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
