Normal and abnormal labour and delivery Flashcards
Common reasons for abnormal labour
- Delay during labour 1 or 2
- Meconium staining
- Retained placenta
- Abnormal foetal heart rate
- Neonatal concerns
Causes of high risk birth
Cardiac/hypertensive disease
Asthma/CF
Hyperthyroidism/diabetes
Hep B/HIV/TB
NICE guidelines for abnormal labour
Raised BP/pulse + protein
Fever
Membrane rupturing etc
Presentation/lie of baby
Reassuring trace
Baseline 110-150 bpm with variations of 5-25 bpm
No concerning decelerations
Non-reassuring trace
<110 or >160 bpm with a lot of variability
There are variable decelerations
Abnormal trace
Below 100 or above 180 bpm with considerable variation
Decelerations lasting over half an hour
Stage 1 labour
True contractions Latent (<4cm) and active (4-10) Cervix effaces and dilates Cervix will become 10cm dilated Up to 18hr
Stage 2 labour
Descent in birth canal
Pushing
Baby born
3 hours
3rd stage of labour
Delivery of placenta
30 mins
PROM
Normally membranes break in the first stage of labour
PROM is where they break more than an hour before labour begins
<37 weeks is pre-term prom
Babies should be delivered within 96hours
Meconium risks
Aspiration pneumonia
Increased c-section and ICU risk - continuous CTG needed
Normal labour length for first baby
8-18 is normal
Normal labour length for second baby or more
5-12 hours
What causes limited progress in labour?
P = power of contractions (dysfunctional uterus)
P = passage through uterus/cervix/pelvis (obstructed labour)
P = passenger size/presentation/position (malpresentation)
Dysfunctional uterine activity
- Inertia
- Weak/infrequent/short contractions <4 in 10 mins
- Most common reason for first baby
- Vaginal exam needed every 2h
- Artificial rupture of membranes + oxytocin infusion → c-section after 4/6h
- Secondary inertia: at full dilation, contractions become weak
Obstructed labour causes
Mass, baby-pelvis disproportion, malpresentation, foetal abnormalities
Maternal impacts of obstructed labour
PPH and rupture
Brow presentation of baby
On VE can palpate brow, orbit, anterior fontanelle - delivery by c-section
Face presentation of baby
On VE can palpate chin
Foetal impacts and risk factors for shoulder dystocia
Effects: hypoxia, death, fractured arm/clavicle, Erb’s
Risk factors: macrosomia, post-term baby
Maternal effects and risk factors for shoulder dystocia
Bleeding, perineal trauma
R/f: diabetes, short stature, obesity
Difference between induction and augmentation
- Induction: stimulate uterus to begin labour
- Augmentation: stimulating uterus during labour to increase frequency and strength
What is Bishop’s score?
Success related to the cervix at the start of induction
Favourable if soft, short and dilated
More than 8 indicates a successful induction is likely
What prostaglandin is found in pessaries?
PGE2
What is a healthy rate of contractions?
> 2cm/4h
Primary PPH
> 500ml within 24h of delivery
Secondary PPH
> 500ml from 24h to 12 weeks
Minor PPH
500-1000ml
Major PPH
> 1000ml
Reasons for PPH
Tone (uterine atopy), Tissue (retained placenta), Trauma (injury during delivery), Thrombin (clotting disorder)
Sx PPH
tachycardia, low BP, N and V, syncope, pallor, slow CRT
