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Flashcards in Abnormal Labour Deck (35):
1

When are women induced in Tayside?

by 42 weeks- induce by 41+3 weeks

2

What is the benefit of using remifentanil compared to diamorphine?

remifentanil is very short-activing powerful opiate

3

What drugs are used in epidurals?

levobupivacaine +/- opiate

4

What are the complications assoicated with epidurals?

hypotension; dural puncture; HA; back pain; urinary retention

5

How is progress in labour assessed?

cervical dilatation; descent of presenting part; signs of obstruction

6

What is defined as failure to prgress in the first stage in nulliparous?

<2cm in 4 hours

7

What is failure to progress in the 1st sgae in a parous woman?

<2cm in 4 hours or slowing in progress

8

What are the causes of failure to progress generally?

3P's: power
passage
passenger

9

What are the power causes of failure to progress?

inadequate contractions- frequency and/or strength

10

What are the passage causes of afilure to progress?

short stature/ traum (to pelvis); shape

11

What are the passenger causes of failure to progress?

big baby; malposition

12

What is the usual presenting diameter of the fetal head?

9.5cm

13

What is assessed on the partogram?

fetal heart; liquor; cervical dilatation; descent; contractions; obstruction-moulding; maternal obs

14

How often should doppler auscultation of the fetal heart be done in stage 1?

during and after a contraction every 15 minutes for 1 minute

15

How often should doppler auscultation of the fetal heart be done in stage 2?

at least every 5 minutes during and after a contraction for 1 whole pulse

16

How often should the maternal pulse be checked suring stage 2?

every 15 mins

17

What are the risk factors for fetal hypoxia?

small fetus; preterm/post dates; antepartum haemorrhage; HT/pre-eclampsia; DM; meconium; epidural analgesia; VBAC; PROM >24hrs; sepsis; induction/augmentation of labour

18

What should be done if there is a risk factor for fetal hypoxia present?

continuous monitoring of fetal heart

19

What are teh acute causes of fetal distress?

abruption; vasa praevia; cord prolapse; uterine rupture; feto-maternal haemorrhage; uterine hyperstimulation; regional anaesthesia;

20

What mnemonic should be used when looking at CTGs?

DR C BRAVADO
risk
contractions
baseline HR
variability
accelerations
decelerations
overall

21

What is an early deceleration?

trough of the deceleleration correlates with the peak of the contraction

22

What is a late decel?

decel is after contraction

23

What is the management of fetal distress?

change maternal position; IV fluids; stop syntocinon; scalp stimulation; consider tocolysis; maternal assessment; fetal blood ssampling; operative delivery

24

What is the normal pH for fetal blood scamples?

>7.25

25

What are the indications for instrumental delivery?

failure to progress in stage 2; fetal distress; maternal cardiac disease; severe pre-eclampsia; intra-partum haemorrhage; umbilical cord prolapse stage2

26

What is the upper limit of normal length of stage 2 for a prim with an epidural?

3 hours

27

What is the upper limit of normal length of stage 2 for prims without an epidural?

2hours

28

What is the upper limit of normal length of stage 2 for a multips with no epidural?

1 hour

29

What is the upper length of normal length of stage 2 for a multips with an epidural?

2 horus

30

What are the problems associated with ventouse?

higher- failure; cephalohaematoma; retinal haemorrhage; maternal worry

31

What are the benefits of ventouse?

less anaesthetisa; vaginal trauma and perineal pain

32

Is there a big difference between ventouse and forceps?

no difference in CS rates; apgars or long-term outcomes

33

What are the main indications for C/S?

previous C/S; fetal distress; failure to progress in labour; breech presentation; maternal request

34

What are hte complications of C/S?

sepsis; haemorrhage; CTE; trauma; TTH; subfertility; regret; complications in future pregnancy

35

What is the difference between mortality in C/S and SVD?

x4 maternal mortality