Labour And Complications Flashcards
Roughly how many pregnancies require an induction of labour?
One in five
What are the indications for induction of labour?
Prolonged gestation before 42 weeks Premature rupture of membranes Maternal health problems Fetal growth restriction Intrauterine fetal death
What are the contra indications for induction of labour?
Head to pelvic disproportion Major placenta previa Vasa praevia Cord prolapse Transverse lie Active primary genital herpes Previous classical cesarian section
What are the three main methods of induction?
Vagina prostaglandins
Amniotomy
Membrane sweep
Describe the use of vagina prostaglandins for induction of labour
Act to prepare the cervix for labour by ripening it
Also have a role in contraction of the uterus
Gel, tablet or pessary
Describe amniotomy for induction of labour
Membranes are ruptured artificially using an instrument called an amnihook
The process releases prostaglandins in an attempt to cause labour, it is only performed when the cervix has been deemed ripe
Often artificial oxytocin will be given alongside to increase the strength and frequency of contractions
When is the membrane sweep offered?
40 and 41 weeks to nulliparous women
41 weeks to multiparous women
A bishop score of seven or more suggest what?
The cervix is ripe and favourable
High chance of a response to interventions made to induce labour
A bishop score of less than four means what?
Suggest that labour is less likely to progress naturally and prostaglandin will be required
What are the complications of induction of labour?
Failure to induce Uterine hyperstimulation Cord prolapse Infection Pain Increased rate of further intervention compared to spontaneous labour
How common is an instrumental vaginal delivery?
12-13%
What are the indications for performing an instrumental delivery?
Inadequate progress
Maternal exhaustion
Maternal medical conditions that mean active pushing should be limited
Suspected foetal compromise
What are the contra indications for an instrumental delivery?
Unengaged fetal head Incompletely dilated cervix True head to pelvic disproportion Breech and face presentations Pre-term gestation < 34 weeks (ventouse) High likelihood of fetal coagulation disorder (ventouse)
What are the complications of an instrumental delivery?
Fetal scalp lacerations Haematoma Facial nerve damage Vagina tears Incontinence PPH Infection
Define labour
The progressive effacement and dilatation of the cervix in the presence of regular uterine contractions
What is the normal cephalic presentation?
Occiput-anterior
What does a station of -1 in labour mean?
Widest part of baby’s head is 1cm above the ischial spines
What is the commonest presentation problem with labour?
Occipital-posterior
What are the different types of breech?
Extended - feet up
Flexed - feet down
Footling
ECV has what chance of causing foetal distress?
1 in 100
What do you do if foetal bradycardia seen for 3 mins?
Call for help
What do you do if foetal bradycardia seen for 6 mins?
Take to theatre
What percentage of VBACs are successful?
70-75%
What is the chance of uterine rupture in VBAC?
1 in 200
Why shouldn’t you induce or give oxytocin in VBAC births?
Increased risk of uterine rupture
What is the management of shoulder dystocia?
Call for help
McRobert’s position - knees to chest
Suprapubic pressure
Woodscrew manoeuvre
What is Sheehan syndrome?
Pan hypopituitarism resulting from massive post-partum haemorrhage causing pituitary ischaemia and necrosis
What is the difference between primary and secondary PPH?
Primary- first 24 hours
Secondary- >24 hours since birth
What management can be used for PPH?
Keep patient laying flat and warm IV crystalloids Blood transfusion FFP Cryoprecipitate and platelets if needed
What are the main causes of PPH?
Uterine atony
Birth trauma
Retained tissue
Coagulopathy
What are the risk factors for PPH?
Placental abruption/praevia Twins High BP Induction Long labour Previous PPH Anaemia
What is the APGAR score used for?
To quickly summarise the health of newborn children against infant mortality
When is the APGAR score generally done?
1 min and 5 mins after birth
What is a normal APGAR score?
7 +
What are the strongest risk factors for post-natal depression?
Prior depression or mental health problems
Prior PND
poor social support/relationship with partner
Recent major life events
What is the peak onset of PND symptoms?
2-3 months post-partum
What are the management options for PROM?
Expectant
Antibiotics
Steroids
Cervical ripening eg. Induction methods
What are the risk factors for PROM?
Previous PROM Unexplained PV bleed Abruption Cervical insufficiency Smoking Polyhydramnios Infection Amniocentesis
Describe the degrees of perineal tear
1st = injury to perineal skin only 2nd = involving perineal muscles 3rd = involving anal sphincter complex 4th = involving anal epithelium
What factors make VBAC more risky?
Last C section <18 months ago
>1 C section
What is a normal foetal heart rate?
110-160
What can cause mild foetal bradycardia?
Post-dates
OP
Transverse
What causes severe foetal bradycardia?
Prolonged cord compression Cord prolapse Epidural/spinal Maternal seizures Rapid foetal descent
What are the causes of decreased variability on CTG?
Foetal sleeping Foetal acidosis Foetal tachycardia Drugs Prematurity
Define decelerations on CTG
Abrupt decrease in baseline HR >15 bpm for >15 secs
What does a late deceleration indicate the presence of?
Insufficient blood flow to the placenta
When do we define a deceleration as prolonged?
> 3 mins
How are the hormones involved in breast feeding?
Prolactin - milk production
Oxytocin - milk let down
What are the advantages of breast feeding?
Babies have fewer infections Bonding Decreased risk breast and ovarian cancer Further contractions of uterus Aids weight loss
