Abnormal Labour Flashcards

1
Q

This deck will cover:

A
  • Failure to start Labour & Induction
  • Inadequate Progress of Labour
  • When to avoid labour
  • Stage 3 complications
  • Assessing for Foetal Distress
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2
Q

How many labours are induced?

A

1 in 5

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3
Q

Why don’t we induce all labours at a time convenient for us?

A
  • Less efficient labour
  • More painful
  • Requires foetal monitoring
  • Risk of uterine hyperstimulation
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4
Q

When would we induce a labour?

A
  • Certain maternal health problems such as on treatment for DVT or Diabetic
  • > 7days overdue
  • Foetal concerns e.g. oligohydramnios or growth issues
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5
Q

What is Bishop’s Score?

A

Clinical score used to assess the change in the cervix and predict success of induction

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6
Q

How do we go about inducing labour?

A

1) Dilate & efface cervix with Vaginal Prostaglandin pessaries or Cook Balloon
2) Amniotomy once bishop score = 7
3) IV oxytocin to achieve contractions

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7
Q

When inducing labour what rate of contractions do we aim for?

A

4-5 / 10mins

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8
Q

How slow do we consider to be Inadequate Progress of labour?

A

Dilation at <0.5cm/hr primagravida or <1cm/hr multigravida

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9
Q

We split the causes of Inadequate Progress into Power vs Passages vs Passenger.
Whats the main “power” cause?

A

Inadequate Uterine Activity

Inadequate contractiosn -> Failure to descend -> No pressure on cervix -> No dilation/effacement

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10
Q

How do we treat Inadequate Uterine Activity?

A

IV oxytocin

Make sure to rule out Obstructed Labour as treating that with oxy will rupture the uterus

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11
Q

What could cause inadequate progress of labour due to the passenger?

A
  • Malposition
  • Malpresentation
  • Cephalopelvic Disproportion (CPD - combination of the passenger and passage)
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12
Q

What are the common forms of malpresentation and malposition?

A

Malpresentation - breech or transverse lie

Malposition - Relative CPD occurs due to foetal head being in the wrong orientation e.g. Occipito-posterior or Occipito-transverse

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13
Q

When might be better not to attempt normal delivery?

A
  • Obstruction e.g. Placental Praevia
  • Malpresentation
  • Unsafe maternal conditions e.g. cardiac problems
  • Previous complications of labour e.g. uterine rupture
  • Foetal conditions
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14
Q

What other options are there when normal delivery isn’t recommended?

A
  • Assisted or Instrumental delivery if fully dilated using forceps or Vacuum Extraction (15%)
  • C-section (25%)
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15
Q

In what cases do you choose to do a C-section?

A
  • Obstructed Labour

- Foetal Distress prior to full dilation

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16
Q

List the common stage 3 complications of labour?

A
  • Retained PLacenta
  • PPH
  • Tears (grazes, 1st->4th degree tears)
17
Q

Labour is very stressful for the wean but they can normally handle it, how do we tell if they’re in distress?

A
  • Intermittent Auscultation of heart
  • Cardiotocography
  • Foetal Blood Sampling
  • Foetal ECG
18
Q

When would we use a Foetal Blood sample and what would it show?

A

If CTG is abnormal

Tell us pH, Acidity is a good indicator of hypoxaemia