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Abnormal labour and obstetric emergencies Flashcards

1
Q

What proportion of labours are induced?

A

1 in 5

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2
Q

What is induction of labour?

A

To instigate labour artificially using medications and/or devices to “ripen cervix”

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3
Q

What are 2 ways to “ripen” the cervix?

A

Prostaglandins (medical)

Balloon (mechanical)

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4
Q

What is Bishop’s score?

A

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

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5
Q

What are the 5 factors considered in Bishop’s score?

A 
Dilation (cm)
Length of cervix (cm)
Position
Consistency
Station (cm)
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6
Q

What Bishop’s score would warrant amniotomy?

A

7 or more

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7
Q

How is labour induced?

A

Cervix dilated and effaced
Amniotomy
IV oxytocin can be used to achieve adequate contractions

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8
Q

What is an amniotomy?

A

Artificial rupture of foetal membranes using a sharp instrument

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9
Q

What may indicate an induction?

A 
Diabetes
Post dates (term + 7 days)
Growth concerns 
Oligohydramnios
Maternal request
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10
Q

What are some “powers” reasons for inadequate progress in labour?

A

Inadequate uterine activity

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11
Q

What are some “passages” reasons for inadequate progress in labour?

A

Cephalopelvic disproportion
Fibroid
Placenta praevia
Foetal anomaly

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12
Q

What are some “passenger” reasons for inadequate progress in labour?

A

Malposition

Malpresentation

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13
Q

What factors are evaluated in abdominal/vaginal examination to check labour progress?

A

Cervical effacement
Cervical dilation
Descent of the foetal head through the maternal pelvis

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14
Q

Name a consequence of inadequate contraction.

A

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

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15
Q

Why is it important to exclude obstructed labour before giving IV oxytocin to stimulate greater contraction strength and duration?

A

Stimulation of an obstructed labour could result in a ruptures uterus

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16
Q

What is malpresentation?

A

Baby not lying in optimal alignment with the birth canal

17
Q

What is malposition?

A

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)

18
Q

What are some things which can cause foetal distress?

A 
Too many contractions can cause insufficient placental blood flow
Hypoxia
Infection
Cord prolapse
Placental abruption 
Vasa praevia
19
Q

What is vasa praevia?

A

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

20
Q

What are some ways the foetus is monitored?

A

Intermittent auscultation of the foetal heart
Cardiotocography (CTG)
Foetal blood sampling
Foetal ECG

21
Q

What are some possible complications occurring in the 3rd stage?

A

Retained placenta
Post partum haemorrhage
Tears

22
Q

What is shoulder dystocia?

A

Fetal shoulder becomes impacted behind the maternal pubic symphysis after delivery of the foetal head

23
Q

What are some possible complications of shoulder dystocia?

A

Foetal oxygen levels can drop, can lead to brain damage or death
Umbilical cord entrapment
Brachial plexus damage

24
Q

How is shoulder dystocia managed?

A 
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)
25
Q

What is primary pph?

A

PPH in first 24 hours after delivery

Accounts for 99% of all pph

26
Q

What is secondary pph?

A

Over 24 hours and up to 6 weeks post delivery

27
Q

What are the first steps in pph management?

A

Call for help
ABCDE
Empty bladder
Rub up uterine fundus by massaging above the umbilicus

28
Q

What are some medications used to manage pph?

A 
Oxytocin slow IV injection
Ergometrine slow IV injection
Tanexamic acid
Carboprost
Misoprostol
29
Q

What is the surgical management of pph?

A

Intrauterine balloon tamponade
Interventional radiology
B-lynch suture
Hysterectomy

30
Q

Why is a cord prolapse significant?

A

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

31
Q

How is cord prolapse managed?

A

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

32
Q

What kind of seizures are sometimes present in pre-eclampsia?

A

Tonic clonic

33
Q

How is pre-eclampsia managed?

A

IV Magnesium Sulfate

Delivery of baby

Reproduction (25 decks)

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