Complications of Labour

Question 1

what number of pregnancies are induced?

Answer 1

approx 1/5

Question 2

what are the pharmacological and mechanical methods of cervical ripening?

Answer 2

• prostaglandins (pharmacological)
• balloon (mechanical)

Question 3

what does induction of labour mean?

Answer 3

when an attempt is made to instigate labour artificially using medications and/or devices to ‘ripen cervix’ followed usually by artificial rupture of membranes (performing an amniotomy).

Question 4

what score is used to clinically assess the cervix?

Answer 4

The Bishop’s score is used to clinically assess the cervix. The higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful.

Question 5

which Bishop score is considered favourable for amniotomy?

Answer 5

7 or more

Question 6

what is the next step in the process of inducing labour following amniotomy?

Answer 6

Once amniotomy performed, IV oxytocin can be used to achieve adequate contractions (unless contractions spontaneously start) – aim for 4-5 contractions in 10 minutes

Question 7

what are the indications for induced labour?

Answer 7

• diabetes
• post dates - term + 7 days
• maternal reason e.g. on treatment for DVT, maternal age, IVF pregnancy
• fetal reasons e.g. growth concerns, oligohydramnios
• social/maternal request

Question 8

inadequate progress in labour may be due to:

powers, passages, passenger

Answer 8

• inadequate uterine activity (powers)
• cephalopelvic disproportion (CPD) (passages)
• other reasons for obstruction e.g. fibroid (passages)
• malposition (passenger)
• malpresentation (passenger)

Question 9

Progress in labour is evaluated by a combination or abdominal and vaginal examinations to determine:

powers

Answer 9

• Cervical effacement
• Cervical dilatation
• Descent of the fetal head through the maternal pelvis

Question 10

In the active first stage of labour suboptimal progress is defined as cervical dilatation:

powers

Answer 10

• less than 0.5cm per hour for primigravid women
• less than 1cm per hour for parous women

Question 11

describe cephalopelvic disproportion (CPD)

passages

Answer 11

• Genuine CPD is relatively rare
• It means that the fetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born
• caput and moulding develop

Question 12

what are the main causes of fetal distress?

Answer 12

• hypoxia
• infection
• rare: cord prolapse, placental abruption and vasa praevia

Question 13

fetal well-being in labour is monitored with:

Answer 13

• Intermittent auscultation of the fetal heart
• Cardiotocography (CTG)
• Fetal blood sampling
• Fetal ECG

Question 14

when is fetal blood sampling used during labour?

Answer 14

• Speculum used to take fetal scalp blood sample
• Used when abnormal CTG ?fetal distress

Provides a direct measurement from baby:
- We can measure pH and base excess
- can measure lactic acid
- pH gives a measure of likely hypoxaemia

Question 15

emergency c-section occurs in what % of births?

Answer 15

20-25%

Question 16

instrumental deliveries (forceps/ventouse) account for what % of births?

Answer 16

15%

Question 17

what are some 3rd stage complications of labour?

Answer 17

• retained placenta
• PPH, 4T’s (tone, trauma, thrombin, tissue)
• tears: graze, 1st-4th degree)