Week 4- abnormal labour Flashcards Preview

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Flashcards in Week 4- abnormal labour Deck (40):
1

What type of analgesia's can be used in labour?

Paracetamol and cocodamol
Entanox
Opiates e.g. Morphine
Epidural/spinal anaesthesia
Remifantanil

2

What non pharmacological support can be given to women in labour which may help with pain relief?

Massage
TENS
Water immersion

3

How effective is epidural anaesthesia?

95% have complete pain relief.

4

Does epidural anaesthesia impair uterine activity?

Nope

5

What part of labour may you not want to have an epidural in?

It may inhibit progress in the second stage of labour.

6

What complications can occur with epidural anaesthesia?

Hypotension (20%)
Dural puncture (1%)
Headache
Backpain
Atonic bladder

7

How do you assess progress in labour?

Look at cervical dilation
Look for descent of presenting part
Look for signs of obstruction.

8

How is failure to progress defined in nulliparous woman?

<2cm dilation in 4 hours.

9

How is failure to progress defined in parous women?

<2cm dilation in 4 hours or slowing of progress.

10

What 3 P's can cause failure to progress in labour?

Power
Passage
Passenger

11

What issues with power can cause failure to progress in labour?

Inadequate strength of contractions
Not enough frequency of contractions etc.

12

What issues with the passage can cause failure to progress in labour?

Short stature
Trauma
Shape

13

What issues with the passenger can cause failure to progress in labour?

Big baby
Malposition

14

What is the normal course of the babies head through the pelvis?

Goes in transversely. Then starts to flex head when it hits the levator ani muscle. It then starts to rotate so the occiput is anterior. Here it will be able to get its head out. It then moves about 1/8th to 1/4 around to get the anterior shoulder out. Once this is out the posterior shoulder can come out.

15

What machine gives a graphic representation of labour?

Partogram.

16

What measurements does a partogram take?

Contractions
Fetal heart
Amniotic fluid
Cervical dilation
Descent
Maternal obs

17

What tests can be used to identify foetal distress?

Doppler auscultation of fetal heart
Cardiotocograph
Colour of amniotic fluid

18

Describe how doppler auscultation is used to monitor the babies heart?

Stage 1- During and after a contraction. Then every 15 mins
Stage 2- atleast every 5 minutes during and after a contraction for one minute.
Check maternal pulse every 15 mins.

19

What things are risk factors for fetal hypoxia?

Small fetus
Preterm
Antepartum haemorrhage
Hypertension/pre-eclampsia
Diabetes
Meconium
Epidural anaesthesia
Sepsis
Induction/augmented labour
Premature rupture of membranes>24 hours
Vaginal birth after caesarian delivery (next baby you have after a c section is delivered vaginally).

20

What is meant by 'augmented labour'?

Labour needed assistance e.g. through drugs or forceps etc.

21

What things can cause fetal distress acutely?

Abruption (separation of the placenta from the walls of the uterus)
Vasa praevia (the babies blood vessels cross the opening to the birth canal)
Cord collapse
Uterine rupture
Feto-maternal haemorrhage
Uterine hyperstimulation (lots of contractions or long contractions)
Regional anaesthesia

22

When is a deceleration of cardiotography considered late? When should they normally occur?

When the contraction happens, then after this the declaration occurs. They should normally occur at the same time as contractions.

23

What four features should you assess and document when reviewing an CTG?

DR C BraVADO
DR- define risk- use history to think about immediate patient risk
C- Contractions- frequency
Bra- Baseline heart rate. Normal is 110-160bpm
V- variability- how squiggly the line is. Normal is at least 10-15bpm.
A- accelerations- these are a sign of a healthy baby. This is when the line goes up
D- decelerations- should be in time or before contractions. Not after.
O- overall.

24

When are decelerations worrying?

When they drop from the baseline by about 60bpm and take 60 seconds or less to recover.
-Present for over 90 mins
-Occur with over 50% of contractions.

or
Drop from the baseline for more than 60bpm or take more than 60 seconds to recover
-Present for up to 30 mins
-Occur with over 50% of contractions.

or
late decelerations
present for 30 mins
occur with over 50% of contractions

25

How do you manage fetal distress?

Change maternal position
IV fluids
Stop syntocinon (oxytocin- stimulates contractions)
Scalp stimulation
Consider tocolysis (medication used to suppress premature labour)
Assess mother- pulse, bp, abdomen, vaginal exam
Fetal blood sampling
Operative delivery

26

What do you test for in fetal blood sampling?

pH

27

How would you interpret a fetal blood sample?

Normal-
pH= >7.25

Borderline
pH= 7.20-7.25

Abnormal
pH=<7.2

28

What standard indications are there for using an operative delivery?

Delay to progress (past stage 2)
Fetal distress

29

What special indications are there for having an operative delivery?

Maternal cardiac disease
Severe PET/ eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse stage 2.

30

What are the main indications for caesarian section?

Previous CS
Fetal distress
Failure to progress in labour
Breech presentation
Maternal request.

31

What is placental abruption?

When part of the placenta becomes detached from the uterus. You might not see a lot of bleeding as it builds up inside the uterus.

32

What is placental praevia?

The placenta lies in the lower uterine segment (blocking the outflow).

33

How does placental abruption present?

Shock out of keeping with visible blood loss.
Constant pain
Tender and tense uterus
Normal lie and presentation
Fetal heart- absent or distressed

34

When might you beware of placental abruption?

In conditions like pre-eclampsia, DIC, anuria.

35

How does placental praevia present?

Shock in keeping with visible blood loss.
No pain, and not tender uterus.
Presentation and lie may be abnormal
Fetal heart is usually normal.
May see some small bleeding before the large one occurs.

36

How can you distinguish between placental praevia and abruption?

Visible blood loss is much greater in placental praevia than abruption. Also in abruption it will be painful and tender whereas this won't be the case in praevia.

37

Do placental praevia and abruption increase the risk of postpartum haemorrhage?

Yes they both do.

38

How do you manage antepartum haemorrhage (this is placental praevia and abruption)?

If bleeding is severe- deliver baby. Need to do a C section for placental praevia.
If milder- and placental praevia, keep them in hospital until delivery (usually at 37-38 weeks). If the pain and bleeding from a small abruption settles, can send the mum home.

39

What is vasa praevia?

When unprotected vessels (that are supposed to lie in the umbilical cord) are lying over the os.
Generally in an artificial rupture of membranes these will be damaged and can bleed.

40

How does uterine rupture present?

Bleeding and pain etc can be variable.
However there is cessation of contractions and disapearence of the presenting part.
Mother will have unexplained tachycardia, shock, fetal distress.