a CTG?

<110bpm

What is a normal variability on a CTG?

5-25bpm

What is a saltatory pattern of variability on a CTG?

>25bpm

What is a reduced variability on a CTG?

<5bpm

How should a CTG be classified?

Normal Non-reassuring Abnormal

What are the criteria for non-reassuring variable decelerations?

Dropping from baseline by 60bpm or less and taking 60 seconds or less to recover Present for over 90 minutes Occurring with over 50% of contractions OR Dropping from baseline by more than 60bpm or taking over 60 seconds to recover Present for up to 30 minutes Occurring with over 50% of contractions

What are the criteria for non-reassuring late decelerations?

Present for up to 30 minutes | Occurring with over 50% of contractions

What is the criteria for normal/reassuring decelerations?

None or early

What is the criteria for baseline variability in abnormal CTGs?

Less than 5 for over 90 mins

What is the criteria for baseline variability in non-reassuring CTGs?

Less than 5 for 30-90 mins

What is the criteria for baseline variability in normal/reassuring CTGs?

5 or more

What are the criteria for abnormal non-reassuring variable decelerations?

As for non-reassuring variable, and: Still observed 30 mins after starting conservative measures Occurring with over 50% of contractions

What are the criteria for abnormal late decelerations?

Present for over 30 mins Do not improve with conservative measures Occuring with over 50% of contractions

What is the criteria for abnormal bradycardia or a single prolonged deceleration?

Must last 3 minutes or more

What is the acronym used in CTG interpretation?

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

What measures can be used to manage fetal distress?

``` 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 ```

Where is fetal blood for sampling taken from?

Scalp

If scalp pH is >7.25, how should this be interpreted and acted on?

Normal | No action

If scalp pH is 7.20-7.25, how should this be interpreted and acted on?

Borderline | Repeat 30 mins

If scalp pH is <7.20, how should this be interpreted and acted on?

Abnormal | Deliver

What are standard indications for operative vaginal delivery?

Delay (failure to progress stage 2) | Fetal distress

What are special indications for operative vaginal delivery?

Maternal cardiac disease Severe PET/eclampsia Intra-partum haemorrhage Umbilical cord prolapse stage 2

What is the normal duration of stage 2 for prims and multips without an epidural?

2h and 1hr respectively

How much longer does an epidural make stage 2 for both prims and multips?

1 hour

Which complications are ventouse associated with?

Increased: failure, cephalohaematoma, retinal haemorrgage, maternal worry Decreased anaesthesia, vaginal trauma, perineal pain

What are the main indications for C-section?

``` Previous CS Fetal distress Failure to progress in labour Breech presentation Maternal request ```

By how much does CS increase maternal mortality?

What can cause morbidity in CS?

``` Sepsis Haemorrhage VTE Trauma TTN Subfertility Regret Complications in future pregnancy ```