Abnormal Labour Flashcards
hwat is induction of labour and how is it done?
- Around 1 in 5 labour are induced (artificially start labour)
- Need foetal monitoring
- Need cervical ripening - prostaglandins (pharmacological), balloon (mechanical)
- Induction of labour is when an attempt is made to instigate labour artificially using medications and/or devices to ripen cervix followed usually by artificial rupture of membranes (performing an amniotomy (artificial rupture of membranes))
what is the bishops score?
- The bishops score is used to clinically assess the cervix. The higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful
- 5 different elements all describing the cervix
- If already score of 7 then already favourable for amniotomy
what is the process of induction of labour?
- Once cervix has dilated and effaced, an amniotomy can be performed – a bishop score of 7 or more is considered favourable for amniotomy
- Amniotomy is artificial rupture of foetal membranes (waters) usually using a sharp device e.g. amniohook
- Once amniotomy performed, IV oxytocin can be used to achieve adequate contractions (unless contractions spontaneously start) – 4-5 contractions in 10 minutes
what are indications for induction (IOL)?
- Diabetes
- Post dates – term + 7 days
- Maternal need for planning delivery e.g. on treatment for DVT
- Foetal reasons e.g. growth concerns, oligohydramnios (low level of amniotic fluid)
- Social/maternal request
whata re intrapartum complications?
- Inadequate progress in labour may be due to:
- Inadequate uterine activity (powers)
- Cephalopelvic disproportion (CPD) - Mismatch in size between the mothers pelvis and the baby (passages)
- Other reasons for obstruction e.g. fibroid (passages)
- Malposition (passenger)
- Malpresentation (passenger)
- Foetal distress
Progress in labour is evaluated by a combination of abdominal and vaginal examinations to determine what?
cervical effacement, cervical dilatation, descent of the foetal head through the maternal pelvis
In active first stage of labour, suboptimal progress is defined as cervical dilatation: less than ___cm per hour for primigravid women or less than __cm per hour for parous women
0.5
1
If contractions are inadequate the foetal head will not descend and exert force on the cervix and the cervix will not dilate.
It is possible to increase the strength and duration of the contractions by giving what?
a synthetic IV oxytocin to the mother
It is important to exclude an obstructed labour in these circumstances as stimulation of an obstructed labour could result in a ruptured uterus
what is Cephalopelvic disproportion (CPD)?
- Genuine CPD is relatively rare
- It means that the foetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born
- Caput (swelling on baby head) and moulding (sutures on baby head cross over each other) develop
what are some other obstructions that may occur stopping a baby being born?
- Placenta praevia - a baby’s placenta partially or totally covers the mother’s cervix — the outlet for the uterus. Placenta previa can cause severe bleeding during pregnancy and delivery
- fetal anomaly (hydrocephalus)
- fibroids (non-cancerous growths that develop around the womb)
what is malpresentation?
- Babies can be born breach but recommend C section in the UK
- In transverse you are worried there is cord presentation where the cord slips down through an opening cervix, haemorrhage, baby needs immediate delivery
- Baby may not be head down till near due date
what is malposition?
- Much more common
- Involved the foetal head being in an suboptimal position for labour and relative CPD occurs (occipito posterior (OP) and occipito transverse (OT)
what position should the babies head be in and how do you find that out?
- Occipito anterior is when the occipito is anterior towards the mother pubic symphysis
- Know position by feeling the suture lines on the babies head, feeling for the fontanelle – posterior is trangle but anterior one is a diamond shape
- In occipito transverse position this is not compatible which delivery as it is too wide – can manually rotate the babies head 90 degrees and support an operative birth or can rotate the babies head using foreceps
Fetuses are well equipped to deal with stresses of labour. Despite this some fetuses will not be able to cope…
what may cause foetal distress?
- It is very important to avoid causing too many contractions (Uterine Hyper-stimulation) as this can result in fetal distress due to insufficient placental blood flow
- The main causes of fetal distress are hypoxia, infection and also rare occurences such as cord prolapse, placental abruption (placenta prematurely separates form the uterine wall) and vasa praevia (foetal vessels presenting causing foetal haemorrhage, extreme anaemia and death)
- In many cases of suspected fetal distress no cause is found
what is vasa praevia?
Vasa praevia is a condition in which fetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue
