Abnormal Labour ( + Induction) Flashcards
How many labours are induced?
1 in every 5 labours are induced.
What is induction?
The artificial start of labour (not spontaneous labour).
- ripening cervix
- rupture of membranes
What are the stages of induction?
- cervical ripening
What changes should occur in the cervix during labour?
- effacement (thin/stretch)
- dilate (opens)
- softens
- moves from post -> ant
- cervix is drawn up into the uterus
What medication can be used to increase strength AND duration of contractions?
IV Oxytocin
How is cervical ripening done?
- Balloon, GOLD STANDARD
- prostaglandins
What should always be done during labour?
Foetal monitoring
What is an amniotomy?
Rupturing of the amniotic sac (membrane) done during induced labour.
When can an amniotomy be performed?
- When the cervix has dilated by 2-3cm
What is the bishops score?
A pre-labour scoring system used to predict whether induction will be needed.
What are the bishop scores?
<5 = labour won’t begin without induction
3 and lower = induction would not be successful
9 and higher = labour is likely to occur on its own
7 or higher = amniotomy can be done
What does the bishops score assess of the Cervix?
dilatation length of cervix position consistency station
What are indications for IOL (induction of labour)?
- diabetes
- Term + 7 days (41 weeks)
- fetal reasons
- social/maternal requests
- if water break >24hrs and labour hasn’t begun
Why is induction offered after 41 weeks?
Due to the increased risk of stillbirth
What are ‘power’ intrapartum complications?
- inadequate uterine activity/contractions
What are ‘passage’ intrapartum complications?
- cephalopelvic disproportion
- fibroids
- placenta praevia
What are ‘passenger’ intrapartum complications?
- malposition
- malpresentation
- foetal distress
- hydrocephalus
What is suboptimal for cervical dilatation?
- primigravida women =. <0.5cm per hour
- porous women = <1cm per hour
What must you rule out before giving IV oxytocin?
obstructions - because stimulation of an obstructed labour can cause a ruptured uterus
What is a sign of cephalopelvic disproportion?
- caput (swelling on babies head)
- moulding (babies skull moves on top of each other to try and make more room)
^ some of this is normal
what’s it called when the placenta lies below the babies head?
Placenta praevia - the baby can’t be delivered without haemorrhage of the mother
What is done when a baby is in the breech position?
The baby can be delivered this way.
In the UK, mothers are offered a Caesarean section
What is the main risk of transverse lie?
Limb/cord could descend through the cervix and could cause an obstructed labour
What is the optimum position for the babies head to be in?
Occipito-Anterior (occipital is anterior to mothers pelvis, so they are facing down)
