Labour - Abnormal labour processes, Induction of Labor

Question 1

Poor labor progress

Patterns of abnormal labor progress
Causes

Answer 1

Question 2

Assessment of labor progress

Features of abnormal progress

Answer 2

Patterns:

1st stage of labor
Latent phase: Prolonged latent phase
Active phase: Primary dysfunctional labor or Secondary Arrest

2nd stage of labor: Prolonged 2nd stage

Question 3

Prolonged latent phase in 1st stage of labor

• Definition
• Management

Answer 3

Question 4

Prolonged active phase in 1st stage of labor

• Definition
• Patterns of poor progress
• Causes of poor active stage

Answer 4

Definition:
- protraction: dilate <1-2cm/h
- arrest: no cervical change for ≥4h (despite adequate contractions) or ≥6h (with inadequate contractions)

Causes of poor active phase:
- Dysfunctional uterine activity
- Malpresentation Cephalopelvic disproportion
- Abnormalities of uterus and cervix e.g. unsuspected fibroids or cervical dystocia

Question 5

Dysfunctional uterine activity

• Features
• Diagnosis
• Management

Answer 5

Question 6

Malpresentation

Summarize mode of delivery for different types of presentation

Answer 6

Question 7

Cephalopelvic disproportion

Risk factors

Answer 7

Question 8

Cephalopelvic disproportion

Diagnosis
Management

Answer 8

Question 9

Prolonged second stage of labor

Definition
Causes
Management

Answer 9

Question 10

Precipitate labor

Definition
Causes
Potential problems

Answer 10

Question 11

Induction of labor

Definition
Indications

Answer 11

Question 12

Induction of labor

Contraindications

Answer 12

Question 13

Timing of expediting delivery with IOL

Answer 13

Question 14

Induction of labor

Key steps

Answer 14

Question 15

IOL

Cervical assessment scoring

Answer 15

Question 16

IOL

Membrane sweeping process
C/I

Answer 16

Question 17

IOL

Pre-induction cervical ripening
Indications

Answer 17

Regarded by some as part of induction process

Indications: unfavorable cervix, use restricted to following
- singleton pregnancy
- cephalic presentation
- term fetus
- normal NST
- caution if Hx of glaucoma and asthma
- Bishop ≤6 (nulliparous) or ≤4 (multiparous): for Propess only

Question 18

IOL

Ripening of cervix drug choices

Answer 18

Question 19

Pre-induction cervical ripening

Monitoring after drug administration
Next steps

Answer 19

Question 20

Oxytocin induction of augmentation

• Preparation

Answer 20

Question 21

Oxytocin induction of augmentation

Initiation and dosing

Answer 21

Question 22

Oxytocin induction of augmentation

Monitoring

Answer 22

Question 23

Induction by prostin vaginal tablet

Indication
Process

Answer 23

Question 24

Amniotomy for IOL

Mechanism
Types

Answer 24

Question 25

Complications of IOL

Answer 25

• Tachysystole and uterine hyperstimulation
• Uterine rupture: Mainly occur in those with prior uterine scars, e.g. previous C/S, other uterine scars in which cavity is entered
• Failed induction
• Pain: more severe than spontaneous labor
• Cord prolapse: when ARM is done with high fetal head position

Question 25

Complication of IOL

Tachysystole and uterine hyperstimulation
- Cause
- Consequence
- Management

Answer 25

Question 26

Failed induction of labor

• Definition
• Management

Answer 26

Question 27

Cord prolapse

Definition and types
Incidence

Answer 27

Question 28

Cord prolapse

Risk factors

Answer 28

Question 29

Cord prolapse

Pathophysiology
Consequence

Answer 29

Question 30

Cord prolapse

Clinical features

Answer 30

Question 31

Cord prolapse

Management

Answer 31

Question 32

Cord prolapse

Prevention

Answer 32

Question 33

Shoulder dystocia

Definition
Cause

Answer 33

Question 34

Shoulder dystocia

Risk factors

Answer 34

Question 35

Shoulder dystocia

Maternal and fetal complications

Answer 35

Question 36

Shoulder dystocia

Prevention

Answer 36

Question 37

Shoulder dystocia

Diagnosis and S/S

Answer 37

Question 38

Shoulder dystocia

Management

Answer 38

Question 39

Shoulder dystocia

Flowchart for management

Answer 39