abnormal labour Flashcards
what is induction of labour
attempt made to instigate labour artificially using medication and/or devices to ‘ripen cervix’ followed usually by artificial rupture of membranes (amniotomy performed)
Bishop’s score
used to clinically assess cervix
higher score more progressive change there is in cervix and indicates that inductiion is likely to be successful
everyone gets a bishops score to see if and what interventions needed
when can amniotomy be performed
once cervix has dilated and effaced (shortened)
bishops score of 7 or more
what is amniotomy
artificial rupture of foetal membranes (‘waters’) using a sharp device e.g amniohook
what happens once an amniotomy has been performed
IV oxytocin can be used to achieve adequate contractions (unless they start spontaneously)
aim for 4-5 contracs a min
indications for induction
- diabetes
- post dates - term + 7days
- maternal need for planning of delivery e.g. receiving DVT Rx
- foetal reasons: growth concerns, oligohydramnios
- social/maternal request
- twin pregnancy
- prev stillbirth or IUD
- hypertension
contraindications for induction
- malpresentation
- placenta praevia/vasa praevia
- prolapsed umbilical cord
- foetal distress
- anatomical abnormalities e.g. pelvic tumour
medication used during induction of pregnancy
topical prostaglandin analogues e.g. misoprostol
- cervical dilatation and effacement
- alternative = balloon catheter
IV synthetic oxytocin e.g. syntocinon
complications of induction of labour
uterine hypertonicity foetal distress adverse effects of drugs (hypotension, hyponatremia) failed induction C section ruptured uterus
intrapartum complications: categories
powers
passages
passenger
inadequate progress in labour may be due to
powers
-inadequate uterine activity
passages
- cephalopelvic disproportion
- other reasons for obstruction e.g. fibroid
passenger
- malposition
- malpresentation
how is progress in labour evaluated
cervical effacement
cervical dilatation
descent of foetal head through maternal pelvis
how is suboptimal progress in labour defined in active 1st stage
cervical dilatation
< 0.5cm per hour for primigravid women
<1cm per hour for parous women
obstructed labour
woman continuing to labour and contract but cervix not dilating
can result in serious complications e.g. uterine rupture
what will happen if contractions are not adequate
foetal head will not descend and exert force on cervix and so cervix will not dilate
how can we increase strength and duration of contractions
giving synthetic IV oxytocin to mother
cephalopelvic disproportion
mismatch between mother’s pelvic dimensions and baby
baby’s head in correct position but is to large to negotiate maternal pelvis and be born
what happens to fetus as result of cephalopelvic disproportion
caput - swelling on baby head
-moulding - sutures on baby head cross over eachother
placenta praevia
low line placenta
placenta presenting and will come out first, cutting out supply to baby
usually accompanied by catastrophic haemorrhage
malpresentation
presenting part is not the vertex - baby head isnt down
breech nothing presenting (transverse lie)
malposition
foetal head in a suboptimal presentation for labour
e..g. occipito-posterior, occipito-transeverse
ideal baby position
occipito-anterior
baby facing sactrum
main causes of feotal distress
hypoxia infection cord prolapse placental abruption vasa praevia
when is foetal distress suspected
when foetal heart rate decelerates after contraction
