Complications of Labour Flashcards
What does induction of labour need?
Foetal monitoring
Cervical ripening - prostaglandins and balloon
What does induction mean?
An attempt is made to instigate labour artificially using medications and/ or devices to ripen cervix followed usually by artificial rupture of membranes
What is the the Bishop’s score?
Clinically assess the cervix
Higher the score then the more progressive change there is in the cervix and indicates induction is likely successful
What are the areas assessed in the Bishop’s score?
Dilatation
Length of cervix (effacement)
Position
Consistency
Station
When can an amniotomy be perfomed?
Once the cervix has been dilated and effaced - Bishops score of 7 is favourable
What is an amniotomy?
Artificial rupture of the foetal membranes (waters) usually using amniohook
What is given after amniotomy is performed?
IV oxytocin can be used to achieve adequate contractions unless they start spontaneously - aim for 4-5 contractions in 10 minutes
What are the stages of dilatation and effacement?
Cervical canal before effacement is before labour
Then partial effacement
Cervix is effaced and dilatation occurs
Then cervix fully dilates
What are the indications for induction?
Diabetes
Post dates - term + 7 days
Maternal reason
Foetal reason
Social/ maternal request
What are maternal reasons for induction?
Treatment for DVT, maternal age if over 40 and IVF pregnancy
What are foetal reasons for induction?
Growth concerns or oligohydramnios
What can inadequate progress in labour be due to?
Inadequate uterine activity - power
Cephalopelvic disproportion and obstruction - passages
Malposition and malpresentation - passenger
What is the progress of labour determined by?
Cervical effacement
Cervical dilatation
Descent of foetal head through maternal pelvis
What is the process of suboptimal labour in active first stage determined by?
Cervical dilatation
Less than 0.5cm per hour for primigravid women
Less than 1cm per hour for parous women
What happens if the contractions are inadequate?
Foetal head will not descend and exert force on the cervix and cervix will not dilate
What increases the strength and duration of contractions?
IV oxytocin
What can stimulation of an obstructed labour result in?
Ruptured uterus
Describe cephalopelvic disproportion (CPD)
Means the foetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born
Caput and moulding (skull bones cross in baby) develop
What are reasons for obstruction of passage in labour?
Placental praevia
Foetal anomaly - hydrocephalus
Fibroids
Describe malpresentation
Baby isn’t in longitudinal lie in vertex presentation
Is in longitudinal lie in breech presentation or transverse lie in shoulder presentation
Describe malposition
Much more common
Foetal head being in suboptimal position for labour and relative CPD occurs - occipito-posterior and occipito-transverse
What helps identify the position of the baby’s head?
Posterior (triangle shaped) and anterior (diamond shaped) fontanelle
What can too many contractions (uterine hyper-stimulation) result in?
Foetal distress due to insufficient placental blood flow
What are the main causes for foetal distress?
Hypoxia and infection
Rare - cord prolapse, placental abruption and vases praevia
What is foetal well being in labour determined by?
Intermittent auscultation of foetal heart
Cardiotocography
Foetal blood sampling
Foetal ECG
Describe foetal blood sampling
Speculum used to take foetal scalp blood sample
Used when abnormal CTG
Can give a measurement of baby - pH, base excess, lactic acid and can see if in hypoxaemia
What are types of operative births?
Instrumental - forceps and ventouse
Planned CS
Emergency CS
What is the most common mode of birth in Grampain?
Spontaneous vaginal birth
Unplanned CS
Planned CS
Forceps
Ventouse
Breech
What are some 3rd stage complications in labour?
Retained placenta
Post partum haemorrhage - 4Ts
Tears - graze, 1st, 2nd, 3rd and 4th degree
What does a 3rd degree tear involve?
Anal sphincter complex
What does a 4th degree tear involve?
Rectal mucosa
