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Flashcards in Abnormal Labour Deck (51):
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

31

What is the criteria for normal/reassuring decelerations?

None or early

32

What is the criteria for baseline variability in abnormal CTGs?

Less than 5 for over 90 mins

33

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

Less than 5 for 30-90 mins

34

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

5 or more

35

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

36

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

37

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

Must last 3 minutes or more

38

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

39

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

40

Where is fetal blood for sampling taken from?

Scalp

41

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

Normal
No action

42

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

Borderline
Repeat 30 mins

43

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

Abnormal
Deliver

44

What are standard indications for operative vaginal delivery?

Delay (failure to progress stage 2)
Fetal distress

45

What are special indications for operative vaginal delivery?

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

46

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

2h and 1hr respectively

47

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

1 hour

48

Which complications are ventouse associated with?

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

49

What are the main indications for C-section?

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

50

By how much does CS increase maternal mortality?

4x

51

What can cause morbidity in CS?

Sepsis
Haemorrhage
VTE
Trauma
TTN
Subfertility
Regret
Complications in future pregnancy