Post-term pregnancy, induction of labor and fetal monitoring during labor Flashcards
What is post-term pregnancy?
Pregnancy after week 42.
What is the main risk factor for post-term delivery?
A previous post-term delivery.
What are risk factors for post-term delivery?
Associated risk factors include previous post-term delivery, first-time mothers, male fetus, maternal obesity and family history.
What are complications of post-term delivery?
Perinatal complications: Placental insufficiency Meconium aspiration Shoulder dystocia Fetal distress og low Apgar score Perinatal death
Maternal complication include: Dystocia, obstetric traumas, C-section and postpartum hemorrage.
What should be included in the routine pregnancy check-up after the due date has passed?
Ultrasound examination assessing fetal biometry, volume of amniotic fluid and flow in the umbilical artery.
Cardiotocography (CTG) scan.
Gynecological examination with assessment of cervical status and membrane sweeping.
What are indications for induction of labor in post-term pregnancies?
Fetal growth restriction Oligohydramnion Abnormal CTG Difference in term Mothers age > 38 years
How long can induction of labor wait in uncomplicated post-term pregnancies?
Induction of labor should not be postponed until after week 42.
True or false: Epidemiological studies have
suggested increased risk for perinatal death in post-term deliveries, but this risk is shown to be reduced by induction of labor.
False. This risk is not shown to be reduced by induction of labor. However, the risks involved in a post-term pregnancy must be weighed up against the risks involved in potentially inducing.
How common is it do induce labor?
Common. 1/5 labors are induced.
What are general indications for induce labor?
Post-term pregnancy. Preeclampsia/hypertension. Diabetes mellitus. Fetal growth restriction, Ruptured membranes > 24 hours without contractions Twins. Polyhydramnios or oligohydramnios. Intrahepatic cholestasis of pregnancy. (Other medical/social indications.)
What are absolute contraindications for inducing labor?
Bleeding, with suspicion of premature separation of the placenta (placental abruption).
Placenta previa.
Previous C-section with longitudinal incision in uterus.
Foetus in transverse position.
Signs of foetal hypoxia.
Severe preeclampsia where fast delivery is desirable.
What is indicated by a Bishop’s score higher than 5?
Favorable cervix.
What is indicated by a Bishop’s score of 5 or lower?
Unfavorable cervix.
What are methods of inducing labor if the Bishop’s score is 5 or less?
Balloon cathether.
Local prostaglandine.
Oral prostaglandin.
What are methods of inducing labor if the cervix is ripe?
Amniotomi and oxytocin.
What are complications of induction of labor?
Hyperstimulation Long, protracted delivery with risk for uterine atony and postpartum. Haemorrhage Increased risk of operative delivery. Difficult shoulder delivery. More painful labour. Uterine rupture. Failure to induce (need for cesarean section).
What are the differences between hypoxemia, hypoxia and asphyxia?
Hypoxemia affects the arterial blood.
Hypoxia affects the peripheral tissue.
Asphyxia affects the major organs.
What is diagnosis based on in fetal monitoring to determine serious oxygen deficiency during labor or induced contractions?
CTG scan, changes in acid-base balance in
fetal blood sample and discoloration of the amniotic fluid.
What is registered through cardiotocography?
Fetal heart sounds.
Fetal movement.
Uterine contractions.
What is meant by STAN as a method of fetal monitoring during labor?
Cardiotocography + ST analysis of fetal ECG = STAN.
What is the advantages of using a scalp electrode in fetal monitoring during labor?
It reduces the risk of confusing the maternal and fetal pulses.
What is a normal fetal heart rate?
110-150 beats per minute.
What is normal variability and accelerations in a CTG?
Variability of 5-25 beats per minute.
2 or less accelerations per hour.
What is the best test to determine if the child was exposed to hypoxemia during birth?
Umbilical blood test.
