Abnormal Labour + Birth Flashcards
How many pregnancies are induced?
1 in 5
Less efficient and more painful
Needs fetal monitoring
Risk of hyperstimulation of PGI’s and oxytocin
What are the indications for induction?
Diabetes
Term +7 days
Maternal health problems
Fetal reasons
What does induction involve?
Ripen the cervix followed by artificial rupture of membranes
What is the Bishop’s score?
Used to assess the cervix, higher score = more progressive change the more likely induction is to be successful
What is the process for the induction of labour?
Cervix not dilated = pessaries or balloons to open the cervix
A bishops score (7+) for amniotomy
IV oxytocin can be used to achieve adequate contractions (4-5/10mins)
How is progress in labour evaluated?
Cervical effacement
Cervical dilation
Descent of the fetal head through the pelvis
What happens in inadequate uterine activity
Fetal head will not descend and the cervix will not dilate
Synthetic IV oxytocin is given
What is cephalopelvic disproportion?
The fetal head is in the correct position but is too large to negotiate the maternal pelvis
What is the correct presentation and position?
Should be longitudinal with cephalic presentation with occiput anterior position
How is fetal wellbeing determined in labour?
Auscultation of the fetal heart
Cardiotocography
Fetal blood sampling (pH and base excess)
Fetal ECG
What situations is labour not advised in?
Obstruction to birth canal Malpresentations Medical conditions where labour would not be safe for women Specific previous labour complications Fetal conditions
What can be used in assisted delivery
Forceps
Vacuum extraction
Caesarian section
What is a 3rd stage complication?
Retained placenta
Post partum haemorrhage
Tears
What happens in the normal post partum period?
See midwife for first 9-10 days and then the health visitor
All women 6 weeks visit GP
What are common post partum problems?
PP haemorrhage (PPH)
-Primary = >500ml within 24hrs (tone, trauma, tissue and thrombin - 4T’s)
-Secondary = >500ml from 24hrs to 6 weeks (retained tissue, endometritis, tears and trauma)
Venous thromboembolism (6-10 times more likely)
Sepsis
Psychiatric problems
Infant feeding
Bonding
Social issues (partner, other child, financial)