Cephalopelvic disproportion, uterine rupture, premature labour

Question 1

What is cephalopelvic disproportion?

Answer 1

It occurs when your baby’s head doesn’t fit through the opening of your pelvis. It’s more likely to happen with babies that are large or out of position when entering the birth canal. The shape of your pelvis can also be a factor.

Question 2

What happens before labour in a typical birth?

Answer 2

Weeks before labor, babies get into position. This occurs when your baby drops into your lower pelvis.

When a baby drops, usually their:

Head is pointed down.
Face is toward your back.
Chin is tucked into their ches

Question 3

What happens during labor in a normal birth?

Answer 3

Your baby’s head enters your pelvic opening.
Pressure from your baby’s head causes your pelvic joints to spread, creating a wider opening.
Your baby’s body rotates so that their shoulders can squeeze through your pelvis.
Contractions ease your baby down the birth canal.
Your baby is born after exiting the birth canal through the exterior opening of your vagina.

Question 4

Incidence of cephalopelvic disproportion?

Answer 4

1/250 births

Question 5

Aetiology of cephalopelvic disproportion?

Answer 5

• Large baby
• Past due date
• High BMI of mother
• FH of large babies
• Diabetes or gestational diabetes
• Multiparity meaning that you’ve given birth at least one time before.
• Birthing in adolescence, when your pelvis isn’t skeletally mature.
• Pelvic malformations that may cause bony growths affecting the opening. Malformations may also result in bones that are out of place.
• Petite birthing parent whose pelvic opening is too small.
  Previous trauma, such as a fractured pelvis

Question 6

Which pelvic shape can raise the risk of cephalopelvic disproportion?

Answer 6

Flat (platypelloid) pelvic opening: A person with this type of pelvis has an oval opening that’s wide from side to side but narrow from top to bottom.
Heart-shaped (android) pelvis: The pelvic opening is wide on top and narrows toward the bottom.

Question 7

When does cephalopelvic disproportion happen

Answer 7

Cephalopelvic disproportion occurs during the early stages of labor. It’s likely to occur during the active phase when a baby descends the birth canal.

Question 8

What are the S + S of cephalopelvic disproportion?

Answer 8

Healthcare providers may suspect cephalopelvic disproportion when there’s failure to progress.
Failure to progress is likely when: You’re in labor for the first time and it lasts 20 hours or longer.
You’ve previously given birth and labor lasts for 14 hours or more.
Additional signs of failure to progress include:
Your baby’s head isn’t moving toward the pelvic opening.
Contractions aren’t strong enough to move your baby along the birth canal.
Slow or no thinning or dilation of your cervix.

Question 9

Investigations for cephalopelvic diagnosis?

Answer 9

It’s rarely diagnosed before labor. If labor fails to progress, skilled birth attendants determine whether it’s due to cephalopelvic disproportion.

This may involve:

Applying pressure to your abdomen to determine your baby’s position.
Checking your cervix to see whether it’s opening as it should.
Using a fetal monitor to assess contraction history.

Question 10

Can cephalopelvic disproportion be diagnosed before labor?

Answer 10

During routine check-ups, healthcare providers use prenatal ultrasound to measure fetal growth. Ultrasound can also measure your pelvic opening. However, these measurements aren’t always accurate, making it challenging to diagnose cephalopelvic disproportion before labor

Question 11

What is the management and treatment for cephalopelvic disproportion treated?

Answer 11

Treatment may involve various assisted delivery techniques, such as:

Vacuum extraction or forceps to ease your baby through your pelvis.
Cesarean birth (C-section), a procedure that removes your baby through an incision in your abdomen.

Question 12

What are the complications of cephalopelvic disproportion?

Answer 12

Complications affecting you or your baby can occur if there’s a vaginal delivery:

Your baby’s shoulders might get stuck (shoulder dystocia), requiring an emergency C-section.
You could have vaginal tears or postpartum hemorrhage.

Question 13

What is the definition of an uterine rupture?

Answer 13

Uterine rupture refers to a tear in the uterine wall during pregnancy or labor, which can lead to significant maternal and fetal complications.

Question 14

What is the definition of a Uterine rupture?

Answer 14

Uterine rupture refers to a tear in the uterine wall during pregnancy or labor, which can lead to significant maternal and fetal complications.

Question 15

What is the aetiology of uterine ruptures?

