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Obstetrics > Intrapartum Care: Abnormal Labour > Flashcards

Intrapartum Care: Abnormal Labour Flashcards

1
Q

What are the causes of abnormal labour

A

3P’s:

Passage
Passanger
Power

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2
Q

What is the commonest cause of abnormal labour

A

Power - insufficient power in contraction

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3
Q

What are ‘passenger’ causes of abnormal labour

A

Macrosomia

Position: brow, breech

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4
Q

What are ‘passenge’ causes of abnormal labour

A

Small pelvis
Short-stature
Tumours
Previous pelvic fracture

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5
Q

What is delayed first stage called

A

Failure to progress

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6
Q

What is the definition of failure to progress

A

Failure of cervix to dilate by 2cm in 4h

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7
Q

If membranes have not ruptured, what is offered for failure to progress

A

Amniotomy and re-assess in 2h

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8
Q

If membranes have ruptured, what is offered for failure to progress

A

Oxytocin

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9
Q

If a women is started on oxytocin what should be offered

A

Continuous CTG monitoring

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10
Q

When may oxytocin need to be used with care and why

A
  • Multiple pregnancy

- Precious LSCS

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11
Q

What should be offered before oxytocin

A
  • Epidural

- Put women in left lateral position

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12
Q

What is a prolonged second stage in primip

A

3h. Contact obsetetrician at 2h.

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13
Q

What is a prolonged second stage in multip

A

2h. Contact obstetrician at 1h

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14
Q

How is prolonged second stage managed if foetal head is engaged

A

Operative Delivery

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15
Q

How is prolonged second stage managed if foetal head is not engaged

A

LSCS

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16
Q

What are 5 indications for inducing labour

A
  1. Prolonged gestation
  2. PROM
  3. Maternal co-morbdities
  4. Foetal growth restriction
  5. Intra-uterine foetal death
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17
Q

In prolonged gestation, between how many weeks is IOL offered

A

40-42W

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18
Q

If PROM >37W what should be offered

A

IOL or expectant management for 24h. (No longer as increased risk of chorioamnionitis)

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19
Q

If PROM <34W what should be done

A

Try to delay induction of labour

20
Q

If PROM 34-37W what should be done

A

Labour if possible

21
Q

What maternal health problems may require early delivery

A

Pre-eclampsia
HTN
Gestational diabetes

22
Q

If a mother wants to be induced on a certain day should it be done

A

No! Induction should not be done on maternal request alone.

23
Q

What are 6 absolute contraindications for IOL

A
  1. Vasa praevia
  2. Major placenta praevia
  3. Previous classical C section
  4. Transverse lie
  5. Active genital herpes
  6. Cephalopelvic disproportion
24
Q

What are 3 relative contraindications for IOL

A
  1. More than two LSCS
  2. Breech
  3. Triplets
25
What scoring system is used to determine probability IOL is successful
Bishops score
26
What is the bishops score
Determines 'cervical ripeness' and therefore need for mechanisms to induce labour
27
When is bishops score checked
Prior to and during IOL
28
What bishops score indicate labour is likely to start spontaneously
>9
29
What bishops score indicates someone needs interventions to start labour
<5
30
What are the 5 components of the bishops score
``` Cervical Position Cervical Dilation Cervical Effacement Cervical consistent Foetal station ```
31
What are the 4 methods of inducing labour
1. Membrane Sweep 2. Amniotomy 3. Prostaglandins 4, Oxytocin
32
In prolonged gestation, when is a membrane sweep offered if nulliparous
40-41W
33
In prolonged gestation, when is a membrane sweep offered if multiparous
41W
34
Explain the procedure of membrane sweep and its advantage
- gloved finger is inserted into the vagina and used to separate decidua and chorion membrane - it encourages spontaneous labour
35
What is primary method for inducing labour
Prostaglandins
36
What is the MOA of prostaglandins
Cervical effacement and contraction uterus
37
How can prostaglandins be given
Pessary or tablet
38
What is aminotomy
using amnihook to artificially rupture membranes
39
When can amniotomy only be performed
if cervix is effaced and dilated
40
What is given with amniotomy
oxytocin infusion
41
Why is amniotomy and oxytocin not first-line for IOL
as oxytocin can cause ovarian hyper stimulation
42
if IOL fails, what should be offered
LSCS
43
What is uterine hyper stimulation
Oxytocin - causes prolonged contraction of the uterus - leads to foetal hypoxia
44
How is uterine hyper stimulation managed
Tocolytics
45
Name a tocolytic
Terbutaline
46
What are 3 other risks of IOL
Uterine rupture Infection Cord prolapse

Obstetrics (27 decks)

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