Abnormal Labour

Question 1

What different types of breech is there?

Answer 1

frank = legs up at head
complete = legs curled
footing = one foot presents

Question 2

What can lead to obstruction in labour?

Answer 2

abnormally positioned body
small pelvis
problems with the birth canal

Question 3

What complications can come from obstruction in labour?

Answer 3

sepsis
uterine rupture
obstructive AKI
PPH
fistula formation
fetal asphixia
neonatal sepsis

Question 4

What are signs of obstruction?

Answer 4

moulding - oblong shape of baby's head
caput - oedema of skull
anuria
haematuria
vulval oedema

Question 5

What constitutes failure to progress in stage 2 in a nulliparous woman?

Answer 5

2 hours = no epidural

3 hours = epidural

Question 6

What constitutes failure to progress in stage 2 in a multiparous woman?

Answer 6

1 hour = no epidural

2 hours = epidural

Question 7

What is a partogram?

Answer 7

graphic representation of progress of labour

Question 8

What is shown in a partogram?

Answer 8

fetal heart
amniotic fluid
cervical dilation
descent - in relation to ischial spines 
contractions - strong or weak 
obstructions
maternal obs (BP + temp)

Question 9

What analgesia is available?

Answer 9

etanox - nitrous oxide/gas and air
TENS - transcutaneous electrical nerve stimulation
Water Immersion
IM opiates - diamorphine or IM Remifentanil

Question 10

Where are pads placed when using a TENS?

Answer 10

T10-4 and S2-4

Question 11

What spinal levels does an epidural anaethetise?

Answer 11

T10-S5

Question 12

What are the complications of an epidural?

Answer 12

hypotension
dural puncture
headache
high block
atonic bladder

Question 13

What drugs are used in an epidural?

Answer 13

Levobupivacaine +/- opiate

Question 14

What is the mode of action of an epidural?

Answer 14

reduced catecholamine secretion

Question 15

How is the decent of the head marked?

Answer 15

+1, +2, +3 if below the ischial spines and -1, -2, -3 if above the spines

Question 16

At what rate should the cervix efface from 0-3cm in multi and nulli parous women?

Answer 16

from 0 to 3cm in 6 hours in a multipara and 8hours in a nuliparous

Question 17

How is foetal distress assessed?

Answer 17

stage 1: doppler auscultation of foetal heart during and after a contraction EVERY 15 MINS
stage 2: doppler auscultaiton of foetal heart at least EVERY 5 MINS during and after contraction for 1 MIN and check mothers pulse every 15 MINS

Question 18

Apart from Doppler, how else is the foetus assessed?

Answer 18

Cardiotocograph (CTG)

colour of amniotic fluid

Question 19

What are the risk factors for foetal hypoxia?

Answer 19

small foetus
preterm/post date
antepartum haemorrhage
hypertension/preecclampsia
diabetes
meconium
epidural analgesia
vaginal birth after cesarean
premature rupture of membranes >24hours
sepsis - temp >38
induction/augmentation of labour

Question 20

What acute causes can cause foetal hypoxia?

Answer 20

placental abruption
cord prolapse
uterine rupture
fetomaternal haemorrhage
vasa previa
regional anaesthetic 
uterine hyperstimulation

Question 21

What chronic causes can cause foetal hypoxia?

Answer 21

placental insufficiency

foetal aneamia

Question 22

How can you manage foetal hypoxia?

Answer 22

change maternal positon
IV fluids
stop syntocinon 
consider tocolysis - terbutaline 250 micrograms
fetal blood sampling
delivery - catagory 1

Question 23

What is the mnemonic for CTGs?

Answer 23

DR C BRaVADO

Question 24

What does DR C BRaVADO stand for?

Answer 24

DR - determine rate
C - contractions
BRa - baseline rate
V - variability
A - accelerations
D - decellerations
O - overall impression

Question 25

What is a good sign - accelerations or late decelerations?

Answer 25

accelerations

Question 26

What does a reduction in variabiltiy mean?

Answer 26

WORRYING - hypoxia?

Question 27

What are early decelerations?

Answer 27

mimic contractions

Question 28

How is hypoxia seen on a CTG?

Answer 28

loss of accelerations repetitive depper and wider decellerations rising fetal baseline HR loss of variability

Question 29

What should the baseline rate be on a CTG?

Answer 29

100-16

Question 30

What should the variability be on a CTG?

Answer 30

>5

Question 31

What is a normal scalp pH?

Answer 31

>7.25

Question 32

What does a scalp pH between 7.2-7.25 warrant?

Answer 32

repeat in 30 mins

Question 33

What does a scalp pH below 7.2 warrant?

Answer 33

delivery

Question 34

What indicates there should be an operative vaginal delivery?

Answer 34

``` failure to progress at stage 2 fetal distress maternal cardiac disease severe PET intrapartum haemorrhage umbillical cord prolapse stage 2 ```

Question 35

What are the pros of ventouse delivery?

Answer 35

decreases perineal pain decreases vaginal trauma no anaesthesia

Question 36

What are the cons of ventouse delivery?

Answer 36

increase in failure increase in cephalohaematoma and retinal haemorrhage worries mother

Question 37

What indicates there should be a c/section?

Answer 37

``` foetal distress previous c/section failure to progress in labour breech position maternal request ```

Question 38

Is there a greater maternal mortality associated with a c/section?

Answer 38

YES - 4x

Question 39

What are the maternal complications of a c/section?

Answer 39

``` sepsis haemorrhage VTE trauma TTN sub fertility regret complications in future pregnancies ```