Abnormal labour

Question 1

Induction of labour

Answer 1

approx 1 in 5 induced
need fetal monitoring
- need for cervical ripening - - moving anterior, thinning (effaced) dow, dilating,

Question 2

Ways for cervical ripening

Answer 2

prostaglandins (pharmacological)

balloon (mechanical)

Question 3

What does induction mean?

Answer 3

attempt is made to instigate labour using medications and/or devices to ripen cervix followed by artificial rupture of membranes

Question 4

artificial rupture of membranes is known as?

Answer 4

amniotomy - hook breaks the water

- synthetic version of oxytocin is more effective

Question 5

what score is used to assess the cervix?

Answer 5

Bishop’s score - the higher the score the more progressive change there is in the cervix

Question 6

5 different elements of the bishop’s score

Answer 6

dilation 
length of cervix
position 
consistency 
station

Question 7

What bishop’s score is favourable for amniotomy?

Answer 7

7

Question 8

What do you do once amniotomy has been performed?

Answer 8

IV oxytocin to achieve contractions

aim for 4-5 contractions every 10 minutes

Question 9

cervical ripening process

Answer 9

efface, dilate, anterior movement

Question 10

Indications for induction (4)

Answer 10

• Diabetes
• post dates - term +7 days - 41 weeks in abz
• maternal need for planning of delivery - eg on treatment for DVT
• Fetal reasons - growth concerns,Oligohydramnios
• social/ maternal request

Question 11

Inadequate uterine activity is known as - leads to?

Answer 11

powers

- leads to inadequate process of labour

Question 12

Passages complications? (2)

Answer 12

cephalopelvic disproportion

- fibroids

Question 13

passenger complications? (2)

Answer 13

• malposition

- malpresentation

Question 14

progress in labour is evaluated by?

what are they to determine? (3)

Answer 14

combo of abdo and vaginal examinations

- cervical effacement, dilation and descent of fetal head through maternal pelvis

Question 15

suboptimal progress is defined as what in the first stage of labour?
what are the rates for women?

Answer 15

cervical dilation

• 0.5 cm per hr for primigravid women
• 1 cm per hour for pravis women

Question 16

if contractions are inadequate, what does this mean for the fetal head?

Question 17

what must you exclude if contractions are inadequate?

Answer 17

it is important to exclude obstructed labour eg make sure baby in good position, lady is not dehyrdrated

Question 18

What is Cephalopelvic disproportion

Answer 18

mismatch between pelvis dimensions and baby -fetal in correct position but it is too large

Question 19

Fetal features of Cephalopelvic disproportion

Answer 19

caput - swelling on top of baby head

moulding -

Question 20

other obstructions that affect the passages (3)

Answer 20

placenta praevia - low lying placenta
fetal anomaly
fibroids

Question 21

passenger - malpresentation -

Answer 21

baby is not head down - not vertex

Question 22

in preterm gestations its normal for..

Answer 22

baby to not be head down, can move week 37-38

Question 23

What is malposition

Answer 23

cephalic, longitudinal - the fetal head is in a suboptimal position

Question 24

ideal baby position

Answer 24

OA - occipital anterior

OP - posterior - delay in second stage
OT - transverse

Question 25

how do you know baby position

Answer 25

vaginal examination
suture lines on baby head - fontanelles
posterior - occipital - triangular shape
anterior - diamond shape

Question 26

What contractions can cause fetal distress?

Answer 26

uterine hyperstimulation - restricted blood flow

fetal head position can be abnormal

Question 27

Main causes of fetal distress (5)

Answer 27

hypoxia
infection 
cord prolapse
placental abruption
vasa praevia

Question 28

Fetal monitorring for high risk (4)

Answer 28

intermittent auscultation of the heart
cardiotocography (CTO)
fetal blood sampling
fetal ECG

Question 29

myconium meaning?

Answer 29

baby passes fetal matter

Question 30

fetal blood sampling will exclusively look for? how do you take sample?

Answer 30

hypoxia
plastic speculum into vagina - scratch on baby head - measure the pH, base excess, can measure lactic acid

CTG

Question 31

pH fetal blood sample will show if ?

Answer 31

hypoxaemic or not immediate delivery

blood samples at 30-60 minute intervals

Question 32

Operative delivery - tools/planned

Emergency CS %?

Answer 32

forceps/ventouse - if fully dialted
CS

20 - 25%

Question 33

3rd stage complications include

Answer 33

retained placenta

PPH - 4t’s

Question 34

3rd stage complications - tears staging

Answer 34

graze
1st degree - vaginal mucosa only
2nd degree - perineal skin only
3rd degree - anal sphincter complex
4th degree- involving rectal mucosa

Question 35

3rd stage of labour is after?

Answer 35

birth of baby to delivery of placenta

Question 36

Fetal hypoxia - pH values

Answer 36

> 7.25 - repeat in 1 hr if CTG remains abnormal
7.21-7.24 - repeat in 30 mins if CTG is abnormal
< 7.2 - immediate delivery

Question 37

what foes fetal hypoxia cause in 10% of cases

Answer 37

cerebral palsy