labour Flashcards
a) what is a category 1 emergency C-section?
b) how soon should it happen?
a) there is immediate threat to the life of the woman or foetus
b) <30 mins
what is a category 2 emergency C-section?
maternal/foetal compromise, but not immediately life-threatening
what is a category 3 emergency C-section?
no maternal / foetal compromise but needs early delivery
what is a category 4 C-section?
elective - delivery timed to suite woman / staff
commonest cause for an emergency C-section?
failure to progress in labour
indications for C-section?
- breech presentation
- unstable / transverse / oblique lie
- twins where first one is not cephalic
- maternal conditions (e.g. cardiomyopathy)
- HSV in third trimester
- placenta praevia
- maternal diabetes
- prev major shoulder dystocia
- prev 3rd/4th perineal tear
when are elective C-sections usually planned for?
- > 39 weeks
- reduces risk of RDS
purpose of corticosteroids in C-section?
if a C-section is happening <39 weeks, maternal corticosteroids stimulate surfactant secretion in foetal lungs
3 types of breech presentation?
- complete breech (bum first, legs tucked in)
- frank breech (bum first, legs pointed up to head)
- footling breech (one leg first)
what is done pre-operatively in C-section?
- FBC
- Group and Save (in case they need blood)
- H2-receptor antagonist
- VTE risk score calculated
why are ranitidine and metoclopramide given pre-operatively in C-section
- to stop them vomiting on their back
- risk of aspirating the vomit
type of anaesthesia in C-section?
- regional
- sometimes epidural is added
indications for general anaesthetic in C-section?
- contraindication to regional anaesthetic
- failure of regional anaesthetic
- need to expedite delivery asap (common in section 1)
positioning in C-section? why?
- left lateral tilt of 15 degrees
- reduces risk of supine hypotension due to aortocaval compression
why is a Foley’s catheter inserted in C-section?
to drain the bladder and stop bladder injury
layers to get through in C-section?
- skin
- Camper’s fascia
- Scarpa’s fascia
- rectus sheath
- rectus muscle
- abdominal peritoneum
- visceral peritoneum
- gravid uterus
what is the purpose of oxytocin 5 IU/ml in C-section?
aids the delivery of the placenta
risks of vaginal birth after a C-section?
- risk of scar rupture
- 75% success rate, compared to 90% in prev vaginal delivery
- increased risk of placenta praevia/accreta + pelvic adhesions
immediate maternal complications of C-section?
- PPH (>1000ml)
- wound haematoma
- intra-abdo haemorrhage
- bladder / bowel trauma
immediate foetal complications of C-section?
- RDS
- foetal lacerations
infections that could come from C-section?
- UTI
- endometritis
- resp (esp if gen anaesthetic used)
late complications of C-section?
- placenta praevia
- subfertility
- psychological issues (e.g. regret)
- caesarean scar ectopic pregnancy
indications for labour to be induced?
- prolonged gestation (>40 weeks)
- premature rupture of membranes >37 weeks
- maternal health problems
- foetal growth restriction
- intrauterine foetal death
absolute contraindications for induction of labour?
- cephalopelvic disproportion
- major placenta praevia
- vasa praevia
- cord prolapse
- transverse lie
- active genital herpes
- prev classical C-section
relative contraindications for induction of labour?
- breech presentation
- triplet / high order pregnancy
- > 1 prev low transverse C-sections
methods to induce labour?
- vaginal prostaglandins
- amniotomy (bishop score 7 or more)
- membrane sweep
what does bishop score tell you?
- it checks “cervical ripeness”
- 7 or higher = induction of labour possible
- less than 4 = labour unlikely to progress naturally, use a prostaglandin
what needs to be checked before induction of labour?
- foetal heart rate
- using cardiotocography
complications of induction of labour?
- failure of induction
- uterine hyperstimulation
- cord prolapse
- infection
- pain
- increased need for further intervention
- uterine rupture (rare)
which features of the cervix are considered in bishop scoring?
- dilation
- length
- foetal station
- consistency
- position
why is induction of labour offered to women with prolonged gestation?
reduces the risk of stillbirth
what is foetal station measured in relation to?
ischial spine
2 main instruments used in operative vaginal delivery?
- ventouse
- forceps
how long should you try to deliver with an instrument for?
if after 3 contractions and pulls with any instrument, there is NO progress, give up
types of ventouse?
- silastic cup
- “kiwi” cup (disposable)
- bird cup
condition for use of a silastic cup in delivery?
occipital-anterior position
pros of ventouse delivery?
- less maternal perineal injuries
- less pain
cons of ventouse delivery?
- lower success rate
- more cephalhaematoma
- more subgaleal haematoma
- more retinal haemorrhage
when are Rhodes forceps used?
occipital-anterior position
when are Wrigley’s forceps used?
at C-section
when are Kielland’s forceps used?
rotational deliveries
pros of forceps?
- fewer foetal injuries
- doesn’t require maternal effort
cons of forceps?
higher rate of 3rd/4th degree tears
maternal indications for instruments in vaginal delivery?
- nulliparous woman who has no delivered after 2 hours of active pushing
- multiparous no delivery within 1 hour of active pushing
- maternal exhaustion
- no urge to push (due to anaesthesia)
foetal indications for instruments in vaginal delivery?
suspected foetal compromise on CTG / blood sample
absolute contraindications for instrumental delivery?
- unengaged foetal head
- incompletely dilated cervix
- true cephalo-pelvic disproportion (head too big to pass)
- breech + face presentations
- preterm gestation <34 weeks for ventouse
relative contraindications for instrumental delivery?
- acute foetal distress
- non-engaged 2nd twin
- prolapsed cord
pre-requisites for instrumental delivery?
- fully dilated
- ruptured membranes
- cephalic presentation
- defined foetal position
- empty bladder
- adequate pain relief
- adequate maternal pelvis
where does foetal head need to be for instrumental delivery?
- level of ischial spines
- no more than 1/5 palpable per abdomen
foetal complications from instrumental delivery?
- neonatal jaundice
- scalp lacerations
- cephalhaematoma
- sobgaleal haematoma
- facial bruising
- facial nerve damage
- skull fractures
- retinal haemorrhage
maternal complications from instrumental delivery?
- 3rd/4th degree vaginal tear (esp forceps)
- VTE
- incontinence
- PPH
- shoulder dystocia
- infection
