Abnormal Labour Flashcards
How many pregnancies are induced?
1 in 5 pregnancies
What is the Bishop’s score?
Used to clinically assess the cervix. Higher scores indicates that induction is more likely to be successful
What elements are involved in Bishops score?
- Dilation
- Length of cervix (effacement)
- Position
- Consistency
- Station
What is amniotomy?
Artificial rupture of fetal membranes (waters) usually using a sharp device (e.g. amniohook)
What is recommended after amniotomy?
IV Oxytocin
to achieve contractions, not needed if contractions spontaneously start
What are indications for induction?
- Diabetes
- Post dates (Term + 7 days)
- Maternal need for planning of delivery e.g. on treatment for DVT
- Fetal reasons e.g. growth concerns, oligohydraminos
- Social/maternal request
Describe the complications in labour in terms of powers, passages and passenger.
Powers:
- Inadequare uterine activity
Passages:
- Cephalopelvic disproportion (CPD)
- Other reasons for abstruction e.g. fibroid
Passenger:
- Malposition
- Malpresentation
What problem can occur in any labour and cause complications?
Fetal distress
How is power measured in labour?
- Cervical effacement
- Cervical dilation
- Descent of fetal head through maternal pelvis
What is regarded as sufficient power
- less than 0.5cm per hour for primigravid women
- less than 1cm per hour for parous women
What is cephalopelvic disproportion (CPD)?
The fetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born
What are other methods of obstruction in labour?
Placenta previa
Fetal anomaly
Fibroids
What is malposition?
When the fetal head is in a suboptimal position for labour and relative CPD occurs
What are the main causes of fetal distress?
- Uterine Hyper-Stimulation (too many contractions)
- Hypoxia
- Infection
- Cord prolapse
- Placental abruption
- Vasa praevia
How is fetal monitoring in labour done?
- Intermittent auscultation of fetal heart
- CTG
- Fetal blood sampling
- Fetal ECG
