Complications of labour Flashcards
when would a pregnancy be induced
Approx 1 in 5 pregnancies induced
Need fetal monitoring
Need for cervical ripening:
Prostaglandins (pharmacological)
Balloon (mechanical)
what does induction mean
Induction of labour is 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)
when is the bishops score used
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.
what makes up the bishops score
dilatation
cervix legnth
position
consistency
station
when is a bishops score favourable for an amniotomy
more than 7
what is an amniotomy
Amniotomy is the artificial rupture of the fetal membranes (“waters”) usually using a sharp device e.g. amniohook
what is done once an amniotomy has been performed
Once amniotomy performed, IV oxytocin can be used to achieve adequate contractions (unless contractions spontaneously start) – aim for 4-5 contractions in 10 minutes
what are indications for induction
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
what are intrapartum complications
3P’s
Inadequate uterine activity (powers)
Cephalopelvic disproportion (CPD) (passages)
Other reasons for obstruction e.g. fibroid (passages)
Malposition (passenger)
Malpresentation (passenger)
Powers in progression of labour
Cervical effacement
Cervical dilatation
Descent of the fetal head through the maternal pelvis
In the active first stage of labour suboptimal progress is defined as cervical dilatation:
less than 0.5cm per hour for primigravid women
less than 1cm per hour for parous women
what could result in inadequate uterine activity
If contractions are inadequate the fetal head will not descend and exert force on the cervix and the cervix will not dilate.
It is possible to increase the strength and duration of the contractions by giving a synthetic IV oxytocin to the mother
It is important to exclude an obstructed labour in these circumstances as stimulation of an obstructed labour could result in a ruptured uterus
Passages
Cephalopelvic disproportion (CPD)
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
Other obstruction
Placenta praevia
fetal anomaly
fibroids
malposition
Much more common
Involves the fetal head being in an suboptimal position for labour and ‘relative’ CPD occurs
Occipito-posterior (OP) & Occipito-transverse (OT)
fetal distress
Fetuses are well equipped to deal with stresses of labour
Despite this some fetuses will not be able to cope…
It is very important to avoid causing too many contractions (Uterine Hyper-stimulation) as this can result in fetal distress due to insufficient placental blood flow
The main causes of fetal distress are hypoxia, infection and also rare occurences such as cord prolapse, placental abruption and vasa praevia
In many cases of suspected fetal distress no cause is found
Fetal well being in labour is determined by
Intermittent auscultation of the fetal heart
Cardiotocography (CTG)
Fetal blood sampling
Fetal ECG
