Abnormal Labour Flashcards by Louise Emerson

what is malpresentation of a baby

non vertex:

breech (frank, footling, complete)
transverse
shoulder/ arm
face
brow

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what is malposition of a baby

abnormal position of the head- OP/ OT

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what is pre term

<37 weeks

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what is post term

> 42 weeks

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when is malposition more likely

if baby too early/ late

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what are the types of breech

complete- hip and knee flexed (cross legged)
footling - one/both feet coming first
frank (most common) - hips flexed, knees extended (legs up, bottom comes first)

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what can happen if a very small baby starts to be delivered through a cervix that is not fully dilated

body goes through but head can get stuck

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what does it mean if a babies arm is delivered first

baby in transverse lie, cannot be delivered need CS

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can face/ brow presentations be delivered

brow means head at widest diameter- wont deliver

face will if chin at front

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what classifies as abnormal labour

Too early (<27wks( - preterm birth
Too late (>42wks)– induction of labour
Too painful - requires anaesthetic input
Too long - failure to progress
Too quick- hyperstimulation
Fetal distress - hypoxia/sepsis
Wrong part presenting

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what pain relief options for mothers in childbirth

support (better usually if not men)
massage/ relaxation techniques
inhalational agents- entonox
TENS machine
water immersion 
IM opiate analgesia (morphine)
IV remifentanil PCA
regional anaesthesia

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what causes labour pain

compression of para cervical nerves

myometrial hypoxia

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does an epidural impair uterine activity

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what might an epidural inhibit

progress during stage 2

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what is given in epidural anaesthesia

levobupivacaine +/- opiate

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what are the possible complications of an epidural

hypotension (20%) due to vasodilation
dural puncture (1%)
headache
high block (blockage goes too high, can make it hard to breath)

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is an epidural more effective than opiods

yes

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do you always need IV access when given an epidural

yes

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what are the risks in obstructed labour

sepsis (increased by vaginal exams)
uterine rupture (uterus thins, more common in women who have had previous section and if given syntocinon)
obstructed AKI (impaired renal drainage)
PPH
fistula formation
fetal asphyxia
neonatal sepsis

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how do you assess progress in labour

dilation
descent of presenting part
signs of obstruction: moulding, caput, anuria, haematuria, vulval oedema

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what dilation progressions indicate a suspected delay in 1st stage

nulliparous <2cm in 4 hours

parous <2cm in 4 pours or slowing in progress

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should parous or nulliparous women usually progress faster in birth

parous

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what is station measured in

fifths (where head is in relation to the ischial spines)

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what are the three P’s of failure to progress

power:
- inadequate contractions (frequency and/ or strength)

passage:

short stature (under 5 ft)
trauma
shape

passenger:
- big baby
- malposition (relative cephalo-pelvic disproportion)

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how many contractions are you aiming to have in 10 mins

3-4

what are the widest parts of the pelvis

inlet- transverse diameter mid cavity- AP = transverse outlet= AP diameter

what is the widest presentation of the babies head

brow- occipito-mental = 13 cm

what is the narrowest presentation of the babies head

vertex (suboccipito-bregmatic = 9cm) and face (submento-bregmatic = 9cm)

what does a partogram measure

``` fetal heart amniotic fluid cervical dilation descent contractions obstruction (moulding) maternal obs- BP, HR, urinalysis ```

what is the minimum expected dilation on a partogram

1cm every 2 hours

what can be give to speed up a labour that is failing to progress

syntocinon

what can be used to identify fetal distress

doppler ausculatation electronic fetal monitoring- cardiotocograph colour of amniotic fluid

when is doppler auscultation of fetal heart done in stage 1 of labour

During and after a contraction | Every 15 minutes

when is doppler auscultation of fetal heart done in stage 2 of labour

At least every 5 minutes during & after a contraction for 1 whole minute check Mat pulse at least every 15 mins

what are the risk factors for fetal hypoxia

