Abnormal labour Flashcards
(17 cards)
Stage 1 abnormal labor
- Cervix dilatation <2 cm in 4 hours
- Failure of descent of fetal head
What to do?
LSCS
Stage 2 abnormal labor
- Pushing >2H in nulliparous
- Pushing >1H in multiparous
What to do before LSCS?
Instrumental delivery
The 3 Ps affecting progress of labor?
Power
Passenger
Passage
1st Stage- Power
Dysfunctional Uterine Activity
How to manage?
Hydration (IV) fluid, analgesia, emotional support
ARM/amniotomy
Augmentation with Oxytocin after 2H
What is the risk if you do not wait at least 2 hours to augment with oxytocin after ARM?
Risk of uterine rupture
1st Stage - Passenger
True Cephalopelvic disproportion
When to suspect? (4)
Slow progress
Fetal head not engaged
VE: severe moulding and caput
Head is poorly applied to cervix
4 stages of moulding
Stage 0: no molding
Stage 1: Suture opposed
Stage 2: Suture overlapping but reducible
Stage 3: Sutures overlapped and not reducible
Significance of molding?
Changes in fetal head form to comply to maternal pelvis as it descends to ease the progress of labor.
Significant molding is not good, can cause fetal face deformation
What is the danger of brow or shoulder presentation? (2)
- Obstructed labor
- Uterine rupture
Other causes of poor progress due to passage problems
True CPD
Fibroid
Cervical dystocia due to scarring
2nd Stage
Power- causes of secondary uterine atony(2)
Epidural analgesia
Maternal dehydration and ketosis
Risk factor for each P
Power
- Dysfunctional uterine activity- Primigravida, older women
Risk factor for each P
Passenger
- Macrosomia- DM
- Malpresentation
- Malposition
Risk factor for
Passage
- Small women
- Short women (<143 cm)
- Soft tissue/ pelvic malformation
Abnormal labor causes (3Ps)
Power (2)
<3 contraction in 10
Each lasts < 40 secs
Abnormal labor causes (3Ps)
Passage (2)
CPD
Metabolic bone disease
Abnormal labor causes (3Ps)
Passenger (4)
Macrosomia
Malpresentation
Malposition
Multiple pregnancy
