Things going wrong in labour

Question 1

What is shoulder dystocia?

Answer 1

Inability to deliver body of the fetus using gentle traction after the head has been delivered- usually impaction of the anterior shoulder on the pubic symphysis

Question 2

Complications of shoulder dystocia?

Answer 2

Mum: postpartum haemorrhage and perineal tears
Bab: brachial plexus injury , hypoxia, death

Question 3

Risk factors for shoulder dystocia?

Answer 3

fetal macrosomia, high maternal body mass index, diabetes mellitus and prolonged labour

Question 4

Management of shoulder dystocia?

Answer 4

Call for help
Mcroberts-flex the hips (thighs to tummy)
(incr ap angle)
Episiotimy if need internal manoeurvres (screw, posterior shoulder delivery)
Las resort is symphysiotomy and zavanelli (push it back in and c section.
These are often too late

Question 5

What is an amniotic fluid embolism?

Answer 5

•This is when fetal cells/ amniotic fluid enters the mothers bloodstream and stimulates a reaction . Rare

Question 6

Presentation of amniotic fluid embolism?

Answer 6

• The majority of cases occur in labour , though they can also occur during caesarean section and after delivery in the immediate postpartum.
• Symptoms include: chills, shivering, sweating, anxiety and coughing.
• Signs include: cyanosis, hypotension, bronchospasms, tachycardia. arrhythmia and myocardial infarction

Question 7

How is amniotic fluid embolism managed?

Answer 7

Mainly supportive, critical care unit and MDT

Question 8

What is chorioamnionitis?

Answer 8

usually the result of an ascending bacterial infection of the amniotic fluid / membranes / placenta. Emergency

Question 9

Major risk factor for chorioamnionitis?

Answer 9

PPROM

Question 10

Treatment of chorioamnionitis?

Answer 10

Prompt delivery of the foetus (via cesarean section if necessary) and administration of intravenous antibiotics

Question 11

What is cord prolapse?

Answer 11

the umbilical cord descending ahead of the presenting part of the fetus. Left untreated, this can lead to compression of the cord or cord spasm, which can cause fetal hypoxia and eventually irreversible damage or death.

Question 12

RF for cord prolapse?

Answer 12

• prematurity
• multiparity
• polyhydramnios
• twin pregnancy
• cephalopelvic disproportion
• abnormal presentations e.g. Breech, transverse lie
• placenta praevia
• long umbilical cord
• high fetal station

Question 13

Management of a cord prolapse?

Answer 13

• presenting part of the fetus may be pushed back into the uterus to avoid compression
• Tocolytics may be used
• If the cord is past the level of the introitus, it should be kept warm and moist but should not be pushed back inside.
• The patient is asked to go on ‘all fours’ until preparations for an immediate caesarian section have been carried out