Abnormal Labour Flashcards
What methods are used for cervical ripening?
- Prostaglandins - usually PV
* Balloon - loop balloon
What is the process for induction of labour?
- After priming cervix, perform amniotomy
- Bishop score >7 favourable for amniotomy
- Artificial ROM using sharp device
- IV oxytocin to achieve adequate contractions (4-5 in 10 minutes)
What are indications for induction of labour?
- Postdate + 7 days
- Maternal need for planning delivery e.g. DVT
- Foetal reasons e.g. growth concerns, oligohydramnios
- Social/maternal request
What are the 3 main categories for intrapartum haemorrhage?
Problems with:
- Power
- Passages
- Passenger
What are possible issues with power?
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.
What are possible issues with passages?
- Cephalopelvic disproportion
- Foetal anomaly
- Placenta praevia
- Fibroids
What is Cephalopelvic disproportion (CPD)?
- Mismatch between pelvic proportions and foetal head (too large)
- Caput and moulding develop, overlap of sutures
What is Placenta praevia?
- Low lying placenta preventing birth
- Cuts off blood supply to baby
- Catastrophic haemorrhage
What are possible issues with passengers?
Malpresentation
Malposition
What are the different presentation/malpresentation(s) and their management?
- Longitudinal lie, cephalic presentation – correct
- Longitudinal lie, breech presentation - caesarean recommended
- Transverse lie – risk cord prolapse, EMERGENCY
What is considered malpositioned?
- Much more common than malpresentation
* Foetal head in suboptimal position + relative CPD
What are the causes of foetal distress?
- Hypoxia: A lot of contractions –> placenta getting insufficient blood flow
- Placental abruption
- Vasa praevia (presentation of foetal vessels)
- Cord prolapse
- Infection
What is foetal blood sampling?
- Speculum used to take foetal scalp blood at 4cm dilation or more
- Abnormal = immediate delivery e.g. forceps, ventouse, C-Section
What are the different forms of operative delivery?
- Instrumental delivery eg forceps/ventouse for 15% births
- Elective CS (approx. 20-30%)
- Emergency CS (approx. 20-25%)
What are 3rd stage complications?
- Retained placenta
- PPH - 4Ts
- Tears
you see PPH, you think 4Ts
How to manage retained placenta?
Active 3rd stage with oxytocic drug and controlled cord traction
Cos you have to deliver it right.
What are the different degrees of tears?
- 1st - vaginal mucosa
- 2nd - perineal skin
- 3rd - anal sphincter complex
- 4th - vaginal mucosa, posterior rectal mucosa
What are the fetal positions that can cause issues?
Occipito-posterior and occipito-transverse can cause delay in 2nd stage
What does fetal blood sampling measure?
Measure pH, base excess, lactic acid, likely measure of hypoxaemia
