Problems in Labour

Question 1

What the definition of ‘Delay in Labour’

Answer 1

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

Question 2

What would define a delay in labour during the first stage of labour

Answer 2

Stage 1: Cervical dilation of less than 2cm in 4 hours

Question 3

What would define a delay in labour during the second stage of labour

Answer 3

Stage 2:
Nulliparous: >2hour duration of second stage in labour
Multiparous: >1hour duration of second stage of labour

Question 4

What would define a delay in labour during the third stage of labour

Answer 4

Third stage:
If its actively managed (oxytocin injection) - longer than >30minutes without placenta delivery

If its physiological: Longer than 60 minute without delivering placenta

Question 5

What is the acronym used to describe the causes of delayed labour

give examples for each?

Answer 5

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

Question 6

What investigations should be carried out during delayed labour?

Answer 6

Vaginal examination to check faetal position
regular foetal monitoring

Question 7

How to manage delay in stage 1 of labour?

Answer 7

If membrane is intact - Amniotomy

1st line: Oxytocin infusion + CTG monitering

Question 8

How to manage delay in stage 2 of labour?

Answer 8

Expediated delivery (c section / instrumental)
consider oxytocin infusion

Question 9

How to manage delay in stage 2 of labour?

Answer 9

Controlled cord traction
IM Oxytocin /ergometrine

Question 10

Whats the definition of Shoulder Dystocia?

Answer 10

vaginal cephalic delivery that requires additional obstetric movements to deliver the fetus after the head was delivered and gentle traction has failed

Question 11

What are the complication of shoulder dystocia?

Answer 11

Can lead to:
HIE hypoxic Ischaemic Encephalopathy
Brachial Plexus Injury:
Erbs Palsy (C5-C6)
Klumpke’s Palsy (C8-T1)

Question 12

What are the RF for shoulder dystocia>

Answer 12

Pvs HX of Shoulder Dystocia
Macrosomia
Maternal DM
High Maternal BMI
Induction of labour
Prolonged Labour

Question 13

What are the signs of shoulder dystocia

Answer 13

Difficulty in delivering face/chin
Turtle-neck sign (head retracts back into birth canal)
failure of shoulder descent

Question 14

How would you describe shoulder dystocia

Answer 14

discrepancy between size of foetal shoulder and mothers pelvic inlet leading to impactions

Question 15

How would you manage shoulder dystocia - intial manouvers

Answer 15

McRobert’s Manouvere (Mother hyperflexes hips ->thigh to abdo
+ Suprapubic pressure
+ discourage pushing to prevent further impaction

Question 16

What is second line for shoulder dystocia after initial manoeuvres didn’t work

Answer 16

1.Deliver posterior arm
2. Attempt internal rotation manouvers

Question 17

What is an instrumental delivery?

Answer 17

Assisted Vaginal birth (either by forceps or vacuum)

Question 18

What are the risk and complications associated with forcep delievery

Answer 18

1 - Vaginal Trauma
2 - Postpartum haemorrhage
3 - Obstetric anal sphincter injury
4 - facial/scalp laceration

Question 19

what are the indications for an instrumental delievery?

Answer 19

1. Suspected foetal compromise
2. Delayed second stage
3. Maternal Exhaustion / distress
4. Medical contraindications for valsalva

Question 20

What are the risk and complications associated with forceps delivery

Answer 20

1- Vaginal Trauma
2- Obstetric Anal Sphincter Injury OASI
3- Facial / scalp Laceration
4- Post partum haemorrhage

Question 21

What are the risk and complications associated with vacuum delievery?

Answer 21

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

Question 22

What are the different classifications used to describe obstetric injuries?

Answer 22

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

Question 23

What are the indications for a C- Section / Classification of urgency?

Answer 23

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

Question 24

What indicated for C-SECTIONS?

Answer 24

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

Question 25

Describe emergency situation requiring immediate c-section

Answer 25

Emergencies:
Foetal bradycardia, placental abruption, cord prolapse, uterine rupture, foetal pH<7.2, failure of instrumental delivery