``` small fetus (biggest risk) preterm/ post dates antepartum haemorrhage HPTx/ PET diabetes meconium epidural analgesia vaginal birth after caesatean premature rupture of membranes >24 hours sepsis (temp >38c) induction/ augmentation of labour ```

what do you need to do additionally when there are risk factors for fetal hypoxia

continuously monitor fetal heart

what are the acute causes of fetal distress

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

what are the symptoms of fetal abruption

severe pain bleeding very acute abnormal fetal HR

what is vasa praevia

when the babies placental or umbilical blood vessels run across the entrance to the cervix

what are the chronic causes of fetal distress

placental insufficiency | fetal anaemia

how can CTG be done

abdominal tracing | fetal scalp electrode- needed sometimes if mother obese

what does CTG tell you about contractions

frequency (not strength)

what are normal fetal heart rates

110-150 bpm tachycardia >150 bradycardia <110

what is variability of fetal HR on CTG

(how wiggly the line is) | normal= changes of 5-25 bmp

what are abnormally variabilities of fetal HR

saltatory: >25 bmp reduced: <5 bmp complete loss all signs of hypoxia

what are acceleration in fetal HR

increases due to baby moving want to see 15 bmp above baseline rate 2x in 10 mins

what are decelerations of fetal HR and when are they normal/ abnormal

reduction in HR early- occur with contractions- normal late- follow the contraction- abnormal- sign of hypoxia variable- most common type- can be complicated or uncomplicated (complicates associated with cord compression)

what should you document when revieing a CTG

baseline fetal HR baseline variability presence/ absence of decelerations presence of accelerations classify as normal, suspicious or pathological

hypoxia can evole gradually in labour- what is seen on a CTG

loss of accelerations repetitive deeper and wider decelerations rising fetal baseline HR loss of variability

what mnemonic for CTG interpretation

``` DR C BRAVADO determine risk contractions baseline rate variability accelerations decelerations overall impression (normal, suspicious, pathological) ```

when is a CTG pathological

when more than 2 abnormal features

what is the management for fetal distress

``` change maternal position IV fluids stop syntocinon scalp stimulation consider tocolysis- terbutaline 250 micrograms s/c (stop/ reduce contractions) maternal assessment -pulse, BP, abdomen, VE fetal blood sampling operative delivery ```

how is fetal blood sampling done

pin prick of scalp via vaginal endoscopic tube

what is normal/ abnormal fetal scalp blood pH

``` >7.24= normal= no action needed 7.2-7.25= borderline= repeat in 30 mins <7.2= abnormal= deliver ```

a what point in labour must a women be at in order to have an instrumental delivery

babies head below/ at ischial spines | cervix must be fully dilated

what are the indications for an instrumental delivery

delay (failure to progress to stage 2) fetal distress special cases: - maternal cardiac disease - severe PET/ eclapmsia - intra-partum haemorrhage - umbilical cord prolapse in stage 2

how long should stage 2 of labour last

prims: 2hrs no epidural, 3hrs with epidural multips: 1 hr no epidural, 2 hrs with epidural

what are the pros and cons of venoutous compared to forceps

ventouse (not used as mush in scotland, foceps used more): - increased failure - increased cephalohaematoma - increased retinal haemrorhage - increased maternal worry - decreased anaesthesia - decreased vaginal trauma - decreased perineal pain long term outcomes the same, ventouse more traumatic to baby, forceps more traumatic for mother

what are the main indications for a c section

``` previous CS fetal distress failure to progress in labour breech presentation maternal request ```

how many people in tayside get a cs

30%

what are the risks of a c sections

4 X greater maternal mortality Morbidity - sepsis, haemorrhage, VTE, trauma, transient tachypnoea of newborn, subfertility, regret, complications in future pregnancy

how many women in tayside have a SVD

~60%

Abnormal Labour Flashcards

(62 cards)