Modes of delivery Flashcards
What causes pain in labour?
- Painful contractions
2. Effectivness of pushing
When assessing a women’s contractions, what do you look out for
Duration
Intensity
Frequency
What factors does the pain experience depend on? (3)
- Type of pelvis
- Ability of the cervix to dilate
- Ability of the vaginal canal to distend
What factors do we need to take into consideration when assessing pain in labour
- Pain threshold
- Medical conditions
- Source of pain
- Foetal position and presentation
What type of pain do we get in the first stage of labour?
Visceral pain from uterine contractions and cervical dilation via afferent routes from T10-L1
What type of pain do we get in the Second stage of labour?
Somatic pain from the vaginal and perineal regions via S2-4 through the pudendal nerve
What are the consequences of pain in labour?
- Unpleasant mental health impact
2. Increases plasma cortisol and catecholamines leading to a reduction in utero-placental blood flow
What are the benefits of relieving pain in labour?
- Reduces plasma noradrenaline
- Prevents metabolic acidosis by reducing the rate of rise of lactate and pyruvate
- Decreases maternal O2 consumption
How does maternal pain lead to foetal metabolic acidosis?
- Pain causes hyperventilation which causes respiratory alkalosis and reducing transfer of O2 into baby
- Pain releases cortisol which stimulates lipolysis and hyperglycaemia causing hypoxia for the baby
- Both processes cause uterine vasoconstriction reducing placental flow and exchange
What are the 4 different ways of managing pain in labour?
- Non-pharmacological
- Inhalation
- Systemic opioids
- Epidural
List 6 Non-pharmacological methods to reduce pain in labour?
- Progressive relaxation
- Thermal stimulation
- Positioning
- Distraction
- Hydrotherapy
- Touch relaxation
What are the advantages of non pharmacological methods to relief pain in labour? (3)
- Non-invasive
- Addresses emotional and spiritual aspects of pain
- Promotes a women’s sense of control over pain
What are the disadvantages of non pharmacological methods to relief pain in labour? (2)
- Interventions require special training/practice
2. Not effective for everyone
Which opioid is recommended to treat pain in labour?
Pethadine
What are the SE of Pethadine? (4)
- N+V
- sedation
- Reduces labour progress
- Increases foetal heart rate and acidosis
What are the advantages of epidural analgesia in labour? (4)
- Effective
- Safe
- Does not increase the risk for C-section
- No foetal compromise
What are the disadvantages of epidural analgesia in labour?
- Prolonged second stage
- increased labour augmentation
- Increased risk of instrumental delivery - hospital stay, sexual dysfunction, incontinence
List 7 perquisites for instrumental delivery
- Head not palpable abdominally
- Head at or below the ischial spine (0/5 station)
- Cervix fully dilated
- Head position unknown
- Adequate analgesia (pudendal nerve block)
- Valid indication
- Bladder empty
What do you need to do before carrying out an instrumental delivery? (5)
- Clear consent from mother
- Appropriate analgesia - regional block
- Pudendal block for urgent delivery
- Maternal bladder emptied + catheter removed or deflated
- Aseptic technique
What are the Maternal complications of instrumental delivery?
- PPH
- Third/fourth degree perineal tear
- Cervical tear
List 5 indications for operative vaginal delivery
- Prolonged active stage
- Maternal exhaustion
- Foetal distress in second stage
- To cut short the second stage in women with severe cardiac disease/HTN
- Breech - for the head
What are the disadvantages of Ventouse? (2)
- High failure rate
2. Foetal trauma - haematoma
What are the advantages of Ventouse? (2)
- No difference in APGAR score
2. Less maternal trauma
What Foetal complications do we get with instrumental delivery? (5)
- Skull fractures/facial nerve damage
- Haematomas
- Intracranial haemorrhage
- Scalp laceration
- Neonatal jaundice
What is the risk associated with changing instrument?
Increased foetal trauma
When do we change the instrument?
When ventous used and head has fully descended
What reduces the need for operative vaginal delivery?
- Upright/lateral position
2. Avoiding epidural
What are the conditions for low-cavity delivery? (3)
- Head well below the ischial spine
- Occipitoanterior position
- Pudendal block or perineal infiltration
What are the conditions for mid-cavity delivery?
- Engaged head
- At or below ischial spine
- Epidural or spinal analgesia
- OA/OT/OP position
What do you do if your unsure whether you should use forceps?
In theatre - trail of forceps
How do you deliver the following:
OA
OT
OA: ventouse/foreceps
OT: manual rotation followed by forceps (kielland)
What do you do if operative vaginal delivery failed?
C-Section
What causes high failure rates in operative vaginal delivery?
- BMI > 30
- Macrosomic baby
- OP
- Mid-cavity delivery or 1st station
When should you abandon operative vaginal delivery?
- No evidence of progressive descent with moderate traction
- Delivery is not imminent following three contractions of correctly applied instrument
What do you have to report in terms of vaginal instrumental delivery?
- Adverse outcomes
2. Unsuccessful trials
After delivery of the baby with operative vaginal techniques, what do you have to do? (5)
- Paired cord blood samples
- Asses mothers DVT risk
- Give the mum regular declofenac
- Bladder care
- Psychological support
