Abnormal labour Flashcards
Induction of labour
approx 1 in 5 induced
need fetal monitoring
- need for cervical ripening - - moving anterior, thinning (effaced) dow, dilating,
Ways for cervical ripening
prostaglandins (pharmacological)
balloon (mechanical)
What does induction mean?
attempt is made to instigate labour using medications and/or devices to ripen cervix followed by artificial rupture of membranes
artificial rupture of membranes is known as?
amniotomy - hook breaks the water
- synthetic version of oxytocin is more effective
what score is used to assess the cervix?
Bishop’s score - the higher the score the more progressive change there is in the cervix
5 different elements of the bishop’s score
dilation length of cervix position consistency station
What bishop’s score is favourable for amniotomy?
7
What do you do once amniotomy has been performed?
IV oxytocin to achieve contractions
aim for 4-5 contractions every 10 minutes
cervical ripening process
efface, dilate, anterior movement
Indications for induction (4)
- 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
Inadequate uterine activity is known as - leads to?
powers
- leads to inadequate process of labour
Passages complications? (2)
cephalopelvic disproportion
- fibroids
passenger complications? (2)
- malposition
- malpresentation
progress in labour is evaluated by?
what are they to determine? (3)
combo of abdo and vaginal examinations
- cervical effacement, dilation and descent of fetal head through maternal pelvis
suboptimal progress is defined as what in the first stage of labour?
what are the rates for women?
cervical dilation
- 0.5 cm per hr for primigravid women
- 1 cm per hour for pravis women
if contractions are inadequate, what does this mean for the fetal head?
what must you exclude if contractions are inadequate?
it is important to exclude obstructed labour eg make sure baby in good position, lady is not dehyrdrated
What is Cephalopelvic disproportion
mismatch between pelvis dimensions and baby -fetal in correct position but it is too large
Fetal features of Cephalopelvic disproportion
caput - swelling on top of baby head
moulding -
other obstructions that affect the passages (3)
placenta praevia - low lying placenta
fetal anomaly
fibroids
passenger - malpresentation -
baby is not head down - not vertex
in preterm gestations its normal for..
baby to not be head down, can move week 37-38
What is malposition
cephalic, longitudinal - the fetal head is in a suboptimal position
ideal baby position
OA - occipital anterior
OP - posterior - delay in second stage
OT - transverse
how do you know baby position
vaginal examination
suture lines on baby head - fontanelles
posterior - occipital - triangular shape
anterior - diamond shape
What contractions can cause fetal distress?
uterine hyperstimulation - restricted blood flow
fetal head position can be abnormal
Main causes of fetal distress (5)
hypoxia infection cord prolapse placental abruption vasa praevia
Fetal monitorring for high risk (4)
intermittent auscultation of the heart
cardiotocography (CTO)
fetal blood sampling
fetal ECG
myconium meaning?
baby passes fetal matter
fetal blood sampling will exclusively look for? how do you take sample?
hypoxia
plastic speculum into vagina - scratch on baby head - measure the pH, base excess, can measure lactic acid
CTG
pH fetal blood sample will show if ?
hypoxaemic or not immediate delivery
blood samples at 30-60 minute intervals
Operative delivery - tools/planned
Emergency CS %?
forceps/ventouse - if fully dialted
CS
20 - 25%
3rd stage complications include
retained placenta
PPH - 4t’s
3rd stage complications - tears staging
graze 1st degree - vaginal mucosa only 2nd degree - perineal skin only 3rd degree - anal sphincter complex 4th degree- involving rectal mucosa
3rd stage of labour is after?
birth of baby to delivery of placenta
Fetal hypoxia - pH values
> 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
what foes fetal hypoxia cause in 10% of cases
cerebral palsy
