Abnormal Labour ( + Induction)

Question 1

How many labours are induced?

Answer 1

1 in every 5 labours are induced.

Question 2

What is induction?

Answer 2

The artificial start of labour (not spontaneous labour).

• ripening cervix
• rupture of membranes

Question 3

What are the stages of induction?

Answer 3

• cervical ripening

Question 4

What changes should occur in the cervix during labour?

Answer 4

• effacement (thin/stretch)
• dilate (opens)
• softens
• moves from post -> ant
• cervix is drawn up into the uterus

Question 5

What medication can be used to increase strength AND duration of contractions?

Answer 5

IV Oxytocin

Question 6

How is cervical ripening done?

Answer 6

• Balloon, GOLD STANDARD

- prostaglandins

Question 7

What should always be done during labour?

Answer 7

Foetal monitoring

Question 8

What is an amniotomy?

Answer 8

Rupturing of the amniotic sac (membrane) done during induced labour.

Question 9

When can an amniotomy be performed?

Answer 9

• When the cervix has dilated by 2-3cm

Question 10

What is the bishops score?

Answer 10

A pre-labour scoring system used to predict whether induction will be needed.

Question 11

What are the bishop scores?

Answer 11

<5 = labour won’t begin without induction
3 and lower = induction would not be successful
9 and higher = labour is likely to occur on its own
7 or higher = amniotomy can be done

Question 12

What does the bishops score assess of the Cervix?

Answer 12

dilatation 
length of cervix
position
consistency
station

Question 13

What are indications for IOL (induction of labour)?

Answer 13

• diabetes
• Term + 7 days (41 weeks)
• fetal reasons
• social/maternal requests
• if water break >24hrs and labour hasn’t begun

Question 14

Why is induction offered after 41 weeks?

Answer 14

Due to the increased risk of stillbirth

Question 15

What are ‘power’ intrapartum complications?

Answer 15

• inadequate uterine activity/contractions

Question 16

What are ‘passage’ intrapartum complications?

Answer 16

• cephalopelvic disproportion
• fibroids
• placenta praevia

Question 17

What are ‘passenger’ intrapartum complications?

Answer 17

• malposition
• malpresentation
• foetal distress
• hydrocephalus

Question 18

What is suboptimal for cervical dilatation?

Answer 18

• primigravida women =. <0.5cm per hour

- porous women = <1cm per hour

Question 19

What must you rule out before giving IV oxytocin?

Answer 19

obstructions - because stimulation of an obstructed labour can cause a ruptured uterus

Question 20

What is a sign of cephalopelvic disproportion?

Answer 20

• caput (swelling on babies head)
• moulding (babies skull moves on top of each other to try and make more room)

^ some of this is normal

Question 21

what’s it called when the placenta lies below the babies head?

Answer 21

Placenta praevia - the baby can’t be delivered without haemorrhage of the mother

Question 22

What is done when a baby is in the breech position?

Answer 22

The baby can be delivered this way.

In the UK, mothers are offered a Caesarean section

Question 23

What is the main risk of transverse lie?

Answer 23

Limb/cord could descend through the cervix and could cause an obstructed labour

Question 24

What is the optimum position for the babies head to be in?

Answer 24

Occipito-Anterior (occipital is anterior to mothers pelvis, so they are facing down)

Question 25

Which malposition of a babies head can they be born in?

Answer 25

Babies are not porn ocipito-transverse and will need to move into ocipito anterior or ocipito posterior to be borne.

Question 26

How can you tell which position the babies head is in?

Answer 26

By using the fontanelles:

• posterior = triangle
• anterior = diamond

Question 27

What are the main causes of foetal distress?

Answer 27

• Hypoxia (MAIN)
• uterine hyper-stimulation (leads to insufficient placental blood flow)
• infection
• cord prolapse
• placental abruption
• vasa praecia

Question 28

What are the methods of foetal monitoring?

Answer 28

• low risk = intermittent auscultation of the foetal heart (HR ^ in second stage of labour), done every 5 mins
• high risk = cardiotocography
• foetal distress = foetal blood sampling
• foetal ECG

Question 29

How is foetal blood sampling done?

Answer 29

a speculum is used to scrape the babies scalp

Question 30

When is foetal blood sampling done?

Answer 30

• then the CTG is abnormal

- can only be done if ther cervix is >4m dilated

Question 31

What can foetal blood sampling show?

Answer 31

• pH (hypoxia)
• lactic acid

**The main thing is tells you about is hypoxia

Question 32

how many births are instrumental?

Answer 32

15% of 1st births

slightly less for 2nd births

Question 33

how much births are done via C section?

Answer 33

• 40-50%
• emergency = 20-25%
• planned = 20-30%

Question 34

what are the instruments used in delivery?

Answer 34

• Ventouse (suction)

- forceps (can be rotational)

Question 35

What are the main 3rd stage complications?

Answer 35

• post partum haemorrhage
• retained placenta
• tears

Question 36

What is a very common sign suggesting foetal distress?

Answer 36

the foetal heart rate decelerates after a contraction

Question 37

What are the contra-indications of induction?

Answer 37

• vasa praevia
• placenta praevia
• prolapsed umbilical cord
• foetal distress
• malpresentation
• asthma
• previous C section

Question 38

Why is induction contraindicated in maternal asthma?

Answer 38

prostaglandins cause smooth muscle contraction

its still often done

Question 39

If on oxytocin, what should be done?

Answer 39

Foetal CTG

Question 40

What are the complications of induced labour?

Answer 40

• foetal distress
• uterine hypertonicity
• failed induction

Question 41

What side effects can oxytocin cause?

Answer 41

• hypertonicity
• hypotension
• hyponatraemia

(Usually IV infusion along with the oxytocin)

Question 42

What are the steps of induction?

Answer 42

Before: offered cervical sweep

• pessaries or vaginal gel

Mix of:

• oxytocin
• prostaglandins
• balloon catheter
• artificial rupture of water

Question 43

When must you not deliver oxytocin?

Answer 43

Before waters have broken - so you don’t cause an increase in pressure.