- baby larger than the 95%th percentile

Complications of Labour Flashcards by Sarah-Louise Watson

What are the three things that normal labour depends on

The Passenger - the baby
The Passages - the pelvis
The Powers - the contractions

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what are any issues in labour related to

The Passenger - the baby
The Passages - the pelvis
The Powers - the contractions

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describe what the baby is attached to within the womb

within the womb there is the amniotic sac which is what the baby is in, it is then attached to the placenta which attaches this to the mother

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what are the two stages of the first stage of labour

latent phase

active phase

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define the two stages of the first state of labour

latent phase 0-4cm

active phase - 4-10cm

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what is the difference between primigravida and multigravida

primigravida - 1st baby

multigravida - multiple baby

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describe how much dilation occurs in the primigradia and multigravida phase per hour

Primigravida - 0.5cm to 1 cm per hour

Multigravida - 1cm per hour

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what are the two phases of the 2nd stage of labour

passive stae

- active stage

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describe the passive and active stage

Passive stage – fully dilated so give them bit of time for head to descend naturally

Active part – active pushing and delivery of the baby

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How long does the 2nd stage of labour last

2nd stages lasts no more than 2 hours for a primigravida and one hour for a multigravida

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what is the 3rd stage of labour

From delivery of baby to expulsion of placenta

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How long does the 3rd stage of labour take

Duration – in both primigravidae & multigravidae =20-30 mts

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list the problems that can occur with the baby in labour

Size, Number, the way they Lie
Presentation & Position
Anatomical Abnormalities

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when does a baby become viable

when it is larger than 500g at 22 weeks

- viable at 24 week

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what is macrosomia

baby larger than the 95%th percentile

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what can cause macrosomia

Maternal diabetes – espically if not diagnosed or controlled

Maternal obesity

Previous large babies

Prolonged pregnancy

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what is multiple pregnancy incidence of twins, triplets, quads

Twins = 1 in 80 
Triplenets = 1 in 6400
Quads = 1 in 512000

what causes monozygotic twinning

chance event

What causes dizygotic twinning

Racial predisposition,
Fertility treatments
Older ages,
parity>5

what does
- dichrionic and diamninotirc
- what does monochorionic and diamniotic
- what is monochorionic and mono amniotic
in twins mean?

dichrionic and diamninotirc= two placentas and two amniotic sac in twins
what does monochorionic and diamniotic = one placenta and two amniotic sacs
what is monochorionic and mono amniotic = one placenta and one amniotic sac

What happens in a twin to twin transfusion

Twin to twin transfusion one twin takes more nourishment than the other twin and this can cause problems for both of them

what happens if the baby is in an abnormal position

they can have an affect it can increase the risk of complications and needing a breach birth
for example if the legs come out which are smaller first this can lead to the head being stuck in as it is not fully dilated therefore can cause strangulation

how do you treat an abnormal position of a baby

External cephalic version

this is when you try and turn your baby
do it after 37 weeks as baby is still likely to turn by itself
if this doesn’t work then do a C section

what are the problems with passage

contracted pelvis
placenta praaevia
soft tissue tumours
pendulum abdomen

describe the different problems with passage

Contracted pelvis – malnourished or have babies younger when the pelvis haven’t formed yet Placenta praevia – haemorrhage Soft tissue tumours = fibroids blocking the way or a big fibroid in the lower part of the uterus Pendulous abdomen- those that have lots of babies before have lost the muscle tone in the tummy it is not as easy for the baby to come out

what is the most favourable choice for a pelvis in pregnancy

Gynaecoid

what is the smallest diameter that a baby can go through

11cm in diameter

what happens in a placenta preaeiva

- this is when the placenta covers the os therefore the baby cannot leave the uterus - need a C section

what are the different problems you can have with the power of contraction

Uterine inertia Inco-ordinate contractions Hypertonic contractions Uterine Rupture

what happens in a uterine rupture

- happens when people have fibroids removed, C sections vacation after miscarriage or a procedure in the uterus - blood supply to the baby stops

what are the signs of a poor fit

Failure of progressive cervical dilatation Failure of descent of the presenting part Moulding Caput

What is caput

swelling of the head

what is. moulding

- in labour it is normal for the bones of the skull to get closer and overlap stage 1; when the bones touch stage 2 - overlap but can be pushed back stage 3 - overlapped and cannot be pushed back in place

What is Cephalopelvic disproportion’ (CPD) or ‘Fetopelvic disproportion’ (FPD)

this is when there is a disproportional fit between the baby and pelvis

How do you manage failure to progress

Powers – ‘uterine inertia’ = give Syntocinon judiciously – artificial oxytoxcin, 3 to 4 in 10 lasting a minute each Passenger – ‘malpresentation’ or ‘malposition’ = consider ECV/ rotational forceps or ventouse delivery/ Caesarean section Passages – ‘contracted pelvis’ or ’rigid cervix’ = Caesarean section

what are the two signs of fatal distress in labour

- Meconium-stained liquor | - fetal heart rate abnormalities

describe how meconium can be a sign of distress

- poo in the abdomen that can be due to distress. - isn't always a sign of stress but can me - if it is thicker it is more likely due to distress whereas if it is inner it is less likely to be due to distress - meconium can be inflammatory to the lungs

what do we look for in fetal heart rate abnormalities

Baseline rate (bradycardia <110/mt; tachycardia >160/mt normal between 110-160mt) Reduced baseline variability (<5/mt – how wobbly the line is if flat line this is bad ) )– if not variable this is an issue Decelerations (early, variable and late – can be a sign of hypoxia

what is chromaminotis

- this is an infection around the baby where water has ruptured into it for a number of days - can cause a raise in the heart rate and then we need to deliver the baby

what are the problems with the 3rd stage of labour

- Retained placenta - Uterine atony - Soft tissue lacerations - Uterine inversion

Describe the problems with the 3rd stage of labour

Retained placenta – placenta should be out before an hour and normally within 30 minutes if not out in this time then manaual removal of the placneta Uterine atony – cytosnoe?, emptying the bladder Soft tissue lacerations Uterine inversion

what is placenta accrete

this is when the placenta hasn't attached properly therefore it invades the muscle and then can further go in an invade other structure s - C section needs to be done - then sometimes a hysterectomy