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Abnormal Labour Flashcards

1
Q

What is induction of labour?

A

This is where you artificially start labour

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2
Q

Describe the steps of induction of labour?

A
  • 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
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3
Q

What is cervical ripening?

A
  • Get cervix ready for labour with prostaglandins (pharmacological) or balloon (mechanical)
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4
Q

What is used for cervical ripening?

A
  • Get cervix ready for labour with prostaglandins (pharmacological) or balloon (mechanical)
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5
Q

How are the membranes artificially ruptured?

A

By amniotomy

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6
Q

What is used to assess the cervix and determine when amniotomy can be performed?

A

Bishops’ score

5 or less means labour unlikely to start without induction

7 or more means labour is likely

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7
Q

What things does Bishop’s score look at?

A
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8
Q

What is used to induce contractions?

A

Oxytocin

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9
Q

What are some indications for labour induction?

A
  • 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
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10
Q

How far overdue is an indication for induction of labour?

A
  • Term plus 7 days
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11
Q

What are contraindications for labour induction?

A
  • Malpresentation
  • Placentral praevia
  • Prolapsed umbilical cord
  • Foetal distress
  • Anatomical abnormalities
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12
Q

What are possible complications of labour induction?

A
  • Uterine hypertonicity
  • Foetal distress
  • Adverse effects of drugs
  • Failed induction
  • Caesarean section
  • Uterine rupture
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13
Q

What can inadequate progress in labour be due to?

A
  • Inadequate uterine activity (power)
  • Cephalopelvic disproportion (CPD) (passages)
  • Other reasons for obstruction such as fibroid (passages)
  • Malposition (passenger)
  • Malpresentation (passenger)
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14
Q

How is progress in labour evaluated?

A

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
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15
Q

Suboptimal progress in the first stage of labour is defined as?

A

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
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16
Q

What is a complication of inadequate uterine activity?

A
  • 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
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17
Q

How can strength and duration of contractions be increased?

A
  • Strength and duration of contractions can be increased by giving synthetic IV oxytocin to the mother
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18
Q

What graph shows movement of head and dilation?

A

Partogram

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19
Q

What does CPD stand for?

A

Cephalopelvic disproportion

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20
Q

What is cephalopelvic disproportion?

A

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)

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21
Q

Is CPD common or rare?

22
Q

Other than cephalopelvic disproportion, what other obstructions can be present?

A
  • Placenta praevia
  • Foetal anomaly
  • Fibroids
23
Q

What is placenta praevia?

A

Placenta partially or completely covers the mothers cervix

24
Q

What are fibroids?

A

Non-cancerous growths that develop in and around the womb

25
What is malpresentation?
Malpresentation = presenting part is not the vertex (baby is not head down)
26
What are different lies for the baby (malpresentation)?
* Longitudinal lie vertex presentation * Longitudinal lie breech presentation * Many more
27
What is malposition?
Malposition = foetal head being in a suboptimal position for labour and relative CPD occurs
28
Is malpresentation or malposition more common?
Malposition
29
What is the ideal position for birth?
* Ideal position is occipito-anterior (OA), refers to babies occopito facing the mothers symphysis (anterior)
30
What are examples of malpositions?
* Malpositions includes occipito-posterior (OP) and occipito-transverse (OT)
31
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
32
What is foetal distress?
Foetal distress = signs before and during childbirth that indicate the foetus is not well
33
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
34
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**
35
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
36
What should be done if anomaly detected with intermittent auscultation of foetal heart?
CTG
37
What does CTG stand for?
Cardiotocography
38
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
39
Out of auscultation of foetal heart and CTG, which is for low and high risk labours?
Auscultation - low risk CTG - high risk
40
What are indications for CTG?
* Indications are basically any abnormal situations
41
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
42
What does feotal blood sampling provide?
* Provides direct measurements from baby of pH and base excess, lactic acid – giving an idea of if hypoxemic
43
What is the normal foetal heart rate?
100-160bpm
44
What are different kinds of operative delivery
* Instrumental devices 15% of all births * Planned caesarean sections 20-30% * Emergency caesarean section 20-25%
45
What is caesarean section?
Caesarean section = deliver baby through abdominal wall
46
What are the 2 types of caesarean section?
* Lower uterine segment incision, 99% of cases * Classical – longitudinal section in upper uterus
47
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
48
What are the 4 grades of caesarean section?
49
What are possible complications of caesarean section?
* Injuries to surrounding structures * Haemorrhage * DVT * Infection
50
When is the 3rd stage of labour?
Third stage is from point of birth of baby to delivery of placenta
51
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)

Reproductive System (54 decks)

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