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Repro > abnormal labour > Flashcards

abnormal labour Flashcards

1
Q

what is induction of labour

A

attempt made to instigate labour artificially using medication and/or devices to ‘ripen cervix’ followed usually by artificial rupture of membranes (amniotomy performed)

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2
Q

Bishop’s score

A

used to clinically assess cervix

higher score more progressive change there is in cervix and indicates that inductiion is likely to be successful

everyone gets a bishops score to see if and what interventions needed

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3
Q

when can amniotomy be performed

A

once cervix has dilated and effaced (shortened)

bishops score of 7 or more

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4
Q

what is amniotomy

A

artificial rupture of foetal membranes (‘waters’) using a sharp device e.g amniohook

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5
Q

what happens once an amniotomy has been performed

A

IV oxytocin can be used to achieve adequate contractions (unless they start spontaneously)

aim for 4-5 contracs a min

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6
Q

indications for induction

A
  • diabetes
  • post dates - term + 7days
  • maternal need for planning of delivery e.g. receiving DVT Rx
  • foetal reasons: growth concerns, oligohydramnios
  • social/maternal request
  • twin pregnancy
  • prev stillbirth or IUD
  • hypertension
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7
Q

contraindications for induction

A
  • malpresentation
  • placenta praevia/vasa praevia
  • prolapsed umbilical cord
  • foetal distress
  • anatomical abnormalities e.g. pelvic tumour
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8
Q

medication used during induction of pregnancy

A

topical prostaglandin analogues e.g. misoprostol

  • cervical dilatation and effacement
  • alternative = balloon catheter

IV synthetic oxytocin e.g. syntocinon

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9
Q

complications of induction of labour

A 
uterine hypertonicity 
foetal distress
adverse effects of drugs (hypotension, hyponatremia) 
failed induction 
C section 
ruptured uterus
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10
Q

intrapartum complications: categories

A

powers
passages
passenger

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11
Q

inadequate progress in labour may be due to

A

powers
-inadequate uterine activity

passages

  • cephalopelvic disproportion
  • other reasons for obstruction e.g. fibroid

passenger

  • malposition
  • malpresentation
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12
Q

how is progress in labour evaluated

A

cervical effacement
cervical dilatation
descent of foetal head through maternal pelvis

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13
Q

how is suboptimal progress in labour defined in active 1st stage

A

cervical dilatation

< 0.5cm per hour for primigravid women

<1cm per hour for parous women

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14
Q

obstructed labour

A

woman continuing to labour and contract but cervix not dilating

can result in serious complications e.g. uterine rupture

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15
Q

what will happen if contractions are not adequate

A

foetal head will not descend and exert force on cervix and so cervix will not dilate

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16
Q

how can we increase strength and duration of contractions

A

giving synthetic IV oxytocin to mother

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17
Q

cephalopelvic disproportion

A

mismatch between mother’s pelvic dimensions and baby

baby’s head in correct position but is to large to negotiate maternal pelvis and be born

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18
Q

what happens to fetus as result of cephalopelvic disproportion

A

caput - swelling on baby head

-moulding - sutures on baby head cross over eachother

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19
Q

placenta praevia

A

low line placenta

placenta presenting and will come out first, cutting out supply to baby

usually accompanied by catastrophic haemorrhage

20
Q

malpresentation

A

presenting part is not the vertex - baby head isnt down

breech
nothing presenting (transverse lie)
21
Q

malposition

A

foetal head in a suboptimal presentation for labour

e..g. occipito-posterior, occipito-transeverse

22
Q

ideal baby position

A

occipito-anterior

baby facing sactrum

23
Q

main causes of feotal distress

A 
hypoxia 
infection 
cord prolapse
placental abruption 
vasa praevia
24
Q

when is foetal distress suspected

A

when foetal heart rate decelerates after contraction

25
Q

how is fetal wellbeing in labour determined

A

intermittent auscultation of foetal heart (low risk labours)

cardiotocography

foetal blood sampling

foetal ECG

26
Q

how is fetal blood sampling performed

A

speculum used to take fetal scalp blood sample

27
Q

when is fetal blood sampling indicated

A

CTG is abnormal and cervix dilated 8cm

28
Q

what does fetal blood monitoring provide

A

direct measurements from baby

pH and base excess
lactic acid

low pH = foetal hypoxia

29
Q

what does CTG represent

A

autonomic and central nervous system activity, and changes due to hypoxia

30
Q

indications of CTG

A
  • induction
  • post-/pre-maturity
  • multiple pregnancy
  • underlying maternal health conditions e.g. cardiac, diabetes
  • ante-/intra-partum haemorrhage
  • pyrexia
  • epidural anaesthesia
  • abnormalities noted on intermittent auscultation
31
Q

post maturity

A

> 42wks

32
Q

prematurity

A

<37wks

33
Q

operative deliveries

A

instrumental deliveries - forceps/ventouse

planned/emergency caesarean section

34
Q

caesarean section

A

deliver fetus through incision on abdominal wall and uterus

35
Q

2 main types C section

A

lower uterine segment incision - most common, horizontal incision

classical - very rarely used now, longitudinal incision in upper segment uterus

36
Q

C section indications

A 
foetal distress
failure to progress in labour 
failed induction of labour 
malpresentation 
severe pre-eclampsia 
placenta praevia 
twin pregnancy with a non-cephalic presenting twin 
repeat CS
37
Q

categories of C section: I emergency

A

within 30 mins

immediate threat to life of woman or foetus

38
Q

categories of C section: II urgent

A

within ~90mins

maternal or foetal compromise but not immediately life threatening

39
Q

categories of C section: III scheduled

A

no time limit

requiring early delivery but no compromise

40
Q

categories of C section: IV elective

A

no time limit
at time to suit woman and maternity team

~1/2 c sections

41
Q

complications of C sections

A

injury to structure e.g. bladder
haemorrhage
DVT
infection

42
Q

3rd stage complications of pregnancy

from birth of baby to birth placenta

A

retained placenta
post-partum haemorrhage
tears

43
Q

retained placenta

A

placenta doesn’t deliver

oxytocic drug and controlled cord traction

if not delivered 60mins may need go theatre for manual removal

44
Q

1st degree tear

A

vaginal mucosa only

45
Q

2nd degree tear

A

perineal skin only

46
Q

3rd degree tear

A

involving anal sphincter complex

47
Q

4th degree tear

A

involving rectal mucosa

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