Abnormal Labour Flashcards
(41 cards)
What are the boundaries of the vertex of the foetal skull?
Anterior and posterior fontanelles and the parietal eminences
What does malpresentation refer to?
Non-vertex birth position = breech, shoulder/arm, transverse, face brow
What are two examples of malposition?
Occipito-posterior and occipito-transverse
What gestation would be referred to as preterm?
<37 weeks
What gestation would be referred to as post-term?
> 42 weeks
What are the types of breech presentation?
Complete, footling and frank
What is the complete breech position?
Legs folded with feet at the level of the baby’s bottom
What is the footling breech position?
One or both feet point down so legs would emerge first
What is the frank breech position?
Legs point up with feet by baby’s head so bottom emerges first
What can abnormal labour refer to?
Too early or too late, too painful, too long or too quick, foetal distress or wrong part presenting
What are some analgesic options for during an abnormal labour?
Support and massage/relaxation techniques
Inhalation agents (entonox) or IM opiates
TENS = T10-L1, S2-4
IV remifentanil PCA or epidural
How effective is an epidural anaesthetic?
Complete pain relief on 95% and doesn’t impair uterine activity = may inhibit progress during stage 2
What drugs are given during an epidural anaesthetic?
Levobupivacaine +/- opiate
What are the complications of an epidural anaesthetic?
Hypotension (20%), dural puncture (1%), headache, high block, atonic bladder (40%)
What are the risks associated with an obstructed labour?
Sepsis, uterine rupture, obstructed AKI, postpartum haemorrhage, fistula formation, foetal asphyxia, neonatal sepsis
How is progress of labour assessed?
Cervical dilation, descent of presenting part, signs of obstruction
What are some signs of obstructed labour?
Moulding, caput, anuria, haematuria, vulval oedema
When would you suspect delay in stage 1 of labour?
<2cm dilation in 4hrs if nulliparous
<2cm dilation in 4hrs or slowing in progress if parous
What are the 3P’s used to assess failure to progress?
Powers = inadequate contractions (frequency/strength) Passage = short stature, trauma, shape Passenger = big baby, malposition (relative cephalo-pelvic disproportion)
What is a partogram?
Graphic representation of labour progress = commenced as soon as in established labour
What are some of the areas assessed in a partogram?
Maternal observations (e.g BP), descent, cervical dilation, foetal heart, amniotic fluid, contractions
What can be used to carry out intraoartum foetal assessment?
Doppler auscultation of foetal heart, electronic foetal monitoring (CTG), colour of amniotic fluid
How often should doppler auscultation of the foetal heart be done during labour?
Stage 1 = during and after every a contraction, every 15 minutes
Stage 2 = at least every 5 mins, during and after a contraction for 1 min
How often should maternal pulse be checked during the second stage of labour?
At least every 15 mins
