Abnormal labour and complications Flashcards
What are the indications of induction of labour?
Prolonged pregnancy- >12 days overdue
Maternal DM at 38 weeks
Maternal health necessitating planning of delivery
Foetal concerns- growth, oligohydramnios
PPROM
What is used to determine whether to induce?
Biship score
What Bishop’s score would recommend induction vs spontaneous start likely?
<5= induce >9= will likely start spontaneously
What are the stages of induction?
- Prostaglandin pessary/Cook balloon= ripens cervix
- Amniotomy once Bishop score >7
- IV oxytocin to achieve contractions 3-4/10mins
What are the indications not to labour?
Obstruction to birth canal Malpresentation Maternal medical condition Specific previous labour complications >3 previous C sections Foetal conditions
What is failure to progress?
Prim= <0.5cm/hr Parous= <1cm/hr
What are the causes of failure to progress?
Cephalopelvic disproportion= rare Malposition= common, causes relative cephalopelvic disproportion Malpresentation Inadequate uterine activity Obstruction
What is the management of failure to progress?
Dependent on cause
Inadequate activity= IV oxytocin
Cephalopelvic disproportion= C section
What are the indications for instrumental delivery?
Foetal distress in second stage
Maternal distress in second stage
Failure to progress in second stage
Control of head in breech
What are the causes of foetal distress?
Uterine hyperstimulation Placental abruption Abnormal foetal position and presentation Uterine rupture Cord prolapse
What are the features of foetal distress?
Decreased foetal movement
Meconium stained fluid
Non re-assuring CTG= tachycardia or bradycardia, decreased variability, late decelerations
Foetal metabolic acidosis
What are the risk factors for cord prolapse?
Main cause= artificial ROM
Polyhydramnios
Multiple pregnancy
Abnormal presentation
What is the presentation of cord prolapse?
Sudden and severe decrease in foetal HR
Visible/palpable cord
What is the management of cord prolapse?
Manual elevation of presenting part
Rapid delivery, usually by C section
What are the Common types of malposition?
Breech
Shoulder dystocia
What are the complications of breech?
Cord prolapse
Injury to head and brain
What is the management of breech?
Recomment C section
EXternal cephalic version if breech at 36 weeks
What is shoulder dystocia?
Anterior shoulder caught above pubic bone
What are the foetal complications of shoulder dystocia?
Brachia; plexus injury= Erb’s palsy
Clavicle fracture
What are the maternal complications of shoulder dystocia?
Perineal/vaginal tear
PPH
Uterine rupture
What is the management of shoulder dystocia
- McRobert’s manoeuvre= hyeprflexion of legs
- Suprapubic pressure
- Rotation of shoulder
What is a 1st degree tear?
Limited to superficial perineal skin or vaginal mucosa, no muscle involvement
What is a second degree tear?
Extends into perineal muscles and fascia but not anal sphincter
What is a 3rd degree tear?
Extends into anal sphincter
What is a 4th degree tear?
Tear extends into rectal mucosa
What are the risk factors for a tear?
Prim Large baby Instrumental delivery Induced labour Shoulder dystocia
What are the causes of retained placenta?
Failed separation of placenta from uterine lining
Placenta separated from lining but retained in uterus
What is the management of retained placenta?
- IV oxytocin and catheterisation
- Controlled cord traction
- Manual extraction
What are the complications of retained placenta?
PPH
Infection
What causes PPH in retained placenta?
Uterus cannot contract down due to close off blood supply due to placenta –> haemorrhage
What can cause meconium aspiration?
Foetal maturity- post dates
Foetal distress
What is the management of meconium aspiration?
Suction
Airway support
Surfactant
