Abnormal Labour

Question 1

How many labours are induced?

Answer 1

1 in 5

Question 2

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

Answer 2

• Less efficient labour - More painful
• Requires foetal monitoring
• Risk of uterine hyperstimulation with prostaglandin/oxytocin induction

Question 3

When would we induce a labour?

Answer 3

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

Question 4

What is Bishop’s Score?

Answer 4

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

The higher the score = more progessive chang there is in cervix which mean induction is likely to be successful

Question 5

How do we go about inducing labour?

Answer 5

1. If cervix not dilated and effaced (lower Bishop’s score), then vaginal prostaglandin pessaries or Cook Balloon can be used to ripen (open) the cervix
2. Amniotomy once bishop score = 7
   
   • Artifical rupture of foetal membrane
3. IV oxytocin to achieve contractions (aim 4-5 in 10mins)

Question 6

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

Answer 6

4-5 / 10mins

Question 7

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

Answer 7

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

Question 8

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

Answer 8

Inadequate Uterine Activity

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

Question 9

How do we treat Inadequate Uterine Activity?

Answer 9

IV oxytocin

Make sure to rule out obstructed labour as treating that with oxy will rupture the uterus

Question 10

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

Answer 10

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

Question 11

What are the common forms of malpresentation and malposition?

Answer 11

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 12

When might be better not to attempt normal delivery?

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

• Obstructed Labour
• Foetal Distress prior to full dilation

Question 15

List the common stage 3 complications of labour?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

If CTG is abnormal

Tell us pH - acidity is a good indicator of hypoxaemia