Complications Of Labour Flashcards
3 stages of labour
Dilation
Birth
Afterbirth
When does mother get urge to push during labour
Transition phase of dilation
Diameter of cervix when fully dilated
10cm+
Which shoulder is normally delivered first
Anterior
Labour lengths defined as failure to progress
First delivery - 20+ hrs
2nd+ delivery - 14+hrs
In which phase of labour is failure to progress most dangerous
Active
Causes of prolonged labour
Slow cervical dilation
Slow effacement
Large baby
Small birth canal/ pelvis
Multiple delivery
Worry, stress, fear
Pain medications
Labour inducing medications
Oxytocin
Misoprostal
Mifepristone
Oestrogen pessary
Surgical management of failure to progress
Membrane sweep
C section
Management of failure to progress
Wait
Labour inducing medications
Surgery
Membrane sweep
Digitally push amniotic sac away from uterine wall to make it easier to fully engage cervix
Instruments used in labour
Forceps
Ventouse
Indications for forceps or ventouse delivery
Maternal exhaustion
Conditions where expulsive efforts prohibited
Breech
Fetal compromise
Low birth weight
Post maturity
Where would the vacuum cup be aimed in a ventouse delivery
Back of head
Forceps delivery complications
Bruising
Marks on skin
Cephalohematoma
Retinal haemorrhage
Skull fracture
Permanent nerve/brain damage
Soft tissue damage in mother
Ventouse delivery complications
Scalp abrasion/laceration
Scalp necrosis
Cephalohematoma
Intracranial haemorrhage
Retinal haemorrhage
Vaginal laceration from entrapment of mucosa by suction cup
Are forceps or ventouse more traumatic to mother and baby
Forceps
Causes of non reassuring fetal status
Insufficient oxygen levels
Maternal anaemia
Pregnancy induced hypertension
IUGR
meconium stained amniotic fluid
How can oxygen saturation be measured in the fetus during delivery
Scalp electrode
How many attempts can be made at a ventouse or forceps delivery
3
Characteristics linked to non reassuring fetal status
Irregular heartbeat
Muscle tone problems
Movement problems
Low amniotic fluid volume
How is fetal status monitored
Heart rate
Oxygen status
Cardiotocography
Continuous fetal heart rate monitoring while in labour
What can cause acceleration of fetal heart rate during delivery
Fetal movement
Scalp stimulation
What indicates the fetal head is compressed and the fetus is in the correct position during delivery
Early heart rate deceleration
What can cause late decelerations in fetal heart rate
Placental insufficiency
How does cord compression affect fetal heart rate
Variable decelerations - Abrupt decrease with rapid recovery
How can non reassuring fetal status be managed
Change mothers position
Increase maternal hydration
Maintain maternal oxygenation
Amnioinfusion
Tocolysis
IV hypertonic dextrose
C section
Tocolysis
Temporary stoppage of contractions to delay preterm labour
Amnioinfusion
Fluid inserted into amniotic cavity to relieve pressure on umbilical cord
Perinatal asphyxia
Failure to initiate and sustain breathing at birth
What can perinatal asphyxia lead to
Hypoxaemia
High CO2 level
Acidosis
CV, neuro, and organ problems
Symptoms of perinatal asphyxia before birth
Low HR
low pH
Low oxygen level
What does APGAR score assess
Appearance
Pulse
Grimace
Activity
Respiration
Perinatal asphyxia signs at birth
APGAR score below 3
Poor skin colour
Low HR
Weak muscle tone
Gasping
Weak breathing
Meconium stained amniotic fluid
Perinatal asphyxia treatment
Providing oxygen to mother
C section
Stimulate baby
Mechanical breathing
Medication
What does a baby being born stained green indicate
Meconium released in utero
Shoulder dystocia
Head delivered vaginally but shoulders get stuck
Shoulder dystocia management
Changing mothers position
Manually turning baby’s shoulders - mcroberts manoeuvre
Episiotomy
What complications can shoulder dystocia lead to in the fetus
Brachial plexus injury - erb duchenne palsy
Humerus/ collar bone fracture
Hypoxic ischemic brain injury
What can shoulder dystocia lead to in the mother
Tearing
Bleeding
How much blood does the mother ususally lose in a single vaginal delivery
500ml
How much blood does a mother use in a single C section
1000ml
What is the most common cause of postpartum haemorrhage
Lack of uterine tone
What causes postpartum haemorrhage
Uterine contractions after placenta expelled too weak to compress blood vessels where placenta attached to uterus
What can postpartum haemorrhage lead to
Low blood pressure
Organ failure
Shock
Death
Lack of nutrition in milk
What can increase the chance of postpartum haemorrhage
Placental abruption
Placenta praevia
Uterine overdistension
Prolonged labour
Forceps or ventouse
General anaesthesia
Drugs to induce/stop labour
Infection
Obesity
Cervical, vaginal, uterine Blood vessel tears
Hematoma
Blood clotting disorders
Uterine rupture
Postpartum haemorrhage treatment
Erogotamine
Uterina massage
Balloon tamponade
Removal of retained placenta
Uterine packing
Tying off vessels
Surgery to find bleeding cause
Hysterectomy
3 types of breech
Frank breech - buttocks first
Complete breech - feet first
Footing breech - legs first
Management of malposition
Manually change position
Forceps
Episiotomy
C section
What makes breech position more likely
Multiple pregnancy
Oligohydramnios/Polyhydramnios
Placenta praevia
Uterine fibroids
Placenta praevia
Placenta covers cervix opening
Placenta praevia treatment
Bed rest
Supervised rest in hospital
Blood transfusion
C section
Cephalopelvic disproportion
Baby’s head unable to fit through mothers pelvis
Cephalopelvic disproportion management
C section
What increases uterine rupture risk
Previous c section
Labour induction
Large baby
Polyhydramnios
Maternal age 35+
Use of instruments in delivery
Uterine rupture management
Deliver at hospital
C section
Blood transfusion
Uterine rupture signs
Abnormal fetal HR
Abdo pain
Uterine tenderness
PV bleeding
Slow progress in labour
Rapid HR and low BP in mother
What complications can uterine rupture lead to
Fetal Oxygen deprivation
Excessive bleeding
Cervix/vaginal tears
PP shock
Fetal Aspiration of amniotic fluid
Infection
Precipitous labour
Labours lasts less than 3 hrs
What increases chance of precipitous labour
Small baby
Uterus contracts efficiently and strongly
Compliant birth canal
When can precipitous labour starts
1st stage of labour
2nd stage of labour
