Abnormal Labour ( + Induction) Flashcards
How many labours are induced?
1 in every 5 labours are induced.
What is induction?
The artificial start of labour (not spontaneous labour).
- ripening cervix
- rupture of membranes
What are the stages of induction?
- cervical ripening
What changes should occur in the cervix during labour?
- effacement (thin/stretch)
- dilate (opens)
- softens
- moves from post -> ant
- cervix is drawn up into the uterus
What medication can be used to increase strength AND duration of contractions?
IV Oxytocin
How is cervical ripening done?
- Balloon, GOLD STANDARD
- prostaglandins
What should always be done during labour?
Foetal monitoring
What is an amniotomy?
Rupturing of the amniotic sac (membrane) done during induced labour.
When can an amniotomy be performed?
- When the cervix has dilated by 2-3cm
What is the bishops score?
A pre-labour scoring system used to predict whether induction will be needed.
What are the bishop scores?
<5 = labour won’t begin without induction
3 and lower = induction would not be successful
9 and higher = labour is likely to occur on its own
7 or higher = amniotomy can be done
What does the bishops score assess of the Cervix?
dilatation length of cervix position consistency station
What are indications for IOL (induction of labour)?
- diabetes
- Term + 7 days (41 weeks)
- fetal reasons
- social/maternal requests
- if water break >24hrs and labour hasn’t begun
Why is induction offered after 41 weeks?
Due to the increased risk of stillbirth
What are ‘power’ intrapartum complications?
- inadequate uterine activity/contractions
What are ‘passage’ intrapartum complications?
- cephalopelvic disproportion
- fibroids
- placenta praevia
What are ‘passenger’ intrapartum complications?
- malposition
- malpresentation
- foetal distress
- hydrocephalus
What is suboptimal for cervical dilatation?
- primigravida women =. <0.5cm per hour
- porous women = <1cm per hour
What must you rule out before giving IV oxytocin?
obstructions - because stimulation of an obstructed labour can cause a ruptured uterus
What is a sign of cephalopelvic disproportion?
- caput (swelling on babies head)
- moulding (babies skull moves on top of each other to try and make more room)
^ some of this is normal
what’s it called when the placenta lies below the babies head?
Placenta praevia - the baby can’t be delivered without haemorrhage of the mother
What is done when a baby is in the breech position?
The baby can be delivered this way.
In the UK, mothers are offered a Caesarean section
What is the main risk of transverse lie?
Limb/cord could descend through the cervix and could cause an obstructed labour
What is the optimum position for the babies head to be in?
Occipito-Anterior (occipital is anterior to mothers pelvis, so they are facing down)
Which malposition of a babies head can they be born in?
Babies are not porn ocipito-transverse and will need to move into ocipito anterior or ocipito posterior to be borne.
How can you tell which position the babies head is in?
By using the fontanelles:
- posterior = triangle
- anterior = diamond
What are the main causes of foetal distress?
- Hypoxia (MAIN)
- uterine hyper-stimulation (leads to insufficient placental blood flow)
- infection
- cord prolapse
- placental abruption
- vasa praecia
What are the methods of foetal monitoring?
- low risk = intermittent auscultation of the foetal heart (HR ^ in second stage of labour), done every 5 mins
- high risk = cardiotocography
- foetal distress = foetal blood sampling
- foetal ECG
How is foetal blood sampling done?
a speculum is used to scrape the babies scalp
When is foetal blood sampling done?
- then the CTG is abnormal
- can only be done if ther cervix is >4m dilated
What can foetal blood sampling show?
- pH (hypoxia)
- lactic acid
**The main thing is tells you about is hypoxia
how many births are instrumental?
15% of 1st births
slightly less for 2nd births
how much births are done via C section?
- 40-50%
- emergency = 20-25%
- planned = 20-30%
what are the instruments used in delivery?
- Ventouse (suction)
- forceps (can be rotational)
What are the main 3rd stage complications?
- post partum haemorrhage
- retained placenta
- tears
What is a very common sign suggesting foetal distress?
the foetal heart rate decelerates after a contraction
What are the contra-indications of induction?
- vasa praevia
- placenta praevia
- prolapsed umbilical cord
- foetal distress
- malpresentation
- asthma
- previous C section
Why is induction contraindicated in maternal asthma?
prostaglandins cause smooth muscle contraction
its still often done
If on oxytocin, what should be done?
Foetal CTG
What are the complications of induced labour?
- foetal distress
- uterine hypertonicity
- failed induction
What side effects can oxytocin cause?
- hypertonicity
- hypotension
- hyponatraemia
(Usually IV infusion along with the oxytocin)
What are the steps of induction?
Before: offered cervical sweep
- pessaries or vaginal gel
Mix of:
- oxytocin
- prostaglandins
- balloon catheter
- artificial rupture of water
When must you not deliver oxytocin?
Before waters have broken - so you don’t cause an increase in pressure.
