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Obs AM > Abnormal labour and complications > Flashcards

Abnormal labour and complications Flashcards

1
Q

What are the indications of induction of labour?

A

Prolonged pregnancy- >12 days overdue
Maternal DM at 38 weeks
Maternal health necessitating planning of delivery
Foetal concerns- growth, oligohydramnios
PPROM

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2
Q

What is used to determine whether to induce?

A

Biship score

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3
Q

What Bishop’s score would recommend induction vs spontaneous start likely?

A 
<5= induce 
>9= will likely start spontaneously
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4
Q

What are the stages of induction?

A
  1. Prostaglandin pessary/Cook balloon= ripens cervix
  2. Amniotomy once Bishop score >7
  3. IV oxytocin to achieve contractions 3-4/10mins
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5
Q

What are the indications not to labour?

A 
Obstruction to birth canal 
Malpresentation 
Maternal medical condition 
Specific previous labour complications 
>3 previous C sections 
Foetal conditions
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6
Q

What is failure to progress?

A 
Prim= <0.5cm/hr 
Parous= <1cm/hr
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7
Q

What are the causes of failure to progress?

A 
Cephalopelvic disproportion= rare 
Malposition= common, causes relative cephalopelvic disproportion 
Malpresentation 
Inadequate uterine activity 
Obstruction
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8
Q

What is the management of failure to progress?

A

Dependent on cause
Inadequate activity= IV oxytocin
Cephalopelvic disproportion= C section

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9
Q

What are the indications for instrumental delivery?

A

Foetal distress in second stage
Maternal distress in second stage
Failure to progress in second stage
Control of head in breech

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10
Q

What are the causes of foetal distress?

A 
Uterine hyperstimulation 
Placental abruption 
Abnormal foetal position and presentation 
Uterine rupture 
Cord prolapse
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11
Q

What are the features of foetal distress?

A

Decreased foetal movement
Meconium stained fluid
Non re-assuring CTG= tachycardia or bradycardia, decreased variability, late decelerations
Foetal metabolic acidosis

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12
Q

What are the risk factors for cord prolapse?

A

Main cause= artificial ROM
Polyhydramnios
Multiple pregnancy
Abnormal presentation

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13
Q

What is the presentation of cord prolapse?

A

Sudden and severe decrease in foetal HR

Visible/palpable cord

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14
Q

What is the management of cord prolapse?

A

Manual elevation of presenting part

Rapid delivery, usually by C section

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15
Q

What are the Common types of malposition?

A

Breech

Shoulder dystocia

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16
Q

What are the complications of breech?

A

Cord prolapse

Injury to head and brain

17
Q

What is the management of breech?

A

Recomment C section

EXternal cephalic version if breech at 36 weeks

18
Q

What is shoulder dystocia?

A

Anterior shoulder caught above pubic bone

19
Q

What are the foetal complications of shoulder dystocia?

A

Brachia; plexus injury= Erb’s palsy

Clavicle fracture

20
Q

What are the maternal complications of shoulder dystocia?

A

Perineal/vaginal tear
PPH
Uterine rupture

21
Q

What is the management of shoulder dystocia

A
  1. McRobert’s manoeuvre= hyeprflexion of legs
  2. Suprapubic pressure
  3. Rotation of shoulder
22
Q

What is a 1st degree tear?

A

Limited to superficial perineal skin or vaginal mucosa, no muscle involvement

23
Q

What is a second degree tear?

A

Extends into perineal muscles and fascia but not anal sphincter

24
Q

What is a 3rd degree tear?

A

Extends into anal sphincter

25
Q

What is a 4th degree tear?

A

Tear extends into rectal mucosa

26
Q

What are the risk factors for a tear?

A 
Prim 
Large baby 
Instrumental delivery 
Induced labour 
Shoulder dystocia
27
Q

What are the causes of retained placenta?

A

Failed separation of placenta from uterine lining

Placenta separated from lining but retained in uterus

28
Q

What is the management of retained placenta?

A
  1. IV oxytocin and catheterisation
  2. Controlled cord traction
  3. Manual extraction
29
Q

What are the complications of retained placenta?

A

PPH

Infection

30
Q

What causes PPH in retained placenta?

A

Uterus cannot contract down due to close off blood supply due to placenta –> haemorrhage

31
Q

What can cause meconium aspiration?

A

Foetal maturity- post dates

Foetal distress

32
Q

What is the management of meconium aspiration?

A

Suction
Airway support
Surfactant

Obs AM (17 decks)

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