Abnormal labour Flashcards
Causes of failure to progress
Power - passenger - passage
Inadequate uterine activity, malposition or malrotation, inadequate pelvis
Management of failure to progress in 1st stage
Amniotomy (ARM) + reassess in 2 hours
Oxytocin infusion
Lower segment CS
Indications for induction
Uteroplacental insufficiency
Prolonged pregnancy
IUGR
Oligo/ anhydraminos
Non reassuring
CTG
Severe pre-eclampsia
PROM
APH
Choriamnionitis
Uncontrolled DM, HTN, renal disease or malignancy
Bishops score - what does it measure, what does a score <6 mean?
Measures position of cervix, length of cervix, consistency and dilatation, and station of presenting part
Score of <6 indicates labour is unlikely to be spontaneous
Induction of labour methods (order)
Stretch + sweep
Prostaglandin pessary
ARM
Oxytocin infusion
Risks of induction of labour
Prematurity
Cord prolapse
CS due to failure
Atonic postpartum haemorrhage
Side effects: pain, uterine hyperstimulation, fetal distress, uterine rupture N+V, diarrhoea
Malposition - what is it, causes
Should be OA - any other position is malposition
Causes: multiparity, tumours, uterine abnormalities, prematurity, multiple pregnancy, macrosomia, placenta praevia, polyhydraminos
Cord presentation - what is it, causes, risks + management
Cord lying below presenting part
Associated with malpresentation + a high head
Can cause cord compression
ARM is contraindicated. CS needed.
Position on knees + elbows until CS
Malpresentation - what is it, risk factors for it
All presentations other than vertex
RF: prematurity, multiple pregnancy, abnormalities of uterus, placenta praevia, polyhydraminos
Unstable lie
Lie is constantly changing after 37 weeks
Risks of abnormal lie
Obstructed labour, uterine rupture, cord prolapse
Types of breech
Extended (70%) = both legs extended with feet by head, presenting part is bum (frank)
Flexed (15%) = legs flexed, presenting part is feet and buttocks
Footling (15%) = one leg extended, one leg flexed
Risks of breech presentation
Risk of hypoxia, trauma in labour
Risks of ECV
Pain, immediate delivery by CS, precipitation of labour, placental abruption, cord accidents
Criteria for operative delivery
Fully dilated cervix
Obstruction excluded
Ruptured membranes
Consent, catheterise
Epidural
Presentation + position
Station of presenting part
If delivery not after 3 pulls, need to do CS
Indications for operative delivery
Prophylaxis to prevent pushing in women
Breech
Prolonged 2nd stage
Fetal distress
Ventouse vs forceps
Ventouse more likely to fail, can cause fetal trauma (cephalohaematoma)
Forceps causing maternal trauma.
Can cause facial bruising and swelling
Indications for cat 1 CS
Placental abruption
Cord prolapse
Scar rupture
Prolonged bradycardia
Scalp ph <7.2
Indications for cat 2 CS
Failure to progress with pathological CTG
Indications for cat 3 CS
Severe pre-eclampsia
IUGR
Failured IoL
Indications for cat 4 CS
Singleton breech
Twin pregnancy
Maternal HIV
Herpes
Placenta praevia
Previous CS
Complications of CS
Uterine lacerations
Blood loss
Hysterectomy
Bladder/ bowel injury
Endometriosis
Wound infection
VTE
UTI
Risks to future pregnancies from CS
Uterine rupture
Placenta praevia
Placenta accreta
Stillbirth
Preterm labour risk factors
Previous preterm
Multiple pregnancy
Cervical surgery
Uterine abnormalities I
nfection (STI, PPROM, UTI)
Polyhydraminos
Fetal abnormalities
APH
Pre-eclampsia, IUGR, medical conditions
Neonatal complications from preterm labour
CP, chronic lung disease, retinopathy, necrotising entercolitis
Management of preterm labour
12mg betametasone IM x2 doses
Tocolysis (nifedipine, atosiban, terbutaline)
IV abx
Causes of antepartum haemorrhage
Placenta praevia
Placental abruption
Cervical erosion/ polyp
Trauma
Causes of postpartum haemorrhage
Primary - more than 500ml within 24hrs of delivery.
Secondary = more than 24hrs after delivery
Tone - atonic uterus
Trauma
Tissue - retained products
Thrombin - abnormal clotting
Management of atonic uterus
Give ergometrine/ syntocinon/ prostaglandins
PE S+S
Pleuritic chest pain
SOB Collapse
Hypotension Tachycardia
Management of PE
CXR then V/Q scan if normal, CTPA if abnormal
anticoagulate
Episiotomy indications
Complicated vaginal delivery: breech, shoulder dystocia, forceps, ventouse FGM, poorly healed tears, fetal distress
Perineal tear classification
1st: injury to skin only
2nd: perineum including perineal muscles
3rd: involving anal sphincter complex
a) <50% external anal sphincter
b) >50% external anal sphincter
c) internal anal sphincter torn
4th: injury to anal sphincter + anal epithelium
How long should the 2nd stage take (max)?
4 hours
What parameter on growth scan changes with maternal diabetes?
AC due to glycogen storage
What dilation can you do a FBS?
3cm
Dose of ergometrine to give in PPH
500 micrograms
