Abnormal Labour and Postpartum Care Flashcards
What proportion of pregnancies are induced currently?
1 in 5
What are the downsides of induction of labour?
Induced labours tend to be less efficient and more painful
Increased fetal monitoring required due to risk of uterine hyperstimulation
What are the indications for induction of labour?
- Diabetes (usually before due date)
- Post-dates- term + 7 days
- Maternal health problems requiring planning of delivery
- Fetal reasons such as growth concerns
- Social/maternal request/pelvic pain/big babies
How is induction of labour given?
Medications and/or devices used to ripen cervix
Membranes ruptured artificially (amniotomy)
How is the cervix assessed clinically?
Using Bishop’s score, higher score means cervix is more progressed and IoL is more likely to be successful
How is induction of labour given when there is a low Bishop’s score?
Vaginal prostaglandin or Cook’s pessaries given to get Bishop’s score >7
Amniotomy given with amniohook
IV oxytocin given to induce contractions (aiming for 4-5 contractions every 10 mins)
Woman can go into labour herself at any stage
What are some common reasons for inadequate progression of labour?
- Cephalopelvic disproportion (CPD)
- Malposition
- Malpresentation
- Inadequate uterine activity
- Other reasons for obstruction (e.g. ovarian cyst or fibroid)
How is progress of labour determined?
Combination of vaginal and abdominal examinations to determine:
- Cervical effacement
- Cervical dilatation
- Descent of the fetal head through the maternal pelvis
How is inadequate progress of labour defined in the active first stage of labour?
- Less than 0.5cm per hour for primigravid women
- Less than 1.0cm per hour for multiparous women
How can contractions be increased?
IV oxytocin to increase strength and length of contractions
What complication is causes by stimulation of an obstructed labour?
Rupture of the uterus
What is cephalopelvic disproportion and what complications can it cause?
When the fetal head is in the right position for labour but it is too big to negotiate the maternal pelvis.
Caput and moulding of the head can develop.
What are the common malpresentations?
Breach or transverse lie
In what cases can a breach presentation be delivered vaginally?
Second twin
Multiparous woman
All other incidences requiring caesarean
What complication can occur if the waters break with the baby in a transverse lie?
Cord prolapse
What occurs in cord prolapse?
The cord is delivered before the baby and when it hits the cold, external air it vaspospasms. Emergency delivery of the baby is required
What is malposition?
Common and involves the fetal head being in an incorrect position for labour, meaning that relative CPD occurs. Occipito-transvers and occipito-posterior positions are deemed malpositioned.
How is fetal well-being determined during labour?
- Intermittent auscultation of the fetal heart
- Cardiotocography
- Fetal blood sampling
- Fetal ECG
How is a CTG interpreted?
Variability in fetal heartbeat is a healthy sign
Long period with no variability is worrying
What is done if CTG is abnormal?
Fetal blood sampling
Provides a direct measurement from the baby and looks at excess pH and base, with excess pH indicating possible hypoxia.
Blood sample obtained by visualising the babies head with a speculum and scratching the baby’s scalp.
In what situations should labour be advised against?
- Obstruction to birth canal (major placenta praevia, masses)
- Malpresentations
- Medical conditions where labour would not be safe for woman
- Specific previous labour complications
- Previous uterine rupture
- Fetal conditions
How many births involve assisted/instrumental delivery?
15%
What instruments can be used in an assisted delivery?
Forceps
Vaccum extraction
Instruments can also be used to turn baby occipito-anteriorly for a vaginal birth
Instruments cannot be used if cervix is not fully dilated
What proportion of UK births are done by caesarean?
~25%
