Complications of Labour Flashcards
Women are monitored for their progress in the first stage of labour using a []
Women are monitored for their progress in the first stage of labour using a partogram
There are two lines on the partogram that indicate when labour may not be progressing adequately. These are labelled “[]” and “[]”.
Explain how a partogram is used:
- Dilation of the cervix is plotted agaisnt what? [1]
- What indicates labour is taking too long on a partogram? [1]
- What does ^ mean? [1]
There are two lines on the partogram that indicate when labour may not be progressing adequately. These are labelled “alert” and “action”.
The dilation of the cervix is plotted against the duration of labour (time). When it takes too long for the cervix to dilate, the readings will cross to the right of the alert and action lines.
Crossing the alert line is an indication for amniotomy (artificially rupturing the membranes) and a repeat examination in 2 hours. Crossing the action line means care needs to be escalated to obstetric-led care and senior decision-makers for appropriate action.
Which stage of labour is the placenta delivered? [1]
Stage 3
Explain the different phases 1st stage of labour [2]
- Latent phase: cervix dilates to 4cm
- Active phase: 4cm - 10cm (full dilation)
Explain the two phases of 2nd stage of labour [2]
- what position is the baby in the first part? [1]
-
2nd Stage - Fully dilated labour to delivery of baby:
- Propulsive / passive phase full dilation until the head reaches the pelvic floor. Head is typically high in pelvis, the head is occipitotransverse and mother has little urge to push
- Expulsive / active phase: fetal head reaches the pelvic floor: causes mother invol. desire to push
Explain 3rd stage of labour [1]
What does active managment of 3rd stage of labour decrease the risk of ? [1]
Which drug do you use for ^? [1]
Expulsion of placenta and membranes
Active management decreases risk of PPH - use oxytocic to stimulate placental delivery
What is defined as failure to progess (of labour) for:
- first time birth [1]
- second + birth [1]
What is defined as failure to progess (of labour) for:
- first time birth: lasts more than 20hrs
- second+ birth: lasts more than 14 hours
(quick birth is normally ok)
However, if prolonged labour happens during the [] phase, medical assessment and intervention may be needed
However, if prolonged labour happens during the active phase, medical assessment and intervention may be needed
On average, women began active labour at [] dilation,
On average, women began active labour at 6cm
At what stage of dilation will NHS keep mother in hospital?
At 4cm dilation
How do you manage failure to progress:
- Initially? [1]
- If continued? [4]
- If still continued? [2]
How do you manage failure to progress:
- Initially: relax and wait
- If continued: givelabour-inducing medications: Oxytocin; misoprostal; mifepristone; oestrogen pessary
- If still not delivered: membrane sweep or c section
What are potential causes for prolonged labour? [7]
- Slow cervical dilations
- Slow effacement
- Large baby
- Small birth canal or pelvis
- Delivery of multiple babies
- Emotional factors, such as worry,stress, and fear
- Pain medication may contribute by slowing or weakening uterine contractions
20% of deliveries need induction. Which drugs can you use to do this? [4]
Oxytocin
misoprostal
mifepristone
oestrogen pessary
Describe what a membrane sweep is
pushing amniotic sac away from uterine lining: gives the baby more freedom to move
How do forceps and ventouse deliveries work? [2]
When would you NOT use ventouse delivery? [2]
Both require fully dilated cervix
Forceps: Aim for either side of the ears and pull out baby (but often they slip and move)
Ventouse: aim for back of head. vacuum cup and help ease baby out of vagina. NOT USED if baby is breeched or preterm
Name 4 complications of forceps delivery
Ranges from bruising and marks on the skin to squashing and crushing of skull and brain
Cephalohematoma 9%
Retinal hemorrhage 30%
Skull fracture
Permanent nerve / brain damage
Explain the significance and causes of acceleration and early deceleration in Cardiotocography [2]
Acceleration:
- Sympathetic activation in response to fetal movement or scalp stimulation. Baby is moving around in the uterus / cervix. Normal
Early deceleration:
- Parasympathetic response to head compression
- Fetal HR decreases BEFORE contractions: normal
Explain the significance and causes of variable decelerations and late deceleration in Cardiotocography [2]
Late deceleration:
* placenta is compressed and o2 to baby is compromised: causes vagal stimulation or myocardial depression
* Late and bradycardia: emergency C-section
variable decelerations:
- Abrupt decrease with rapid recovery from cord compression
- Looking at length of recovery of HR (as long as recovery is rapid, its fine)
- When contraction lessens is when HR should return to normal
Explain manoeuvre used to fix shoulder dystopia? [1]
Whats are two other options? [2]
- McRoberts manoeuvrers tries to dislodge shoulder from being stuck on the pubis by pelvic symphysis orientated more horizontally to facilitate shoulder delivery
- Changing the mother’s position
- An episiotomy: surgical widening of the vagina, may be needed to make room for the shoulders
