Abnormal Labour Flashcards
What is an amniotomy?
when you induce labour by artificially rupturing the fetal membranes using a sharp device (amniohook)
(‘breaking you water’)
if the cervix is not dilated or effaced - what kind of bishops score would this woman have?
low bishops score
what is the bishops score used for?
to assess the cervix clinically
(higher the score, the more progressive change there is in the cervix - therefore the induction is more likely to be successful)
indications for the induction of labour
diabetes
post dates (+7 days)
maternal health problems (eg DVT treatment)
fetal abnormalities (growth, oligohydraminos)
pelvic pain/ big baby etc
what is a favourable Bishop’s score for an amniotomy?
7 or higher
once the amniotomy is performed - what is used to achieve adequate contractions?
IV oxytocin
effacement
the cervix gets shorter and thinner
at 100% effacement the cervix should be paper thin
dilation
cervix opening up to let the baby through
cephalopelvic disproportion
babys head is too large to fit through pelvis
3 large tests that determine the progress of labour
cervical effacement
cervical dilation
descent of fetal head in to the maternal pelvis
what are the 4 main ways to detemine fetal well being during labour?
intermittment auscultation of the fetal heart
cardiotocography
fetal blood sampling
fetal ECG
what does a cardiotocography (CTG) do?
can monitor babys HR AND can monitor contractions
what is fetal blood sampling used?
when there is an abnormal CTG
in what situations would you NOT advise labour?
obstruction to birth canal (placenta praevia/masses)
malpresentations (transverse/ ??breech/ shoulder (oblique!!!))
medical/ fetal conditions
uterine rupture
what are ways to assist deliver using instruments?
forceps
vacuum
% of c section in the UK out of all births
25%
when is C section used?
when managing an obstructed labour or fetal distress before the cervix is fully dilated
post partum period (when getting back to normality) what 2 big things need to be monitored?
observe for signs of abnormal bleeding
observe for evidence infection
major post-partum problems
postpartum haemorrhage
venous thromboembolism
sepsis
psychiatric disorder of the puerperium
pre-eclampsia
primary post-partum haemorrhage
blood loss of >500ml within 24 hours of delivery
secondary post-partum haemorrhage
blood loss of >500ml between 24 hours and up to 6 weeks post partum
causes of primary post partum haemorrhage
4 T’s
thrombin
trauma
tone
tissue
causes of secondary post partum haemorrhage
retained tissue
endometritis (infection)
tears/ trauma
women are at an increased risk of postnatal depression if:
FH or personal history of affective disorder
what is the leading cause of maternal death in the UK?
maternal sepsis
what tests would you do when investigating maternal sepsis?
MSSU
LVS
blood cultures
wound swabs
signs of thromboembolic disease in pregnancy/ post partum
SOB or chest pain
unilateral leg swelling and/or pain
unexplained tachycardia (PE)
puerperium
period of 6 weeks after birth during which reproductive organs return to normal condition
what are the 3 main stages in the induction of labour?
- RIPEN the cervix
- amniotomy (after effaced and dilated)
- IV oxytocin to induce contractions (aim for 4-5 contractions in 10 minutes)
how do you ripen the cervix during the induction of labour?
prostaglandin pessaries
cook balloon
why is IV oxytocin given to pregnant women when inducing labour?
to induce contraction
aim for 4-5 contractions in 10 minutes
hyper-stimulation of the uterus can result in what?
fetal distress
