Abnormal Labour

Question 1

This deck will cover:

Answer 1

• Failure to start Labour & Induction
• Inadequate Progress of Labour
• When to avoid labour
• Stage 3 complications
• Assessing for Foetal Distress

Question 2

How many labours are induced?

Answer 2

1 in 5

Question 3

Why don’t we induce all labours at a time convenient for us?

Answer 3

• Less efficient labour
• More painful
• Requires foetal monitoring
• Risk of uterine hyperstimulation

Question 4

When would we induce a labour?

Answer 4

• Certain maternal health problems such as on treatment for DVT or Diabetic
• > 7days overdue
• Foetal concerns e.g. oligohydramnios or growth issues

Question 5

What is Bishop’s Score?

Answer 5

Clinical score used to assess the change in the cervix and predict success of induction

Question 6

How do we go about inducing labour?

Answer 6

1) Dilate & efface cervix with Vaginal Prostaglandin pessaries or Cook Balloon
2) Amniotomy once bishop score = 7
3) IV oxytocin to achieve contractions

Question 7

When inducing labour what rate of contractions do we aim for?

Answer 7

4-5 / 10mins

Question 8

How slow do we consider to be Inadequate Progress of labour?

Answer 8

Dilation at <0.5cm/hr primagravida or <1cm/hr multigravida

Question 9

We split the causes of Inadequate Progress into Power vs Passages vs Passenger.
Whats the main “power” cause?

Answer 9

Inadequate Uterine Activity

Inadequate contractiosn -> Failure to descend -> No pressure on cervix -> No dilation/effacement

Question 10

How do we treat Inadequate Uterine Activity?

Answer 10

IV oxytocin

Make sure to rule out Obstructed Labour as treating that with oxy will rupture the uterus

Question 11

What could cause inadequate progress of labour due to the passenger?

Answer 11

• Malposition
• Malpresentation
• Cephalopelvic Disproportion (CPD - combination of the passenger and passage)

Question 12

What are the common forms of malpresentation and malposition?

Answer 12

Malpresentation - breech or transverse lie

Malposition - Relative CPD occurs due to foetal head being in the wrong orientation e.g. Occipito-posterior or Occipito-transverse

Question 13

When might be better not to attempt normal delivery?

Answer 13

• Obstruction e.g. Placental Praevia
• Malpresentation
• Unsafe maternal conditions e.g. cardiac problems
• Previous complications of labour e.g. uterine rupture
• Foetal conditions

Question 14

What other options are there when normal delivery isn’t recommended?

Answer 14

• Assisted or Instrumental delivery if fully dilated using forceps or Vacuum Extraction (15%)
• C-section (25%)

Question 15

In what cases do you choose to do a C-section?

Answer 15

• Obstructed Labour

- Foetal Distress prior to full dilation

Question 16

List the common stage 3 complications of labour?

Answer 16

• Retained PLacenta
• PPH
• Tears (grazes, 1st->4th degree tears)

Question 17

Labour is very stressful for the wean but they can normally handle it, how do we tell if they’re in distress?

Answer 17

• Intermittent Auscultation of heart
• Cardiotocography
• Foetal Blood Sampling
• Foetal ECG

Question 18

When would we use a Foetal Blood sample and what would it show?

Answer 18

If CTG is abnormal

Tell us pH, Acidity is a good indicator of hypoxaemia