Problems in Labour Flashcards
What the definition of ‘Delay in Labour’
Delay in labour is associated with specific stage:
Stage 1: Cervical dilation of less than 2cm in 4 hours
Stage 2:
Nulliparous: >2hour duration of second stage in labour
Multiparous: >1hour duration of second stage of labour
Third stage:
If its actively managed (oxytocin injection) - longer than >30minutes without placenta delivery
If its physiological: Longer than 60 minute without delivering placenta
What would define a delay in labour during the first stage of labour
Stage 1: Cervical dilation of less than 2cm in 4 hours
What would define a delay in labour during the second stage of labour
Stage 2:
Nulliparous: >2hour duration of second stage in labour
Multiparous: >1hour duration of second stage of labour
What would define a delay in labour during the third stage of labour
Third stage:
If its actively managed (oxytocin injection) - longer than >30minutes without placenta delivery
If its physiological: Longer than 60 minute without delivering placenta
What is the acronym used to describe the causes of delayed labour
give examples for each?
3PS:
POWER
Uterine Contractions Deviations from normal (3-5 contractions /30s/10min)
PASSENGER
Size of fetus (head /shoulder diameter)
Foetal presentations (cephalic: vertex. face, breech)
Foetal position (occipito anterior)
PASSAGE
cephalopelvic disporportion
What investigations should be carried out during delayed labour?
Vaginal examination to check faetal position
regular foetal monitoring
How to manage delay in stage 1 of labour?
If membrane is intact - Amniotomy
1st line: Oxytocin infusion + CTG monitering
How to manage delay in stage 2 of labour?
Expediated delivery (c section / instrumental)
consider oxytocin infusion
How to manage delay in stage 2 of labour?
Controlled cord traction
IM Oxytocin /ergometrine
Whats the definition of Shoulder Dystocia?
vaginal cephalic delivery that requires additional obstetric movements to deliver the fetus after the head was delivered and gentle traction has failed
What are the complication of shoulder dystocia?
Can lead to:
HIE hypoxic Ischaemic Encephalopathy
Brachial Plexus Injury:
Erbs Palsy (C5-C6)
Klumpke’s Palsy (C8-T1)
What are the RF for shoulder dystocia>
Pvs HX of Shoulder Dystocia
Macrosomia
Maternal DM
High Maternal BMI
Induction of labour
Prolonged Labour
What are the signs of shoulder dystocia
Difficulty in delivering face/chin
Turtle-neck sign (head retracts back into birth canal)
failure of shoulder descent
How would you describe shoulder dystocia
discrepancy between size of foetal shoulder and mothers pelvic inlet leading to impactions
How would you manage shoulder dystocia - intial manouvers
McRobert’s Manouvere (Mother hyperflexes hips ->thigh to abdo
+ Suprapubic pressure
+ discourage pushing to prevent further impaction
What is second line for shoulder dystocia after initial manoeuvres didn’t work
1.Deliver posterior arm
2. Attempt internal rotation manouvers
What is an instrumental delivery?
Assisted Vaginal birth (either by forceps or vacuum)
What are the risk and complications associated with forcep delievery
1 - Vaginal Trauma
2 - Postpartum haemorrhage
3 - Obstetric anal sphincter injury
4 - facial/scalp laceration
what are the indications for an instrumental delievery?
- Suspected foetal compromise
- Delayed second stage
- Maternal Exhaustion / distress
- Medical contraindications for valsalva
What are the risk and complications associated with forceps delivery
1- Vaginal Trauma
2- Obstetric Anal Sphincter Injury OASI
3- Facial / scalp Laceration
4- Post partum haemorrhage
What are the risk and complications associated with vacuum delievery?
1- Vaginal Trauma
2- Obstetric Anal Sphincter Injury OASI
3- Facial / scalp Laceration
4- Post partum haemorrhage
5- retinal haemorrhage
6- Cephalohematoma
7- Subgaleal Haemorrhage
What are the different classifications used to describe obstetric injuries?
1st Degree tear - SKIN only
2nd Degree tear- perineal muscle
3rd degree tear- Anal sphincter complex:
Type A - Less than 50% external AS
Type B - More than 50% than external AS
Type C - Internal and external AS injury
4th Degree tear
Anorectal Epithelium
What are the indications for a C- Section / Classification of urgency?
Category 1 : Within 30 minute of decision
-> immediate threat to maternal/fetal life
e.g. placental abrubtion / abnormal CTG
Category 2: within 75 mins of decision
-> maternal/fetal compromise - birth must be expedited
Category 3: no compromise/ early birth indicated
Category 4: Elective
What indicated for C-SECTIONS?
Breech Presentation and unresponsive to manoeuvrers
placenta praevia
palcenta accreta spectrum
Maternal Choice
Emergencies:
Foetal bradycardia, placental abruption, cord prolapse, uterine rupture, foetal pH<7.2, failure of instrumental delivery
Describe emergency situation requiring immediate c-section
Emergencies:
Foetal bradycardia, placental abruption, cord prolapse, uterine rupture, foetal pH<7.2, failure of instrumental delivery
