32. Complications of Labour Flashcards
What 3 key factors does normal labour depend on?
Describe the 3 stages of labour.
What are some potential problems with the passenger?
The passenger, the passages, the powers.
1) latent phase (0-3cm cervical dilation), active phase (3-10cm)
2) propulsive phase (full dilation - presenting part reaching pelvic floor), expulsive phase (reaching pelvic floor - baby delivery)
3) delivery of baby - placenta expulsion.
Size (NB: term weight 3.5-4kg), number, lie, presentation and position, anatomical abnormalities.
What would you deduce about this baby from its foetal growth chart?
Head growing along 50th centile = good. But abdo circumference has increased above 95th centile b/c baby is well nourished = typical of diabetic baby, lots of glycogen stored in liver so abdo larger and may get stuck in delivery. Normal baby = head should be largest bit.
What is macrosomnia? What are the risk factors?
How can mutiple pregnancies cause problems?
What is abnormal lie and how might this be rectified?
Increased foetal size. RF: maternal diabetes/obesity, previous large babies, prolonged pregnancy.
Legs/body entwined, first baby breech (3x risk of brain damage, encourage c-section), twin-to-twin chin locking etc. IUGR, congenital abnormalities, polyhydraminos, PE and anemia, miscarriage.
E.g. transverse foetal lie. Rectifed with external cephalic version (ECV): procedure used to turn a foetus from breech or side-lying (transverse) position into a head-down (vertex) position before labor onset.
What are some problems with the passage?
Why are perineal tissues often torn during birth?
What are some problems with the powers.
Contracted pelvis, placenta praevia, soft tissue tumours (eg. fibroids - will need c-section b/c v vascular, cysts), pendulous abdomen (dilation of rectus abdominus - greatly relaxed muscular walls sag down over pubic region).
Woman lies on back so uterus has to push baby down and then up, so tear tissues. After head delivered, baby turns so one shoulder can be delivered before the other.
Uterine inertia (inadequate contractions), incoordinate contractions (one strong, one weak), hypertonic contractions (v strong, can cut blood supply to placenta), uterine rupture (scar from prev c-section tears open).
What are some signs of a ‘poor fit’ during labour/birth?
How is a ‘failure to progress’ managed in terms of the powers, passenger and passages?
What are some signs of foetal distress in labour?
Failure of progressive cervical dilation/descent of preesnting part, moulding (extent of overlap in foetal skull bones), caput (scalp swelling), cephalopelvic disproportion (capacity of pelvis inadequate to allow feetus to negotiate the birth canal), fetopelvic disproportion (inability of the fetal head to pass through the maternal pelvis).
Powers - uterine inertia, give syntocinon (synthetic oxytocin). Passenger - malpresentation/position, consider ECV/rotational forceps/ventouse/C-section. Passages - contracted pelvis or rigid cervix, do C-section.
Meconium-stained liquor = baby hypoxic in utero, if ingests it may die. Foetal heart rate abnormalities = brady/tachycardia, reduced baseline variability, decelerations. C-section.
What are some problems of the 3rd stage of labour?
What is placenta accreta?
Retained placenta, uterine atony (uterus fails to contract after the delivery - post partum haemorrhage), soft tissue lacerations, uterine inversion (placenta fails to detach from uterus as it exits, pulls on inside surface, and turns organ inside out. Rare).
Chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis. Increased risk of heavy bleeding with delivery.
