Complications of Labour Flashcards
What are the 3 key factors in labour?
Passenger
Passages
Power
What are the phases in 1st stage labour?
Latent Phase - 0-3cm cervical dilation
Active Phase - 3-10cm cervical dilation
What is the dilation for primigravida and multigravida in 1st stage of labour?
Primigravida: 1-3cm/hr
Multigravida: 3-6cm/hr
How long is the 2nd stage of labour for primigravida and multigravida?
Primigravida: 40 minutes
Multigravida: 20 minutes
What are the phases in 2nd stage of labour?
Propulsive: from full dilation to present part reaching pelvic floor
Expulsive: from reaching pelvic floor to delivery of baby
What is the 3rd stage of labour?
From delivery of baby to expulsion of placenta
How long is the 3rd stage of labour in primigravida and multigravida?
20-30 minutes for both
What is the fetal size throughout pregnancy?
- 22 weeks: 500g
- 28 weeks: 1000g
- 32 weeks: 1800g
- 36 weeks: 2500g
- 40 weeks: 3300g
What is macrosomia?
Fetal size significantly larger than normal
What is macrosomia caused by?
Maternal diabetes
Maternal obesity
Previous large babies
Prolonged pregnancy
How many people have twins?
1 in 80
How many people have triplets?
1 in 6400
How many people have quads?
1 in 512 000
What is the cause of monozygotic twins?
Chance
What is the cause of dizygotic twins?
Racial predisposition
Fertility treatments
Older ages
Define diamniotic foetuses?
In separate amniotic sacs
Define dichorionic foetuses?
Different placental blood supply
What are the symptoms of multiple pregnancy?
Anaemia -> pre-eclampsia
Congenital anomalies
Intrauterine growth restriction
Polyhydramnios
What is an abnormal fetal position?
'breech' = wrong way around sideways = do cesarian (uterus not developed for birth)
What is external cephalic version?
Physically move fetus after giving uterine muscle relaxation
What are the main 4 problems with the passage?
- contracted pelvis (if too small baby cannot fit)
- placenta praevia
- soft tissue tumours (fibroids, if at bottom of uterus)
- pendulous abdomen (loose muscular walls)
What are the 4 main problems with powers?
- uterine rupture
- poor fit (cephalopelvic disproportion) or (fetopelvic disproportion)
- uterine inertia (absence of effective contractions)
- in-coordinate contractions, hypertonic contractions
What is uterine rupture?
- patient has had fibroids removed/C section/evacuation after miscarriage/miscarriage/uterus procedure
- dangerous as stops blood supply to fetus
What is poor fit indicated by? (CPD or FPD)
- failure of progressive cervical dilatation
- failure of descent of presenting part
- moulding (bones of infant’s skull overlap each other)
- caput (swelling of infant’s scalp)
How do you manage uterine inertia?
Give syntocinon (oxytocin)
How do you manage passenger failure?
- consider ECG/rotation forceps/C section
How do you manage passage failure?
C-section
What are signs of fetal distress in labour?
- meconium (faeces in abdomen due to distress)
- fetal heart abnormalities (bradycardia, tachycardia)
- decelerations
What are some 3rd stage problems?
- retained placenta
- uterine anatomy
- soft tissue lacerations
- uterine inversion
- placenta accreta
What is placenta accrete?
Blood vessels and other parts of placenta grow too deeply into uterine wall
What happens in the 1st phase of labour?
Dilatation of the cervix
What happens in the 2nd phase of labour?
Movement of the baby down towards pelvic floor to go through it pass out of passage
What happens in the 3rd stage of labour?
From delivery of fetus to placenta delivery
