Complications of labour and delivery

Question 1

Meconium in amniotic fluid

Answer 1

Causes - likely cord compression +/- uterine hypertonic, undetected breech, signs of fetal distress.
Tx
Call for respiratory therapy, neonatology or paediatrics to delivery room
Oropharynx suctioning upon head expulsion or immediately after delivery if baby not breathing spontaneously. Do not stimulate infant before suction
Monitor FHR signs of fetal distress.

Question 2

Abnormal progression of labor - Dystocia

Answer 2

Cause 4 Ps
- Power
- Passenger
- passage
- Psyche
Define: active phase of greater 4h of less then 0.5cm/h or 2nd phase greater then 1hr with no descent during active pushing.

Question 3

Power cause of dystocia

Answer 3

Contraction - hypotonic, incoordinate

inadequate maternal explosive efforts

Question 4

Passenger causes of dystocia

Answer 4

Fetal position
attitude
size
anomalies eg hydrocephalus

Question 5

Passage causes of dystocia

Answer 5

Pelvic structure (CPD)
Maternal soft tissue factors e.g. tutors, full bladder or rectum, vaginal septum.

Question 6

Psyche causes of dystocia

Answer 6

Hormones released in response to stress may contribute to dystocia
psychological and physiological stress should be evaluated as part of the management once dystocia has been diagnosed

Question 7

Types of pelvics

Answer 7

Gynecoid - 50% - ideal obstetrically
Android
Anthropoid
Platypelloid

Question 8

Mx of Dystocia

Answer 8

Confirm diagnosis of labor to rule out false labor
search for factors of Cephalopelvic disproportion (pelvis)
Diagnosed if adequate contractions measured by intrauterine pressure catheter with no descent/dilatation for greater then 2hr
If CPD ruled out, IV oxytocin augmentation +/- amniotomy

Question 9

Risk of dystocia

Answer 9

maternal stress
maternal infection
postpartum haemorrhage
Need for neonatal resuscitation.