Abnormal labour Flashcards
After what time would you suspect delay in stage 1 in a nulliparous women?
Less than 2cm dilation in 4 hours
After what time would you suspect delay in stage 1 in a parous women?
Less than 2cm in 4 hours
What are the three Ps that can cause a failure to progress in labour?
Powers
Passages
Passenger
When should you start recording a partogram?
As soon as the women enters the labour ward
In stage 1 of labour how often should you do a doppler auscultation of the fetal heart?
Every 15 minutes
During and after a contraction
In stage 2 of labour how often should you do a doppler auscultation of the fetal heart?
Every 5 - 10 minutes
Where does the shoulder get stuck in shoulder dystocia?
Behind the pubic symphisis
What is the first position you should put the women in if there is shoulder dystocia?
McRoberts. Hyperflexion and abduction of the hips (Knees to forhead)
What is a cord prolapse?
When the umbilical cord descends ahead of the fetal presenting part
What is the management of a cord prolapse?
Oxygen to women
Place mother in knee chest position and apply pressure against the fetal head to lift it away from the prolapsed cord.
(Avoid handling the cord outside the vagina as this induces vasospasm)
Proceed to emergency caeserean section.
If possible give terbutaline
SC to reduce contractions.
What does terbutaline do?
Stops contractions
At what scalp pH would you need immediate delivery of the baby?
Below 7.20
What is a normal scalp pH for a fetus?
7.25
What is a borderline scalp pH for a fetus?
7.20 - 7.25
Which instrument used in assisted delivery is more associated with cephalohaematoma and retinal haemorhage?
Ventouse
What is meant by primary dysfunctional labour?
Poor progress in the active 1st phase of labour. Most commonly due to inefficient uterine contractions.
What is meant by secondary arrest in labour?
Progress in the active phase of labour is initially good but then slows (typically after 7cm of dilatation)
What are likely causes of secondary arrest of labour?
Fetal malpresentation, malposition, Cephalopelvic disproportion
What are likely causes of delayed labour if initial progress has been good and there are efficient contractions but the fetal head is not becoming engaged?
Cephalopelvic disproportion
When is it acceptable to give oxytocin in suspected CPD?
If it is a primagravida with mild to moderate CPD and the CTG is reactive.
What is a common way of getting secondary uterine inertia?
Epidural analgesia
How would you treat secondary uterine inertia?
Oxytocin infusion
What type of pelvis has a narrow middle and prevents internal rotation of the fetal head?
Android
What should you do if the baby gets stuck in a transverse position at the ischial spines?
Rotational (Kiellends) forceps
When is induction of labour for post dates usually recommended?
10 - 12 days after due date
What infection is a women at risk of if there is prolonged prelabour rupture of the membranes?
Chorioamniotis
What is the bishops score?
A scoring system used to assess whether or not it is safe to induce labour
What are all the parts of the bishop score?
Cervical dilation Cervical effacement Cervical consistency Cervical Position Fetal station
What does a bishops score of less than 5 suggest?
Labour is unlikely to start without induction
What does a bishop score of more than 9 suggest?
Labour will probably start spontaneosly
