Abnormal Labour Flashcards
What is induction of labour?
This is where you artificially start labour
Describe the steps of induction of labour?
- 1/5 induced
- Needs foetal monitoring
- Needs cervical ripening
- Get cervix ready for labour with prostaglandins (pharmacological) or balloon (mechanical)
- Then artificial rupture of membranes (by amniotomy)
- Bishop’s score used to clinically assess cervix and when amniotomy can be performed, indicated by score of 7 or more, 5 or less means labour unlikely to start without induction
- Oxytocin then used to induce contractions
- Aim for 4-5 per minute
What is cervical ripening?
- Get cervix ready for labour with prostaglandins (pharmacological) or balloon (mechanical)
What is used for cervical ripening?
- Get cervix ready for labour with prostaglandins (pharmacological) or balloon (mechanical)
How are the membranes artificially ruptured?
By amniotomy
What is used to assess the cervix and determine when amniotomy can be performed?
Bishops’ score
5 or less means labour unlikely to start without induction
7 or more means labour is likely
What things does Bishop’s score look at?
What is used to induce contractions?
Oxytocin
What are some indications for labour induction?
- Diabetes
- Post dates
- Term plus 7 days
- Maternal need for planning delivery
- Such as treatment for DVT
- Foetal reasons
- Such as growth concerns
- Social/maternal request
How far overdue is an indication for induction of labour?
- Term plus 7 days
What are contraindications for labour induction?
- Malpresentation
- Placentral praevia
- Prolapsed umbilical cord
- Foetal distress
- Anatomical abnormalities
What are possible complications of labour induction?
- Uterine hypertonicity
- Foetal distress
- Adverse effects of drugs
- Failed induction
- Caesarean section
- Uterine rupture
What can inadequate progress in labour be due to?
- Inadequate uterine activity (power)
- Cephalopelvic disproportion (CPD) (passages)
- Other reasons for obstruction such as fibroid (passages)
- Malposition (passenger)
- Malpresentation (passenger)
How is progress in labour evaluated?
Progress in labour is evaluated by abdominal and/or vaginal examinations to determine:
- Cervical effacement
- Cervical dilation
- Descent of the foetal head through the maternal pelvis
Suboptimal progress in the first stage of labour is defined as?
Suboptimal progress in the first stage of labour is defined as cervical dilation less than:
- 0.5cm per hour for primigravid woman
- 1cm per hour for parous woman
What is a complication of inadequate uterine activity?
- If contractions are inadequate foetal head will not descent and exert force on the cervix, so cervix will not dilate
- Strength and duration of contractions can be increased by giving synthetic IV oxytocin to the mother
- Important to exclude an obstructed labour, as could lead to ruptured uterus
How can strength and duration of contractions be increased?
- Strength and duration of contractions can be increased by giving synthetic IV oxytocin to the mother
What graph shows movement of head and dilation?
Partogram
What does CPD stand for?
Cephalopelvic disproportion
What is cephalopelvic disproportion?
Cephalopelvic disproportion (CPD) = complication where there is a size mismatch between mother’s pelvis and the foetus’ head (head to large or pelvis to small)