abnormal labour Flashcards
(27 cards)
what can this be due to
faults in powers, passages or passengers
what features of the passenger can make it abnormal
presentation and size
what presentations of fetus require C section
transverse and brow
what can happen if the fetus presentation is face or OP
fail to progress
what can be due to passages
cephalopelvic disproportion- if diametes are unfavourable and/or head is big
where do contractions start
fundus
when is it a problem with the powers
uterine dysfunction- lack of cervical dilatation over 2h and weak contractions
what can the contractions be divided into
hypotonic- decr resting tone, low contraction peak. normotonic- but too infreq or may be coupled
if the membranes are intact what can you try
amniotomy
if cervical dilatation is
oxytocin
management prolonged latent
no treatment or rupture of membranes
management prolonged active
rupture membranes or oxytocin
what is shoulder dystocia
inability to deliver shoulders after head delivered- gentle downward traction fails
what can occur with shoulder dystocia
PPH, perineal tears, brachial plexus injury- Erbs palsy
what is the danger in shoulder dystocia
asphyxia, cord squashed
associations shoulder dystocia
large/postdate baby, induced/oxytocin, prolonged labour-1st or 2nd stage, assisted vaginal delivery, prev shoulder dystocia
management dystocia
McRoberts position, apply suprapubic pressure 30s, rotate by 180so post shoulder now lies ant, episiotomy, get mother into all fours position, maternal symphiosotomy, cleidotomy (cutting through clavicles)
what is prolapsed cord
descent of the cord through the cervix either alongside (occulta) or in front of (overt) the presenting part in presence of ruptured membranes
why is prolapsed cord an emergency
as cord compression causes asphyxia
risk factors cord prolapse
2nd twin, footling breech, shoulder presentation, polyhydramnios, unengaged head, transverse lie, male
management prolapse if cord presentation noted before rupture of membranes
c section
when could cord prolapse occur iatrogenically
rupture of membranes, external cephalic version
signs prolapse
obvious if at the inoitrus, if not- bradycardia and variable decels- needs to do vaginal exam
management prolapse
keep the cord in vagina, stop presenting part from occluding cord. displace presenting part by putting a hand in vagina and push up, place woman head down. catheter and saline into bladder. tocolytics.
