Abnormal labour Flashcards

1
Q

Induction of labour

A

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

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2
Q

Ways for cervical ripening

A

prostaglandins (pharmacological)

balloon (mechanical)

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3
Q

What does induction mean?

A

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

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4
Q

artificial rupture of membranes is known as?

A

amniotomy - hook breaks the water

- synthetic version of oxytocin is more effective

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5
Q

what score is used to assess the cervix?

A

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

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6
Q

5 different elements of the bishop’s score

A
dilation 
length of cervix
position 
consistency 
station
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7
Q

What bishop’s score is favourable for amniotomy?

A

7

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8
Q

What do you do once amniotomy has been performed?

A

IV oxytocin to achieve contractions

aim for 4-5 contractions every 10 minutes

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9
Q

cervical ripening process

A

efface, dilate, anterior movement

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10
Q

Indications for induction (4)

A
  • 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
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11
Q

Inadequate uterine activity is known as - leads to?

A

powers

- leads to inadequate process of labour

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12
Q

Passages complications? (2)

A

cephalopelvic disproportion

- fibroids

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13
Q

passenger complications? (2)

A
  • malposition

- malpresentation

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14
Q

progress in labour is evaluated by?

what are they to determine? (3)

A

combo of abdo and vaginal examinations

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

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15
Q

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

A

cervical dilation

  • 0.5 cm per hr for primigravid women
  • 1 cm per hour for pravis women
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16
Q

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

17
Q

what must you exclude if contractions are inadequate?

A

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

18
Q

What is Cephalopelvic disproportion

A

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

19
Q

Fetal features of Cephalopelvic disproportion

A

caput - swelling on top of baby head

moulding -

20
Q

other obstructions that affect the passages (3)

A

placenta praevia - low lying placenta
fetal anomaly
fibroids

21
Q

passenger - malpresentation -

A

baby is not head down - not vertex

22
Q

in preterm gestations its normal for..

A

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

23
Q

What is malposition

A

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

24
Q

ideal baby position

A

OA - occipital anterior

OP - posterior - delay in second stage
OT - transverse

25
how do you know baby position
vaginal examination suture lines on baby head - fontanelles posterior - occipital - triangular shape anterior - diamond shape
26
What contractions can cause fetal distress?
uterine hyperstimulation - restricted blood flow | fetal head position can be abnormal
27
Main causes of fetal distress (5)
``` hypoxia infection cord prolapse placental abruption vasa praevia ```
28
Fetal monitorring for high risk (4)
intermittent auscultation of the heart cardiotocography (CTO) fetal blood sampling fetal ECG
29
myconium meaning?
baby passes fetal matter
30
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
31
pH fetal blood sample will show if ?
hypoxaemic or not immediate delivery | blood samples at 30-60 minute intervals
32
Operative delivery - tools/planned Emergency CS %?
forceps/ventouse - if fully dialted CS 20 - 25%
33
3rd stage complications include
retained placenta | PPH - 4t's
34
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 ```
35
3rd stage of labour is after?
birth of baby to delivery of placenta
36
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
37
what foes fetal hypoxia cause in 10% of cases
cerebral palsy