Answer 15

Previous uterine surgery (e.g., cesarean section, myomectomy)
Trauma during labor (e.g., excessive uterine contractions, forceps delivery)
Uterine overdistension (e.g., multiple gestations, polyhydramnios)
Maternal age over 35 years
Induction or augmentation of labor with oxytocin

Question 16

What are the clinical features of a uterine rupture?

Answer 16

Sudden, severe abdominal pain
Vaginal bleeding
Fetal distress
Maternal tachycardia
Hypotension
Loss of uterine contractions
Palpable fetus outside the uterus in complete rupture

Question 17

What are the investigations for a uterine rupture and how do we get a diagnosis?

Answer 17

Clinical suspicion based on symptoms and risk factors
Fetal heart rate abnormalities on cardiotocography (CTG)
Ultrasound may show free fluid in the abdomen or absence of fetal parts within the uterine cavity
Magnetic resonance imaging (MRI): Provides detailed visualization of uterine anatomy and extent of rupture, especially in cases where ultrasound findings are inconclusive.
Computed tomography (CT) scan: Reserved for unstable patients to rule out other causes of abdominal pain and hemorrhage.

Question 18

What is the management for a uterine rupture?

Answer 18

Immediate cesarean delivery for fetal extraction
Maternal stabilization with fluid resuscitation and blood transfusion if necessary
Repair of uterine rupture during cesarean section
Consideration of hysterectomy in severe cases or if future pregnancy is not desired

Question 19

What are the complications for a uterine rupture?

Answer 19

Maternal hemorrhage leading to shock
Fetal hypoxia and acidosis
Neonatal asphyxia
Uterine scar dehiscence in subsequent pregnancies

Question 20

How can we prevent a uterine rupture?

Answer 20

Careful consideration of risks associated with uterine surgery before performing cesarean sections or myomectomies
Avoidance of excessive uterine stimulation during labor induction or augmentation
Monitoring high-risk pregnancies closely for signs of uterine rupture

Question 21

What is the prognosis of a uterine rupture?

Answer 21

The prognosis depends on the timing of diagnosis, extent of rupture, and promptness of intervention.
Maternal mortality rates range from 1% to 5%, while fetal mortality rates are higher, especially in cases of complete rupture.

Question 22

What are the risk factors of a uterine rupture?

Answer 22

Previous uterine rupture or dehiscence
Previous uterine surgery with vertical uterine incision (e.g., classical cesarean section)
Grand multiparity (more than five previous pregnancies)
Use of prostaglandins for cervical ripening
Uterine abnormalities (e.g., fibroids, congenital malformations)
Maternal obesity

Question 23

What are the types of uterine rupture?

Answer 23

Complete rupture: Involves full-thickness disruption of the uterine wall, leading to extrusion of fetal parts into the peritoneal cavity.
Incomplete rupture: Involves partial thickness disruption of the uterine wall, with the fetus remaining confined within the uterus or in the broad ligament.

Question 24

What are the clinical presentation of uterine rapture?

Answer 24

Shock: Maternal hypotension, tachycardia, and pallor due to hemorrhage.
Abdominal tenderness: May be diffuse or localized, depending on the extent and location of the rupture.
Uterine contractions: May be absent in complete rupture but can persist in incomplete rupture.
Abnormal fetal heart rate patterns: Variable decelerations, late decelerations, or bradycardia may indicate fetal distress.

Question 25

What is a differential diagnosis for uterine rupture?

Answer 25

Placental abruption: Presents with similar symptoms but lacks the palpable fetal parts outside the uterus.
Amniotic fluid embolism: Presents with sudden cardiovascular collapse and respiratory distress in the absence of uterine tenderness.

Question 26

What are the management challenges of a uterine rupture?

Answer 26

Hemodynamic instability: Requires aggressive resuscitation with intravenous fluids and blood products to stabilize the mother before surgical intervention.
Surgical decision-making: Timing of cesarean delivery depends on maternal and fetal status, extent of rupture, and available resources for neonatal support.

Question 27

What is the long term impacts of a uterine rupture?

Answer 27

Uterine scar: Increases the risk of uterine rupture in subsequent pregnancies, especially if the scar is located on the anterior uterine wall or is associated with extensive tissue damage.
Psychological impact: Women who experience uterine rupture may have increased anxiety and fear in subsequent pregnancies and deliveries.

Question 28

What is the Multidisciplinary approach to a uterine rupture?

Answer 28

Involves obstetricians, anesthetists, neonatologists, and blood bank personnel working together to manage uterine rupture cases effectively and optimize maternal and fetal outcomes.