Malpresentation intrapartum Flashcards
Define Lie
Relationship of Longitudinal axis of uterus and of foetus
Define presentation and presenting part
Foetal pole in lower part of uterus
PP: Portion of foetus felt on vag exam
Define position
Relationship between defined area of presenting part and mother’s pelvis
What are the 3 stages of labour?
1) Regular painful contractions leading to
a) Latent: Cervical dilation/effacement up to 4cm
b) Active: Regular contractions and progressive dilation beyond 4cm
2) 10cm and delivery of baby
3) Placenta out and after delivery
What is moulding
Movement of bregma to fit through the vagina
How do uterine contractions work?
1) Originate from pacemaker near cornua
2) Peristaltic waves travel across uterus
3) Myometrial contractions occur
Define cervical ripening
Increased softening, distensibility, effacement and dilation of the cervix during labour
What are some uterine problems leading to an abnormal labour?
1) IntraUterine: Placenta praevia, uterine fibroids, multiple pregnancy
2) ExtraUterine: Pelvic tumours, maternal obesity
What are some other abnormal labour problems?
1) Overall large foetal size: constitutional, mat diabetes
2) Incomplete flexion of head: Occipitofrontal diameter, brow presentation and face presentation
3) Foetal malformation
What is a partogram and its importance?
Def: Graphical representation of foetal progression
Important for documentation
What are the main problems of prolonged labour?
Mat: Ketosis, Increased risk of instrumental delivery/caesarean, Genital tract trauma, uterine rupture, 3rd stage complications and long term fistula formation
FOETAL: shoulder dystocia, hypoxia, birth injuries
How are Breeches managed?
1) Breech vaginal delivery
2) Lower segment caesarean section
3) ECV
How are prolonged first and second stage managed?
1st: Oxytocin (^ power of cont)
2nd: Instrumental delivery, lower segment caesarean section, oxytocin (with care), correct malposition by rotation (manual/instrumental)
