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Reproductive System > Abnormal Labour > Flashcards

Abnormal Labour Flashcards

1
Q

What portion of labours are induced?

A

1/5

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2
Q

When labour is induced, what is it important to do?

A

•Increases risk so there must be foetal monitoring

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3
Q

What is cervical ripening?

A
  • Getting the cervix ready for labour

* Softening, moving anteriorly, thinning down and dilating

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4
Q

How is the cervix ripened?

A
  • Prostaglandins - pharmacological

* Balloon - mechanical (used in Aberdeen)

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5
Q

What is labour induction?

A

Induction of labour is when an attempt is made to instigate labour artificially using medications and/or devices to “ripen cervix” followed usually by artificial rupture of membranes (performing an amniotomy)

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6
Q

What is the Bishop’s score?

A

•A score used to clinically assess the cervix
The higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful

BISHOPS SCORE

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7
Q

What are the 5 elements of the Bishop’s Score?

A
  • Dilation
  • Length of cervix (effacement)
  • Postion
  • Consistency
  • Station
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8
Q

When can the amniotomy be performed?

A

Once the cervix has dilated and effaced

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9
Q

What Bishop score is considered favourable for amniotomy?

A

7 or more

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10
Q

What is an amniotomy?

A

The artificial rupture of the foetal membranes (“waters”) usually using a sharp device e.g. amniohook

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11
Q

What can be done after the amniotomy?

A
  • IV oxytocin can be used to achieve adequate contractions (unless contractions spontaneously start)
  • Aim for 4-5 contractions in 10 minutes
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12
Q

What are the indications for induction?

A
  • Diabetes
  • Post dates – Term + 7 days
  • Maternal need for planning of delivery e.g. on treatment for DVT
  • Foetal reasons e.g. growth concerns, oligohydramnios (low levels of amniotic fluid)
  • Social/maternal request
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13
Q

Why might there be inadequate progress in labour?

A

(POWERS, PASSAGES, PASSENGER)
•Inadequate uterine activity (powers)
•Cephalopelvic disproportion (CPD) (passages)
•Other reasons for obstruction e.g. fibroid (passages)
•Malposition (passenger)
•Malpresentation (passenger)

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14
Q

How is progress evaluated in labour?

A
  • Cervical effacement
  • Cervical dilatation
  • Descent of the fetal head through the maternal pelvis
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15
Q

In the active first stage of labour suboptimal progress is defined as cervical dilatation of what?

A
  • Less than 0.5cm per hour for primigravid women

* Less than 1cm per hour for parous women

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16
Q

What happens if contractions are inadequate?

A

The fetal head will not descend and exert force on the cervix and the cervix will not dilate

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17
Q

Is it possible to increase strength of contractions?

A

It is possible to increase the strength and duration of the contractions by giving a synthetic IV oxytocin to the mother

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18
Q

What is it important to exclude when inducing labour?

A

An obstructed labour in these circumstances as stimulation of an obstructed labour could result in a ruptured uterus

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19
Q

What is a partogram?

A

A composite graphical record of key data (maternal and fetal) during labour entered against time on a single sheet of paper

20
Q

What is cephalopelvic disproportion (CPD)?

A
  • Genuine CPD is relatively rare
  • It means that the fetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born
21
Q

What happens as a result of CPD?

A

•Caput (swelling on baby’s head) and moulding develop (cross-over of suture)

22
Q

What are the other causes of obstruction in labour?

A
  • Placenta praevia - placenta comes first and cuts off supply to the baby
  • Foetal anomaly e.g. hydrocephalus
  • Fibroids
23
Q

What is malpresentation?

A

When the presenting part is not the vertex

24
Q

What is the optimum presentation?

A

Longitudinal lie with vertex presentation

25
Q

What is recommended for a breech labour?

A

C-section

26
Q

What are transverse and oblique lies?

A
  • Transverse - longitudinal axis across mother’s abdomen

* Oblique - baby lying diagonally

27
Q

What is the transversals and oblique lie?

