Labour - Abnormal labour processes, Induction of Labor Flashcards
Poor labor progress
Patterns of abnormal labor progress
Causes
Assessment of labor progress
Features of abnormal progress
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
Prolonged latent phase in 1st stage of labor
- Definition
- Management
Prolonged active phase in 1st stage of labor
- Definition
- Patterns of poor progress
- Causes of poor active stage
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
Dysfunctional uterine activity
- Features
- Diagnosis
- Management
Malpresentation
Summarize mode of delivery for different types of presentation
Cephalopelvic disproportion
Risk factors
Cephalopelvic disproportion
Diagnosis
Management
Prolonged second stage of labor
Definition
Causes
Management
Precipitate labor
Definition
Causes
Potential problems
Induction of labor
Definition
Indications
Induction of labor
Contraindications
Timing of expediting delivery with IOL
Induction of labor
Key steps
IOL
Cervical assessment scoring
IOL
Membrane sweeping process
C/I
IOL
Pre-induction cervical ripening
Indications
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
IOL
Ripening of cervix drug choices
Pre-induction cervical ripening
Monitoring after drug administration
Next steps
Oxytocin induction of augmentation
- Preparation
Oxytocin induction of augmentation
Initiation and dosing
Oxytocin induction of augmentation
Monitoring
Induction by prostin vaginal tablet
Indication
Process
Amniotomy for IOL
Mechanism
Types
Complications of IOL
- 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
Complication of IOL
Tachysystole and uterine hyperstimulation
- Cause
- Consequence
- Management
Failed induction of labor
- Definition
- Management
Cord prolapse
Definition and types
Incidence
Cord prolapse
Risk factors
Cord prolapse
Pathophysiology
Consequence
Cord prolapse
Clinical features
Cord prolapse
Management
Cord prolapse
Prevention
Shoulder dystocia
Definition
Cause
Shoulder dystocia
Risk factors
Shoulder dystocia
Maternal and fetal complications
Shoulder dystocia
Prevention
Shoulder dystocia
Diagnosis and S/S
Shoulder dystocia
Management
Shoulder dystocia
Flowchart for management