Abnormal labour, Disproportion, Deep Transverse Arrest, Occipital- posterior position Flashcards
(32 cards)
What is cephalopelvic disproportion (CPD)?
A misfit between the foetal presenting part and the maternal pelvis.
List three pelvic causes of CPD.
Contracted pelvis, abnormal pelvic shape (e.g., platypelloid), pelvic deformities (e.g., rickets).
List three foetal causes of CPD.
Large fetus (e.g., in diabetes), fetal anomalies (e.g., hydrocephalus), malposition (e.g., OP).
What are historical risk factors for CPD?
History of pelvic trauma, difficult instrumental deliveries, previous macrosomia or prolonged labour.
What are physical signs or risk factors suggestive of CPD?
Height <152 cm, abnormal gait, spinal/pelvic asymmetry, polyhydramnios, uterine overdistension.
What is the purpose of clinical pelvimetry?
To assess the pelvic brim, cavity, and outlet (typically between 36–38 weeks).
What are indications for X-ray pelvimetry?
Malpresentation, pelvic abnormality, previous CS, previous prolonged labour, suspected CPD.
What is the head fitting test?
A clinical method to assess the engagement of the foetal head in late pregnancy.
How is CPD diagnosed in labour?
Slow or no progress in labour despite good contractions; may lead to obstructed labour.
What are the management options for CPD?
Emergency CS, symphysiotomy, destructive operations (e.g., craniotomy).
What is a trial of labour and when is it considered?
Supervised vaginal delivery attempt in a primigravida with mild CPD.
What is the goal of a trial of labour?
To achieve vaginal delivery if uterine contractions and head moulding are favourable.
What are key features of occipitoposterior (OP) position?
Foetal occiput lies posteriorly instead of anteriorly; occurs in ~10% of cases.
What is the aetiology of OP position?
Cord around neck, anterior placenta, poor foetal tone, abnormal pelvis, unknown.
What are the late pregnancy signs of OP?
Fundal height greater than dates, periumbilical flattening, foetal limbs palpable anteriorly.
What are the first and second stage signs of OP in labour?
Floating head at brim, early rupture of membranes, anterior fontanelle felt, slow descent.
What is the management of persistent OP position?
Conservative monitoring, oxytocin augmentation, instrumental delivery with episiotomy.
What complications are associated with OP position?
Prolonged labour, membrane rupture, deflexed head, arrest in mid-cavity, tentorial tear.
What is uterine rupture?
A tear in the uterine wall, either spontaneous or traumatic, during pregnancy or labour.
What is the incidence of uterine rupture in developing vs developed countries?
1:200 in developing countries; 1:4000 in developed countries.
What are types of uterine rupture occurring during pregnancy?
Scar rupture (e.g., classical CS), accessory horn pregnancy, uterine manipulation with prior scar.
List three causes of uterine rupture during labour.
Scarred uterus, especially after CS, obstructed labour, misuse of oxytocin.
What are causes of rupture in an unscarred uterus?
Obstructed labour, overuse of oxytocin, especially in grand multiparas.
What are traumatic causes of uterine rupture?
Forceps delivery (e.g., Kielland’s), destructive procedures, internal podalic version.
