Induced Labour, Foetal Monitoring and Caesarean Sections Flashcards
What is an amniotomy?
Artificial rupture of the amniotic membrane
What is the induction of labour?
Starting labour via the use of medications, can also include amniotomies
(IV oxytocin often given to induce uterine contractions)
What are some indications for the induction of labour?
- Hypertensive disorders in pregnancy / other maternal medical conditions (eg. diabetes)
- Prolonged pregnancy
- Twin pregnancy
- Prelabour rupture of membranes
- Foetal growth restriction or macrosomia
- Maternal request
- Prebious stillbirth or in-utero death
- Post-dated uncomplicated pregnancy
What are some contraindications for induction of pregnancy?
- Malpresentation
- Placenta praevia / vasa praevia
- Prolapsed umbilical cord
- Foetal distress
- Anatomical abnormalities (eg. pelvic tumour)
- Previous caesarean sections
- Maternal asthma
What is the Bishops score?
Method of assessing the cervix for readiness for labour
A low Bishops score (<5) means labour is unlikely to start without induction
What is the effect of misoprostol? How is it usually administered?
Encourage cervical dilatation and effacement
Usually given topical cream
Alternative is a balloon catheter
What is given to initiate uterine contractions?
Syntocinon - synthetic oxytocin. Given via IV
What are some possible complications of induction of labour?
Uterine hypertonicity Foetal distress Adverse effects of drugs (hypotension / hyponatraemia) Failed induction Ruptured uterus
How is foetal monitoring done?
Low risk labours - intermittent auscultation
Higher risk labours - cardiotocography (CTG)
How is intermittent auscultation done? What does it measure? When is it done?
Done via doppler ultrasound
Measures foetal heart rate
It is done for one minute after a contraction every:
- 15 mins in the first stage of labour
- 5 mins in the second stage of labour
If any abnormalities are detected on Intermittent auscultation what is done?
If abnormalities are detected switch to CTG
What does a CTG measure?
- Fetal heart sensor measures the fetal heart rate
- Contraction motion sensor measures the contractions of the uterus
What are some indications for CTG monitoring?
- Induction of labour
- Multiple pregnancy
- Post / pre maturity of the child
- Underlying maternal health conditions
- Antepartum or intrapartum haemorrhage
- Pyrexia
- Abnormal presentation / size for gestational age
- Epidural anaesthesia
- Abnormalities seen on intermittent auscultation
What information needs to be interpreted from the results of the CTG?
Contractions - how many in 10 minutes
Heart:
- Rate (100-160 normal)
- Variability of rate
- Accelerations (up spikes)/ Decelerations (downward spikes - can be a sign of foetal distress)
What can be done to confirm signs of foetal distress on CTG?
Foetal blood sampling
Small scratch made on the foetal scalp and the blood analyzed for pH
- Low pH (<7.2) = foetal hypoxia, need immediate delivery
What can be a common complication of foetal hypoxia?
Foetal hypoxia is responsible for 10% of all cerebral palsy
What is a caesarean section? How common are they?
Delivery of a foetus through an incision in the abdominal wall and uterus
32% of deliveries in Scotland are by C-Section
What are the two types of caesarean section?
Lower uterine segment incision - horizontal cut through the lower abdomen, done in 99% of C-Sections
Classical - vertical cut through the abdomen near the level of the umbilicus, rarely done. Indicated if very premature foetus or rapid delivery required
What are some of the indications for Caesarean Sections?
- Foetal distress
- Failure to progress in labour
- Failed induction of labour
- Malpresentation
- Severe pre eclampsia
- Placenta praevia
- Twin pregnancy with non-cephalic presenting twin
- Repeat caesarean section
What are the four categories of caesarean section?
- Emergency - immediate threat to life of the woman or the foetus
- Urgent - Maternal or foetal compromise, but not immediately life threatening
- Scheduled - requires early delivery but no compromise / time limit
- Elective - At a time to suit the woman and maternity team (around half of C sections)
What are some possible complications of c sections affecting the mother?
Injury to structures (iatrogenic)
DVT
Infection
(prophylactic antibiotics and LMWH usually given to prevent these complications)
What are some long term risks of caesarean sections impacting future pregnancies?
- Increased risk of placenta praevia / accreta
- Increased risk of antepartum stillbirth
- Uterine rupture
- Post operative adhesions affecting future fertility
