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)
Is CPD common or rare?
Rare
Other than cephalopelvic disproportion, what other obstructions can be present?
- Placenta praevia
- Foetal anomaly
- Fibroids
What is placenta praevia?
Placenta partially or completely covers the mothers cervix
What are fibroids?
Non-cancerous growths that develop in and around the womb
What is malpresentation?
Malpresentation = presenting part is not the vertex (baby is not head down)
What are different lies for the baby (malpresentation)?
- Longitudinal lie vertex presentation
- Longitudinal lie breech presentation
- Many more
What is malposition?
Malposition = foetal head being in a suboptimal position for labour and relative CPD occurs
Is malpresentation or malposition more common?
Malposition
What is the ideal position for birth?
- Ideal position is occipito-anterior (OA), refers to babies occopito facing the mothers symphysis (anterior)
What are examples of malpositions?
- Malpositions includes occipito-posterior (OP) and occipito-transverse (OT)
How can the position of the baby be detected?
Can detect position by feeling for suture lines – anterior and posterior fontanelle:
- Anterior is diamond shape
- Posterior is triangle shape
What is foetal distress?
Foetal distress = signs before and during childbirth that indicate the foetus is not well
What can foetal distress occur due to?
- Too many contractions (uterine hyper-stimulation)
- Causes insufficient placental blood flow
- Main causes are hypoxia, infection
- Rare causes like cord prolapse, placental abruption and vasa praevia
What are different methods of foetal monitoring?
-
Intermittent auscultation of foetal heart – in low risk labours
- Done by Doppler US for 1 minute after a contraction every 15 mins in first stage of labour, or 5 mins in second stage
- If abnormality detected, do CTG
-
Cardiotocography (CTG) – in high risk labours
- Represents autonomic and CNS activity, changes due to hypoxia
- Foetal heart rate and contractions are monitored
- Indications are basically any abnormal situations
-
Foetal blood sampling
- Speculum used to take foetal scalp blood sample
- Used when abnormal CTG
- Provides direct measurements from baby of pH and base excess, lactic acid – giving an idea of if hypoxemic
- Foetal ECG
How is intermittent auscultation of the foetal heart done?
- Done by Doppler US for 1 minute after a contraction every 15 mins in first stage of labour, or 5 mins in second stage
What should be done if anomaly detected with intermittent auscultation of foetal heart?
CTG
What does CTG stand for?
Cardiotocography
What is a cardiotocography?
- Represents autonomic and CNS activity, changes due to hypoxia
- Foetal heart rate and contractions are monitored
- Indications are basically any abnormal situations
Out of auscultation of foetal heart and CTG, which is for low and high risk labours?
Auscultation - low risk
CTG - high risk
What are indications for CTG?
- Indications are basically any abnormal situations
What is done if CTG is abnormal?
- Foetal blood sampling
- Speculum used to take foetal scalp blood sample
- Used when abnormal CTG
- Provides direct measurements from baby of pH and base excess, lactic acid – giving an idea of if hypoxemic
What does feotal blood sampling provide?
- Provides direct measurements from baby of pH and base excess, lactic acid – giving an idea of if hypoxemic
What is the normal foetal heart rate?
100-160bpm
What are different kinds of operative delivery
- Instrumental devices 15% of all births
- Planned caesarean sections 20-30%
- Emergency caesarean section 20-25%
What is caesarean section?
Caesarean section = deliver baby through abdominal wall
What are the 2 types of caesarean section?
- Lower uterine segment incision, 99% of cases
- Classical – longitudinal section in upper uterus
What are indications for caesarean section?
- Foetal distress
- Failure to progress in labour
- Failed induction of labour
- Malpresentation
- Severe pre-eclampsia
- Placenta praevia
- Repeat caesarean section
What are the 4 grades of caesarean section?
What are possible complications of caesarean section?
- Injuries to surrounding structures
- Haemorrhage
- DVT
- Infection
When is the 3rd stage of labour?
Third stage is from point of birth of baby to delivery of placenta
What are possible third stage complications?
- Retained placenta
- Post-partum haemorrhage
- Tears
- Classed from graze, 1st, 2nd, 3rd (involving anal sphincter complex), 4th degree (involving rectal mucosa)
