Dysfunctional Labour Flashcards
What are the 4 P’s of labour?
Powers, Passenger, Passage and Psyche
What are some common causes of ineffective uterinecontractions?
Mnemonic: “Fatigue In Mothers Hardly Cause Any Contractions”
Fatigue
Increased amniotic fluid (polyhydramnios)
Multiple gestation (causing uterine distention)
Heavy Medications i.e. analgesics
Cephalopelvic disproportion
Anxiety (causes release of catecholamines in response to pain)
Carbohydrate and metabolic imbalance
These are drugs that reduce uterine resting tone and improve placental blood flow.
Tocolytics i.e. terbutaline, magnesium sulphate, indomethacin
Name 4 fetal factors can cause delayed or prolonged labor:
Fetal size
Presentation
Multifetal pregnancy
Presence of fetal anomalies
A sign commonly seen when shoulder dystocia occurs.
“Turtle sign” – as soon as the head is born, it retracts against the perineum, much like a turtle’s head drawing into its shell.
This is a condition where the infant weights more than 4000 g (8 lb, 13 oz) at birth such that the head or shoulder may not be able to pass through the pelvis.
Macrosomia
What is shoulder dystocia?
This occurs when the shoulders of the fetus become impacted above the maternal symphysis.
Name and describe two methods that can relieve shoulder dystocia:
McRoberts maneuver – the woman flexes her thigh sharply against the abdomen, which straightens the pelvic curve
Suprapubic pressure – an assistant pushes the fetal anterior shoulder downward to displace it from the mother’s symphysis pubis.
After delivery, an infant who had shoulder dystocia should be checked for what common complication/s?
Clavicle fracture
Erb palsy – nerve injury to the brachial plexus
Name common symptoms that may indicate that a fracture has occurred in patients with shoulder dystocia.
Crepitus
Deformity
Bruising
Flaccid muscle tone on the affected side
What is the ideal position and presenting part to ensure passage of fetus through maternal pelvis?
Occiput anterior position
Chin or mentum presentation (indicates good flexion)
Which positions and presentation increases the risk of difficult labor?
Occiput posterior or occiput transverse
Face presentation (indicates poor flexion)
Give at least three maternal positions that can promote fetal head rotation to occiput anterior:
Rocking pelvis back and forth while on hands and knees
Side-lying
Lunge
Squatting
Sitting, kneeling, or standing while leaning forward
This is a common soft tissue obstruction which impedes labour because it reduces available space in the pelvis.
A full bladder
What is an important fetal assessment to look out for because it indicates an early sign of uterine infection?
FHR: Persistent fetal tachycardia (more than 160 beats per minute for more than 10 minutes) is an early sign of intrauterine infection
What change in amniotic fluid characteristics suggest infection?
Yellow or cloudy fluid or fluid with a foul or strong odour
