Malpresentation -ILA Flashcards
What are risk factors for failure to progress in labour?
Starting labor with medicine or other methods Epidural Problems with amniotic sac Water breaks before labor starts—PROM A large baby/ small pelvis Wrong position Weak contractions uterus Prior FTP nulliparous woman Diabetes Fertility treatments
How is labour induced?
1st- membrane sweep -> oxytocin and PG release
2nd- syntocin (analogue of oxytocin) if nulliparous; prostins; cervical balloon catheter
What are indications for labour induction?
Induction – indications: gestational DM, multiple pregnancy, PROM, FGR, pre-eclampsia
BISHOP score
Waht drug stops the effects of oxytocin?
atosiban- used against premature labour
Describe the first stage of labour
First stage –
Latent is first 4cm cervical effacement with irregular contractions and active is until full 10cm dilation with regular contractions
Head descends flexed to remain small diameter
90 degree rotation from occipito transverse to occpito anterior/posterior happens
SROM
Describe the second stage of labour
Passive stage: Head descends and flexes further a rotation usually complete - reaches pelvic floor
Active stage (pushing):
Head extends as reaches perineum (crowning – often tears at this part)
Head restitutes, rotating back to transverse before shoulders deliver
Describe the third stage of labour?
placental delivery - afterbirth
What is defined as adaquate progress of labour?
Should progress at 1cm an hour for multiparous and 1/2cm per hour for multiparous
Latent phase should take up to 24 hours in nulliparous women and 12 hours in multiparous
What are the 3 main causes of failure to
progress in labour?
Power (force of contractions)
passenger
passage
What is the most common cause of failure to progress in labour?
Poor uterine contractions (power) - common in nulliparous
What are the problems with the passenger in labour?
malpresentation
malposition of large fetal head
What problems with the passage in labour?
Disparity between size of mother and baby - cephalopelvic disproportion
How do you assess failure to progress in labour?
Palpate abdomen for lie, head and contractions
CTG
colour amniotic fluid
PV exam
What are fetal and maternal consequences of failure to progress in labour?
low oxygen levels for the baby and therefore fetal distress
abnormal heart rhythm in the baby
abnormal substances in the amniotic fluid
maternal - haemorrhage, tears, PTSD, UTI
What is monitored on a partogram?
Fetal heart rate (FHR) State membranes Uterine contractions (/10 mins) Vitals mother Dilatation of mother Station of head (every hour in second stage) Drugs given Engagement urine Position of baby (is it cephalic, longitudinal or transverse)
What is an action line on a partogram?
Indicates slow progression
At action line need to take ACTION