A

Potential for cord prolapse

28
Q

When is malpresentation more likely to occur?

A

In pre-term labour as baby may not be in the best position until right up to pregnancy (particularly for parous mothers)

29
Q

What is malposition?

A
  • Much more common

* Involves the fetal head being in an suboptimal position for labour and ‘relative’ CPD occurs

30
Q

What is the optimal position?

A

OA - occipital-anterior (baby facing sacrum)

31
Q

What are sub-optimal positions for delivery?

A
  • Occipito-posterior (OP) - possible to delivery but may cause delay in second stage
  • Occipito-transverse (OT)
32
Q

How is the position of the baby’s head determined?

A
  • Vaginal examination

* Feeling suture lines on baby’s head

33
Q

How can you determine between the anterior and posterior fontanelles?

A
  • Posterior fontanelle - triangular

* Anterior fontanelle - diamond

34
Q

What are the main causes of foetal distress?

A

•The main causes of fetal distress are:

  • hypoxia
  • infection

•Rare occurences such as:

  • cord prolapse
  • placental abruption
  • vasa praevia

•In many cases of suspected fetal distress, no cause is found

35
Q

What is foetal distress?

A
  • It is very important to avoid causing too many contractions (Uterine Hyper-stimulation) as this can result in foetal distress due to insufficient placental blood flow
  • Head may not be in an optimal position - head compression
  • If the baby is growth restricted it may not have the reserves of a full-grown baby to cope with labour - changes in blood flow

•The main causes of fetal distress are:

  • hypoxia
  • infection - corioamnionitis

•Rare occurences such as:

  • cord prolapse
  • placental abruption - placenta prematurely separates from the uterine wall
  • vasa praevia - foetal vessels presenting

•In many cases of suspected foetal distress, no cause is found

36
Q

How is the foetus monitored during labour?

A

•Intermittent auscultation of the fetal heart
-if pregnancy completely “normal”
-midwife listening in with Doppler or pinard stethoscope
•Cardiotocography (CTG) - signs of infection, health issues, meconium etc.
•Foetal blood sampling - worried about foetal distress
•Foetal ECG - some units offer

37
Q

When is foetal blood sampling used?

A

Abnormal CTG (foetal distress)

38
Q

How is the foetal blood sampled?

A
  • Plastic speculum used to take foetal scalp blood sample

* Require open cervix - 4cm or more

39
Q

What is the foetal blood sample used to investigate?

A
  • Exclusively looks for hypoxia, no infection or anaemia
  • pH and base excess
  • Sometimes also lactic acid
  • pH gives a measure of likely hypoxaemia
40
Q

What happens if baby has an abnormal blood test?

A
  • Immediate delivery
  • Fully dilated - forceps, ventouse
  • Caesarean section
41
Q

At what intervals are FBS taken if the CDG continues to be abnormal?

A

Every 30-60 mins

42
Q

What are the methods of operative delivery?

A
  • Instrumental deliveries (forceps/ventouse) account for around 15% of births
  • Planned (elective) Caesarean section (CS) approx. 20-30% (but higher and lower rates reported globally)
  • Emergency CS approx. 20-25%
43
Q

What are 3rd stage complications in labour (birth of baby to placental delivery)?

A

•Retained placenta (after 60mins) - may have to go to theatre
•Post partum haemorrhage - 4 Ts: tone, trauma, tissue, thrombin
•Tears (perineal trauma)
-Graze
-1st degree - vagina mucosa only
-2nd degree - perineal skin
-3rd degree – involving anal sphincter complex
-4th degree – involving rectal mucosa

44
Q

What do 3rd and 4th degree tears require?

A

Obstetrician repair in theatre

45
Q

Summary

A
  • Labour problems are common especially in primigravid women
  • They are due to ‘The passage, The powers or The passenger’
  • Operative vaginal birth or caesarean section may be necessary when problems occur in labour to prevent fetal and maternal morbidity and mortality

Reproductive System (31 decks)

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