Abnormal Labour

Question 1

What methods are used for cervical ripening?

Answer 1

• Prostaglandins - usually PV

* Balloon - loop balloon

Question 2

What is the process for induction of labour?

Answer 2

1. After priming cervix, perform amniotomy
2. Bishop score >7 favourable for amniotomy
3. Artificial ROM using sharp device
4. IV oxytocin to achieve adequate contractions (4-5 in 10 minutes)

Question 3

What are indications for induction of labour?

Answer 3

• Postdate + 7 days
• Maternal need for planning delivery e.g. DVT
• Foetal reasons e.g. growth concerns, oligohydramnios
• Social/maternal request

Question 4

What are the 3 main categories for intrapartum haemorrhage?

Answer 4

Problems with:

1. Power
2. Passages
3. Passenger

Question 5

What are possible issues with power?

Answer 5

Suboptimal progress
• <0.5cm/hour for primigravid women
• <1cm/hour for parous women

Inadequate contractions do not open cervix
• Manage with IV oxytocin
• Exclude obstructed labour as can lead to ruptured uterus and hysterectomy.

Question 6

What are possible issues with passages?

Answer 6

• Cephalopelvic disproportion
• Foetal anomaly
• Placenta praevia
• Fibroids

Question 7

What is Cephalopelvic disproportion (CPD)?

Answer 7

• Mismatch between pelvic proportions and foetal head (too large)
• Caput and moulding develop, overlap of sutures

Question 8

What is Placenta praevia?

Answer 8

• Low lying placenta preventing birth
• Cuts off blood supply to baby
• Catastrophic haemorrhage

Question 9

What are possible issues with passengers?

Answer 9

Malpresentation

Malposition

Question 10

What are the different presentation/malpresentation(s) and their management?

Answer 10

• Longitudinal lie, cephalic presentation – correct
• Longitudinal lie, breech presentation - caesarean recommended
• Transverse lie – risk cord prolapse, EMERGENCY

Question 11

What is considered malpositioned?

Answer 11

• Much more common than malpresentation

* Foetal head in suboptimal position + relative CPD

Question 12

What are the causes of foetal distress?

Answer 12

• Hypoxia: A lot of contractions –> placenta getting insufficient blood flow
• Placental abruption
• Vasa praevia (presentation of foetal vessels)
• Cord prolapse
• Infection

Question 13

What is foetal blood sampling?

Answer 13

• Speculum used to take foetal scalp blood at 4cm dilation or more
• Abnormal = immediate delivery e.g. forceps, ventouse, C-Section

Question 14

What are the different forms of operative delivery?

Answer 14

• Instrumental delivery eg forceps/ventouse for 15% births
• Elective CS (approx. 20-30%)
• Emergency CS (approx. 20-25%)

Question 15

What are 3rd stage complications?

Answer 15

• Retained placenta
• PPH - 4Ts
• Tears

you see PPH, you think 4Ts

Question 16

How to manage retained placenta?

Answer 16

Active 3rd stage with oxytocic drug and controlled cord traction

Cos you have to deliver it right.

Question 17

What are the different degrees of tears?

Answer 17

• 1st - vaginal mucosa
• 2nd - perineal skin
• 3rd - anal sphincter complex
• 4th - vaginal mucosa, posterior rectal mucosa

Question 18

What are the fetal positions that can cause issues?

Answer 18

Occipito-posterior and occipito-transverse can cause delay in 2nd stage

Question 19

What does fetal blood sampling measure?

Answer 19

Measure pH, base excess, lactic acid, likely measure of hypoxaemia