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
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
