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Flashcards in Complications Exam Deck (350)
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What is the gestation of a prolonged pregnancy?

42 weeks or beyond


Name 8 possible reasons for a prolonged pregnancy

- Inaccuracy of dating
- Malpresentation
- Malposition
- Cephalopelvic disproportion
- Hereditary and ethnic origin
- Seasonal variations
- Congenital abnormalities
- Maternal stress, anxieties and fears


List 8 potential maternal complications of a prolonged pregnancy

- Anxiety and fear
- Macrosomic fetus
- Cephalopelvic disproportion
- Shoulder dystocia
- Perineal, vaginal and cervical trauma
- Increased risk of LUSCS
- Chorioamnionitis


List 8 potential fetal complications of a prolonged pregnancy

- Post maturity
- Macrosomia
- Fetal distress
- Birth asphyxia
- Shoulder dystocia (neurological and orthopaedic trauma)
- Increased risk of neonatal seizures
- Hypoglycaemia
- Stillbirth / perinatal death


If a mother wishes to avoid induction, what type of management can be offered?

Expectant management


What is expectant management of prolonged pregnancy?

If no obvious complications with the mother or baby and the mother wishes to avoid induction then fetal surveillance should be offered from 41 weeks. This includes:
- Fetal kick chart
- Non stress test (CTG)
- Amniotic fluid measurement
- Biophysical profile


What is an induction of labour?

It involves the stimulation of contractions prior to the onset of spontaneous labour.


List 8 indications (reasons) for the induction of labour

- Prolonged pregnancy
- Obstetric or medical complications
- Poor obstetric history
- Fetal wellbeing
- Prolonged rupture of membranes
- Unstable lie
- Maternal request
- Intrauterine death


List 8 contraindications (reasons not to) for induction of labour

- Placenta praevia
- Malpresentation
- Cord presentation / prolapse
- Cephalopelvic disproportion
- Severe fetal compromise
- Active genital herpes
- Previous LUSCS
- Maternal condition


How is the best method of induction determined?

The cervix is assessed using the modified Bishop's score


List the 5 factors that are assessed using the Bishop's score

- Dilatation (cm)
- Length of cervix (cm)
- Station (cm)
- Consistency of cervix
- Position of cervix


List 10 natural methods of induction

- Sexual intercourse
- Clitoral stimulation
- Nipple stimulation
- Pineapple
- Reflexology
- Castor oil
- Raspberry leaf tea
- Exercise
- Homeopathy
- Membrane sweep


What is the medical method of induction?

The use of oxytocic drugs which cause the uterus to contract


What are the three types of oxytocic drugs and what effect do they have?

- Propess (synthetic prostaglandin E2 in pessary form) - causes cervical ripening
- Prostin (synthetic prostaglandin E2 & F2 in gel form) - causes cervical ripening and uterine contractions
- Synthetic oxytocin (administered IV) - stimulates uterine contraction


What is the NHS Forth Valley protocol for the induction of labour on a woman with intact membranes?

On a nulliparous woman with a Bishop score of:
- 4 or less = Propess pessary 10mg for 24 hours

- 7 or less = Prostaglandin E2 gel 1mg. Review and repeat every 6 hours with a maximum of 3 doses in 24 hours


What is the NHS Forth Valley protocol for the induction of labour on a woman with ruptured membranes?

Add 30 IU of Syntocinon to a 500ml infusion bag of normal saline and give via an infusion pump with a non-return valve.
Dose should start at 1ml/hour and increase every 30 minutes dependant upon uterine activity and fetal and maternal wellbeing


What should be undertaken following the induction process?

Continuous fetal monitoring for 30-60 minutes while the woman remains recumbent to maximise the effectiveness of the prostaglandins


List 7 potential risks involved with induction of labour

- Hyperstimulation / hypercontractability
- Uterine rupture
- Increased sensitivity to pain
- Pyrexia
- Vasodilation and hypotension
- Inflammation
- Gastro-intestinal disturbance


What 3 medications can be given to counteract contractions if an adverse reaction occurs?

Salbutamol, ritodrine or terbutaline


What is the surgical method of induction and what two things should be done at the time of the procedure?

Amniotomy or artificial rupture of the membranes.
Documentation of amount and colour of liquor is vital!
Fetal heart should be auscultated before and after procedure.


What effect does syntocinon have on endogenous oxytocin production?

It does not suppress the production


What is the half life of syntocinon?

Approximately 15 minutes


How long can the syntocinon regime continue if labour does not establish?

5 hours


In what 4 circumstances should the explicit approval of the consultant be given before the use of syntocinon?

- Multiple pregnancy
- Malpresentation
- Previous LUSCS or other uterine scar
- Grandmultiparity


List 12 potential side effects of the use of syntocinon

- Overstimulation
- Contraction of umbilical blood vessels
- Constriction / Dilatation of blood vessels
- Nausea
- Trauma
- Uterine rupture
- Placental abruption
- DIC (disseminated intravascular coagulation)
- Amniotic fluid embolism
- Fetal hypoxia
- Neonatal jaundice


List 5 points in the midwifery management of induction

- Full informed discussion with woman prior to procedure
- Gain consent
- Ensure suitability for induction
- Appropriate method of induction used and administered
- Continuously monitor wellbeing of fetus and mother throughout


When can disordered uterine action occur and what is it attributed to?

It can occur at any stage in labour and is attributed to an abnormal pattern in uterine contractability


What can disordered uterine action result in?

Slow or rapid progress in labour


What is the most common cause of prolonged labour in primigravid women?

Inefficient uterine activity


In what type of women, is over efficient uterine activity most common?

Multiparous women