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Flashcards in Abnormal Labour Deck (51)
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1

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

2

How effective is an epidural?

Complete relief in 95%

3

What does an epidural do to labour?

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

4

What is administered in an epidural?

Levobupivacaine +- Opiate

5

What are some complications of an epidural?

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

6

What is used to assess progress in labour?

Cervical dilatation
Descent of presenting part
Signs of obstruction

7

What is a nulliparous delay?

<2cm dilation in 4 hours

8

What is a parous delay?

<2cm dilation in 4 hours or slowing in progress

9

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

Ischial spines (+-3 either way)

10

What is the attitude in pregnancy?

Flexion/extension of passenger

11

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

Suboccipito-bregmatic (9.5cm)

12

What is a partogram?

A graphic representation of the progress of labour

13

When does a partogram commence?

As soon as woman enters labour ward

14

What is included in a partogram?

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

15

What is involved in an Intra-partum fetal assessment?

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

16

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

During and after every contraction
Every 15 mins

17

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

Every 5-10 mins

18

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

19

What are some acute causes of fetal distress?

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

20

What is a subacute cause of fetal distress?

Hypoxia

21

What is included in a CTG?

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

22

What is a normal baseline HR on a CTG?

110-150bpm

23

What is a tachycardia on a CTG?

>150bpm

24

What is a bradycardia on a CTG?

<110bpm

25

What is a normal variability on a CTG?

5-25bpm

26

What is a saltatory pattern of variability on a CTG?

>25bpm

27

What is a reduced variability on a CTG?

<5bpm

28

How should a CTG be classified?

Normal
Non-reassuring
Abnormal

29

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

30

What are the criteria for non-reassuring late decelerations?

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