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