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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
Q

What scoring system is used to determine probability IOL is successful

A

Bishops score

26
Q

What is the bishops score

A

Determines ‘cervical ripeness’ and therefore need for mechanisms to induce labour

27
Q

When is bishops score checked

A

Prior to and during IOL

28
Q

What bishops score indicate labour is likely to start spontaneously

A

> 9

29
Q

What bishops score indicates someone needs interventions to start labour

A

<5

30
Q

What are the 5 components of the bishops score

A 
Cervical Position
Cervical Dilation
Cervical Effacement 
Cervical consistent 
Foetal station
31
Q

What are the 4 methods of inducing labour

A
  1. Membrane Sweep
  2. Amniotomy
  3. Prostaglandins
    4, Oxytocin
32
Q

In prolonged gestation, when is a membrane sweep offered if nulliparous

A

40-41W

33
Q

In prolonged gestation, when is a membrane sweep offered if multiparous

A

41W

34
Q

Explain the procedure of membrane sweep and its advantage

A
  • gloved finger is inserted into the vagina and used to separate decidua and chorion membrane
  • it encourages spontaneous labour
35
Q

What is primary method for inducing labour

A

Prostaglandins

36
Q

What is the MOA of prostaglandins

A

Cervical effacement and contraction uterus

37
Q

How can prostaglandins be given

A

Pessary or tablet

38
Q

What is aminotomy

A

using amnihook to artificially rupture membranes

39
Q

When can amniotomy only be performed

A

if cervix is effaced and dilated

40
Q

What is given with amniotomy

A

oxytocin infusion

41
Q

Why is amniotomy and oxytocin not first-line for IOL

A

as oxytocin can cause ovarian hyper stimulation

42
Q

if IOL fails, what should be offered

A

LSCS

43
Q

What is uterine hyper stimulation

A

Oxytocin - causes prolonged contraction of the uterus - leads to foetal hypoxia

44
Q

How is uterine hyper stimulation managed

A

Tocolytics

45
Q

Name a tocolytic

A

Terbutaline

46
Q

What are 3 other risks of IOL

A

Uterine rupture
Infection
Cord prolapse

Obstetrics (27 decks)

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