Abnormal Labour

Question 1

What are reasons to induce a labour?

Answer 1

Maternal diabetes
Overdue (Grampian 7 days overdue) as increasing risk of stillbirth
Mother on treatment for DVT
Oligohydramnios
Growth concern
Big baby
Maternal request

Question 2

What methods are used to ripen the cervix for an induction?

Answer 2

Mechanical Cook balloon inserted into cervix to open it up

Pessaries with prostaglandins in them, has risk of causing too many contractions resulting in foetal distress

Question 3

What scoring system is used to evaluate the cervix for an induction?

Answer 3

Bishop’s score

Question 4

What is an amniotomy and why is it done?

Answer 4

Amniotomy is the artificial rupture of the foetal membranes (waters) usually using a sharp device like an amniohook
IV oxytocin is more effective when waters have been broken

Question 5

In the active first stage of labour what is described as sub optimal progress in relation to cervical dilatation?

Answer 5

Less than 0.5cm per hour for primigravid women

Less than 1cm per hour for parous women

Question 6

What is cephalopelvic disproportion?

Answer 6

It means that the foetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born

Question 7

What are two types of malpresentation?

Answer 7

Longitudinal, breech presentation

Transverse, shoulder presentation

Question 8

What is malposition?

Answer 8

Involves the foetal head being in an incorrect position for labour and relative CPD occurs

Question 9

How is foetal wellbeing monitored during labour?

Answer 9

Intermittent auscultation of the foetal heart
Cardiotocography
Foetal blood sampling
Foetal ECG

Question 10

In what situations should labour be not advised?

Answer 10

Obstruction to birth canal- major placenta praevia, masses
Malpresentations- transverse, shoulder, hand
Medical conditions where labour would not be safe for woman
Specific previous labour complications- previous uterine rupture
Foetal conditions- anencephaly
Fetal conditions

Question 11

What are the risks associated with C section?

Answer 11

Infection
Bleeding
Visceral injury
VTE compared

Question 12

What are the degrees of vaginal tears?

Answer 12

First-degree tears – small, skin-deep tears which usually heal naturally
Second-degree tears – deeper tears affecting the muscle of the perineum as well as the skin; these usually require stitches
A third-degree tear extending downwards from the vaginal wall and perineum to the anal sphincter, the muscle that controls the anus
A fourth-degree tear extending to the anus or rectum

Question 13

What are the two types of PPH and what are the causes?

Answer 13

Primary = blood loss of >500ml within 24 hrs of delivery
Tone, Trauma, Tissue, Thrombin (4 T’s)

Secondary = blood loss > 500ml from 24 hrs post partum to 6 weeks
Retained tissue, Endometritis (infection), Tears / trauma

Lochia normal for 3-4 weeks postnatal “should be like a period or less”