Abnormal labour and obstetric emergencies Flashcards
What proportion of labours are induced?
1 in 5
What is induction of labour?
To instigate labour artificially using medications and/or devices to “ripen cervix”
What are 2 ways to “ripen” the cervix?
Prostaglandins (medical)
Balloon (mechanical)
What is Bishop’s score?
Used clinically to 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
What are the 5 factors considered in Bishop’s score?
Dilation (cm) Length of cervix (cm) Position Consistency Station (cm)
What Bishop’s score would warrant amniotomy?
7 or more
How is labour induced?
Cervix dilated and effaced
Amniotomy
IV oxytocin can be used to achieve adequate contractions
What is an amniotomy?
Artificial rupture of foetal membranes using a sharp instrument
What may indicate an induction?
Diabetes Post dates (term + 7 days) Growth concerns Oligohydramnios Maternal request
What are some “powers” reasons for inadequate progress in labour?
Inadequate uterine activity
What are some “passages” reasons for inadequate progress in labour?
Cephalopelvic disproportion
Fibroid
Placenta praevia
Foetal anomaly
What are some “passenger” reasons for inadequate progress in labour?
Malposition
Malpresentation
What factors are evaluated in abdominal/vaginal examination to check labour progress?
Cervical effacement
Cervical dilation
Descent of the foetal head through the maternal pelvis
Name a consequence of inadequate contraction.
The foetal head will not descend and exert force on the cervix
The cervix will not dilate
Why is it important to exclude obstructed labour before giving IV oxytocin to stimulate greater contraction strength and duration?
Stimulation of an obstructed labour could result in a ruptures uterus
What is malpresentation?
Baby not lying in optimal alignment with the birth canal
What is malposition?
Where their head is positioned in the pelvis and in relation to maternal pubic symphysis
Ideally in occipitoanterior (OA) position (face facing mother’s pelvis)
What are some things which can cause foetal distress?
Too many contractions can cause insufficient placental blood flow Hypoxia Infection Cord prolapse Placental abruption Vasa praevia
What is vasa praevia?
Foetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue
What are some ways the foetus is monitored?
Intermittent auscultation of the foetal heart
Cardiotocography (CTG)
Foetal blood sampling
Foetal ECG
What are some possible complications occurring in the 3rd stage?
Retained placenta
Post partum haemorrhage
Tears
What is shoulder dystocia?
Fetal shoulder becomes impacted behind the maternal pubic symphysis after delivery of the foetal head
What are some possible complications of shoulder dystocia?
Foetal oxygen levels can drop, can lead to brain damage or death
Umbilical cord entrapment
Brachial plexus damage
How is shoulder dystocia managed?
H- Call for help E- Evaluate for episiotomy L- Legs (McRoberts position) P- Suprapubic pressure E- Enter manoeuvre (internal rotation) R- Remove posterior arm R- Roll the patient (onto all fours)
What is primary pph?
PPH in first 24 hours after delivery
Accounts for 99% of all pph
What is secondary pph?
Over 24 hours and up to 6 weeks post delivery
What are the first steps in pph management?
Call for help
ABCDE
Empty bladder
Rub up uterine fundus by massaging above the umbilicus
What are some medications used to manage pph?
Oxytocin slow IV injection Ergometrine slow IV injection Tanexamic acid Carboprost Misoprostol
What is the surgical management of pph?
Intrauterine balloon tamponade
Interventional radiology
B-lynch suture
Hysterectomy
Why is a cord prolapse significant?
If the umbilical cord prolapses between the presenting part of the fetus it is very likely to become compressed and reduce oxygen supply to the fetus
How is cord prolapse managed?
Call for help
Replace cord into vagina
Digital elevation of presenting part
Catheterise and fill bladder to elevate presenting part
Encourage knee chest or lateral position with raised hips for mother
Consider tocolysis
Category 1 c section
What kind of seizures are sometimes present in pre-eclampsia?
Tonic clonic
How is pre-eclampsia managed?
IV Magnesium Sulfate
Delivery of baby
