Complications of Labour

Question 1

Which meds are used to induce labour>?

Answer 1

Prostaglandins

Question 2

What is a mechanical way to induce labour?

Answer 2

Balloon tamponade

Question 3

What is meant by induction of labour?

Answer 3

Initiation of labour by ‘ripening’ cervix and artificially rupturing membranes (amniotomy)

Question 4

Which score is used to clinically assess the cervix?

Answer 4

Bishop’s score

->the higher the score, the more progressive change there is in the cervix and this indicates that induction is more likely to be successful

Question 5

List some of the indications for induction of labour.

Answer 5

Diabetes
Post dates- term + 7days
Maternal reason- treatment for DVT, maternal age
Foetal reason- growth concerns, oligohydramnios

Question 6

What are the three ways to remember why there may be inadequate progress in labour?

Answer 6

Powers
Passages
Passenger

Question 7

List some of the reasons progress in labour may be limited.

Answer 7

Inadequate uterine activity (powers)
Cephalopelvic disproportion (passage)
Other reasons for obstruction (passage)
Malposition (passenger)
Malpresentation (passenger)

Question 8

In first delivery, how much is the women expected to dilate per hour?

Answer 8

0.5cm/hr

->vaginal examination is recommended every 4hrs, so each 4hrs, should be 2cm more dilated

Question 9

In subsequent deliveries, how much is the women expected to dilate per hour?

Answer 9

Approx 1cm/hr

Question 10

Which medication is given if the strength/duration of contractions of the mother is not adequate?

Answer 10

IV oxytocin

Question 11

It is important to rule out obstructed labour as the cause of inadequate uterine activity. If this is the case and isn’t noticed, what may be the result?

Answer 11

Ruptured uterus

Question 12

What is meant by cephalopelvic disproportion (CPD)?

Answer 12

Foetal head is in the correct position for labour but it too large to negotiate the maternal pelvis

Question 13

What other things may cause obstruction of the birth passage?

Answer 13

Placenta praevia
Foetal anomaly
Fibroids

Question 14

It is very important to avoid causing too many contractions in labour. Why?

Answer 14

Can cause foetal distress due to insufficient placental blood supply

Question 15

What are some of the main causes of foetal distress?

Answer 15

Hypoxia
Infection
Cord prolapse
Placental abruption

Question 16

How is foetal wellbeing in labour monitored?

Answer 16

Intermittent auscultation of the foetal heart
Cardiotocography
Foetal blood sampling
Foetal ECG

Question 17

When may foetal blood sampling be carried out?

Answer 17

When abnormal CTG as ?foetal distress

->provides a direct measurement from baby, allowing measurement of pH and base excess, lactic acid. pH gives a measure of likely hypoxaemia

Question 18

What are some of the complications which can arise in the third stage of labour?

Answer 18

Retained placenta
Postpartum haemorrhage
Tears

Question 19

List the four T’s of causes for postpartum haemorrhage.

Answer 19

Thrombin
Tone
Tissue
Trauma

Question 20

Which structures are damaged in 3rd degree tears?

Answer 20

Anal sphincter

Question 21

Which structures are damaged in 4th degree tears?

Answer 21

Rectal mucosa