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Flashcards in Obstetrics Deck (185)
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1

How should a low risk woman be monitored during labour?

intermittent fetal heart rate auscultation with Doppler or Pinnard
once every 15 minutes for a whole minute
After a contraction
Listen for rate, accelerations and deceleration

2

When could continuous CTG monitoring be indicated during labour?

maternal pulse over 120 beats/minute on 2 occasions 30 minutes apart
temperature of 38°C or above on a single reading, or 37.5°C or above on 2 consecutive occasions 1 hour apart
suspected chorioamnionitis or sepsis
pain reported by the woman that differs from the pain normally associated with contractions
the presence of significant meconium (as defined in ongoing assessment)
fresh vaginal bleeding that develops in labour
severe hypertension: a single reading of either systolic blood pressure of 160 mmHg or more or diastolic blood pressure of 110 mmHg or more, measured between contractions
hypertension: either systolic blood pressure of 140 mmHg or more or diastolic blood pressure of 90 mmHg or more on 2 consecutive readings taken 30 minutes apart, measured between contractions
a reading of 2+ of protein on urinalysis and a single reading of either raised systolic blood pressure (140 mmHg or more) or raised diastolic blood pressure (90 mmHg or more)
confirmed delay in the first or second stage of labour
contractions that last longer than 60 seconds (hypertonus), or more than 5 contractions in 10 minutes (tachysystole)
oxytocin use.

3

When is someone 'in labour'

>=4cm dilation
regular contractions

4

What is defined as delay in teh first stage of labour

less than 2cm dilation in 4 hours
wing in the progress of labour for multip
changes in the strength, duration and frequency of uterine contractions

5

What is defined as delay in the second stage of labour

For a nulliparous woman:
diagnose delay in the active second stage when it has lasted 2 hours
suspect delay if progress (in terms of rotation and/or descent of the presenting part) is inadequate after 1 hour of active second stage

For a multiparous woman:
diagnose delay in the active second stage when it has lasted 1 hour
suspect delay if progress (in terms of rotation and/or descent of the presenting part) is inadequate after 30 minutes of active second stage.

6

What do you look for when assessing a CTG trace?

baseline HR
variability
deceleration
acceleration

7

What would be reassuring, non-reassuring or abnormal for a baseline heart rate on a CTG

reassuring - = 110-160 bpm
non-reassuring - 100-109 or 161-180
abnormal = <100

8

What would be reassuring, non-reassuring or abnormal for variability on a CTG

reassuring - = 5-25

non-reassuring = less than 5 beats/minute for 30 to 50 minutes
more than 25 beats/minute for 15 to 25 minutes

abnormal = less than 5 beats/minute for more than 50 minutes
more than 25 beats/minute for more than 25 minutes
sinusoidal.

9

What would be reassuring for decelerations on a CTG

reassuring:
no decelerations
early decelerations
variable decelerations with no concerning characteristics (see below) for less than 90 minutes

10

What makes a CTG normal?

all reassuring features

11

What makes a CTG suspicious?

one non-reassuring feature, two reassuring

12

What makes a CTG pathological?

one abnormal or two non-reassuring

13

What should be done if a CTG is pathological?

exclude acute events - cord prolapse, placental abruption, uterine rupture
conservative measure - mobilise, IV fluids
senior review
digital fetal scalp stimulation

14

What is expected to happen to the fetal heart rate with fetal scalp stimulation

it is expected to increase! Shows that the baby is healthy

15

If fetal scalp stimulation does not increase the baseline fetal heart rate, what should be done

senior!!!
fetal blood sample
expediate delivery

16

How should a fetal blood sample be taken

woman lies in left laterla position
do not take during or immediately after a decerlation

17

What are the normal, borderline and abnormal parameters for fetal pH on fetal blood sampling

normal - >=7.25
borderline 7.21-7.24
abnormal <=7.20

18

What are the normal, borderline and abnormal parameters for fetal lactate on fetal blood sampling

normal - <=4.1
borderline 4.2-4.8
abnormal >=4.9

19

What should be done if a fetal blood sample is abnormal?

expediate delivery!
caesarean or instrumental delivery

20

What should be done if a fetal blood sample is normal?

If no accelerations in response to fetal scalp stimulation,
consider taking a second fetal blood sample no more than 1 hour later
if this is still indicated by the cardiotocograph trace.

21

What should be done if a fetal blood sample is borderline?

If no accelerations in response to fetal scalp stimulation,
consider taking a second fetal blood sample no more than 30 minutes later
if this is still indicated by the cardiotocograph trace.

22

What is fetal distress

compromise of fetus due to inadequate oxygen or nutrient supply due to uteroplacental insufficiency

23

What are the pathophysiological reasons for fetal distress

uteroplacental vascular disease
decreased uterine perfusion
intrauterine sepsis
decreased fetal reserves
cord compression

24

What are the risk factors for fetal distress

history of Stillbirth.
Intrauterine growth restriction (IUGR).
Oligohydramnios or polyhydramnios.
Multiple pregnancy.
Rhesus sensitisation.
Hypertension.
Obesity.
Smoking.
Diabetes and other chronic diseases.
Pre-eclampsia or pregnancy-induced hypertension.
Decreased fetal movements.
Recurrent antepartum haemorrhage.
Post-term pregnancy.
Maternal age over 35 years, and particularly over 40,

25

What are the features of fetal distress

decreased fetal movements
slowing or stop of growth of serial symphysis fundal height
abnormal USS parameters - IUGR, macrosomia
doppler USS abnormality <34w
abnormal antenatal or intrapartum CTG
fetal scalp sampling - raised lactate, acidic pH
meconium stained liquor

26

How is suspected fetal distress managed?

antenatal - induction/c-section/defer delivery. weight up risks of preterm delivery

during delivery - expediate delivery within 30 minutes if risk to life.

27

how is HTN during pregnancy defined?

diastolic >=90 mmHg or on two occasions more than 4 hours apart,
and/or
diastolic >110 mmHg

28

What are the parameters for mild, moderate and severe HTN in pregnancy

mild: >=140/90
moderate >= 150/100
severe >= 160/110

29

what is chronic hypertension in pregnancy

present at <20 weeks

As blood pressure tends to fall during the first and second trimesters, a woman with a high blood pressure before weeks' gestation can be assumed to have pre-existing hypertension.

30

what is gestational HTN

new HTN at >20 weeks
WITHOUT proteinuria