Abnormal Labour and Postnatal Period Flashcards
What procedures are commonly done in induced labours?
Fetal monitoring - via CTG
Cervical Ripening - Either via prostaglandin administration or balloon dilatation
Amniotomy - artificial rupture of membranes
Administration of IV oxytocin analogue (if needed)
What is the Bishops Score?
Measures the readiness of the cervix for labour to progress
Also indicates whether the patient is ready for an amniotomy to be performed
What is cervical effacement? What is cervical dilatation?
Effacement - the cervix is stretching and getting thinner
Dilatation - the cervix is opening
Both make up the process of cervical ripening
What are some indications for induction?
Maternal Diabetes (bc risk of postdate stillbirth seems to increase later on in pregnancy - 41 / 42 weeks)
7+ days post date
Maternal need for planning - eg. she’s on treatment for DVT
Fetal reasons (growth concerns etc.)
Social / maternal request
What are the main reasons inadequate progress during labour tends to occur?
- Inadequate uterine activity
- Obstruction of pelvic passage
- Malpresentation / malposition
What is defined as inadequate cervical dilatation in the active first stage of labour? What are some possible complications of this?
Less than 0.5cm per hour for primigravid women
Less than 1cm per hour for parous women
Inadequate dilatation may lead to obstruction of delivery and uterine rupture
How can you increase the strength and duration of contractions? Why is this needed?
By administering IV oxytocin
Because if uterine contractions are inadequate the fetal head will not descend and the exert force on the cervix, so the cervix will not dilate
What is cephalopelvic disproportion (CPD)? What are some possible complications?
A condition in which the baby’s head is too large to get through the maternal pelvis and be born
Complications:
Caput - swelling of the baby’s head
Moulding - The sutures of the baby’s skull begin to overlap (cross over each other)
Aside from CPD, what are some other pathologies that involve obstruction of the birth passage?
Placenta Praevia - low-line placenta, the placenta is presenting
Fetal anomaly - such as hydrocephalus
Fibroids - cervical myomas (benign growths of muscle tissue) can obstruct the birth canal
Can breech presentation babies be born vaginally?
Yes
Caesarean section is often recommended but Breech babies are capable of being born vaginally
Do babies have a constant presentation through their whole period of gestation?
No
Some babies may only assume vertex presentation at around 38 weeks into gestation, can be even later for multiparous women
How do you determine the fetal head position?
Through vaginal examination. Feel the fontanelles of the sutures of the baby’s skull though the vagina
The anterior fontanelle is diamond shaped, the posterior is triangular
What can be a significant complication of giving too much IV oxytocin for the fetus?
Uterine hyper-stimulation can cause fetal distress due to insufficient placental blood flow
What are the main causes (types) of fetal distress?
- Hypoxia
- Infection
rare:
- cord prolapse
- placental abruption (placenta separates from the uterus early)
- vasa praevia (fetal blood vessels present)
What is meconium?
The earliest stool of an infant, may be seen in the amniotic discharge and may indicate fetal distress
