abnormal labour Flashcards
how many labours are induced?
about 1 in 5
what are the disadvantages of induction?
- need foetal monitoring
- need for cervical ripening (prostaglandins, balloon)
what is there risk of the prostaglandin/oxytocin induction?
hyperstimulation
what are the indications for induction?
- diabetes
- post dates
- maternal need for planning of delivery
- foetal reasons (growth concerns, oligohydramnios)
- social/maternal request
describe the process of induction
cervix dilated and effaced
amniotomy
IV oxytocin
what is induction of labour?
an attempt to instigate labour artificially
using medications/devices to “ripen cervix”
and artificial rupture of membranes (performing an amniotomy)
what score is used to clinically assess the cervix?
Bishop’s score
the higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful.
how is progress evaluated in labour
- cervical effacement
- cervical dilatation
- descent of the fetal head through the maternal pelvis
describe intrapartum complications because of power
inadequate uterine activity
- > inadequate contractions
- > foetal head will not descend and exert force on the cervix
- > cervix will not dilate
how can the strength and duration of contractions be increased?
synthetic IV oxytocin to the mother
what could stimulation of an obstructed labour lead to?
ruptured uterus
describe intrapartum complications because of passages
cephalopelvic disproportion
- foetal head in correct position but too large to negotiate maternal pelvis
- caput and moulding develop
other obstruction
- placenta praevia
- foetal anomaly
- fibroids
describe intrapartum complications because of passengers
malpresentation
- longituidinal lie with breech presentation
- longituidinal lie with vertex presentation
- transverse lie with shoulder presentation
malposition
- occipito-posterior
- occipito-transverse
describe foetal distress
inability of foetus to cope with stresses of labour due to insufficient placental blood flow
causes
- uterine hyperstimulation (too many contractions)
- hypoxia
- infection
- cord prolapse
- placental abruption
- vasa praevia
what is foetal monitoring during labour
intermittent auscultation of the foetal heart
cardiotocography (if abnormal -> foetal blood sampling)
foetal blood sampling: pH (measure of hypoxaemia), base excess, lactic acid
foetal ECG
