Complications Of Labour Flashcards by Bel Luscombe

3 stages of labour

Dilation
Birth
Afterbirth

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When does mother get urge to push during labour

Transition phase of dilation

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Diameter of cervix when fully dilated

10cm+

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Which shoulder is normally delivered first

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Labour lengths defined as failure to progress

First delivery - 20+ hrs
2nd+ delivery - 14+hrs

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In which phase of labour is failure to progress most dangerous

Active

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Causes of prolonged labour

Slow cervical dilation
Slow effacement
Large baby
Small birth canal/ pelvis
Multiple delivery
Worry, stress, fear
Pain medications

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Labour inducing medications

Oxytocin
Misoprostal
Mifepristone
Oestrogen pessary

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Surgical management of failure to progress

Membrane sweep
C section

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Management of failure to progress

Wait
Labour inducing medications
Surgery

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Membrane sweep

Digitally push amniotic sac away from uterine wall to make it easier to fully engage cervix

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Instruments used in labour

Forceps
Ventouse

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Indications for forceps or ventouse delivery

Maternal exhaustion
Conditions where expulsive efforts prohibited
Breech
Fetal compromise
Low birth weight
Post maturity

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Where would the vacuum cup be aimed in a ventouse delivery

Back of head

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Forceps delivery complications

Bruising
Marks on skin
Cephalohematoma
Retinal haemorrhage
Skull fracture
Permanent nerve/brain damage
Soft tissue damage in mother

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Ventouse delivery complications

Scalp abrasion/laceration
Scalp necrosis
Cephalohematoma
Intracranial haemorrhage
Retinal haemorrhage
Vaginal laceration from entrapment of mucosa by suction cup

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Are forceps or ventouse more traumatic to mother and baby

Forceps

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Causes of non reassuring fetal status

Insufficient oxygen levels
Maternal anaemia
Pregnancy induced hypertension
IUGR
meconium stained amniotic fluid

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How can oxygen saturation be measured in the fetus during delivery

Scalp electrode

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How many attempts can be made at a ventouse or forceps delivery

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Characteristics linked to non reassuring fetal status

Irregular heartbeat
Muscle tone problems
Movement problems
Low amniotic fluid volume

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How is fetal status monitored

Heart rate
Oxygen status

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Cardiotocography

Continuous fetal heart rate monitoring while in labour

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What can cause acceleration of fetal heart rate during delivery

Fetal movement
Scalp stimulation

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What indicates the fetal head is compressed and the fetus is in the correct position during delivery

Early heart rate deceleration

What can cause late decelerations in fetal heart rate

Placental insufficiency

How does cord compression affect fetal heart rate

Variable decelerations - Abrupt decrease with rapid recovery

How can non reassuring fetal status be managed

Change mothers position Increase maternal hydration Maintain maternal oxygenation Amnioinfusion Tocolysis IV hypertonic dextrose C section

Tocolysis

Temporary stoppage of contractions to delay preterm labour

Amnioinfusion

Fluid inserted into amniotic cavity to relieve pressure on umbilical cord

Perinatal asphyxia

Failure to initiate and sustain breathing at birth

What can perinatal asphyxia lead to

Hypoxaemia High CO2 level Acidosis CV, neuro, and organ problems

Symptoms of perinatal asphyxia before birth

Low HR low pH Low oxygen level

What does APGAR score assess

Appearance Pulse Grimace Activity Respiration

Perinatal asphyxia signs at birth

APGAR score below 3 Poor skin colour Low HR Weak muscle tone Gasping Weak breathing Meconium stained amniotic fluid

Perinatal asphyxia treatment

Providing oxygen to mother C section Stimulate baby Mechanical breathing Medication

What does a baby being born stained green indicate

Meconium released in utero

Shoulder dystocia

Head delivered vaginally but shoulders get stuck

Shoulder dystocia management

Changing mothers position Manually turning baby’s shoulders - mcroberts manoeuvre Episiotomy

What complications can shoulder dystocia lead to in the fetus

Brachial plexus injury - erb duchenne palsy Humerus/ collar bone fracture Hypoxic ischemic brain injury

What can shoulder dystocia lead to in the mother

Tearing Bleeding

How much blood does the mother ususally lose in a single vaginal delivery

500ml

How much blood does a mother use in a single C section

1000ml

What is the most common cause of postpartum haemorrhage

Lack of uterine tone

What causes postpartum haemorrhage

Uterine contractions after placenta expelled too weak to compress blood vessels where placenta attached to uterus

What can postpartum haemorrhage lead to

Low blood pressure Organ failure Shock Death Lack of nutrition in milk

What can increase the chance of postpartum haemorrhage

Placental abruption Placenta praevia Uterine overdistension Prolonged labour Forceps or ventouse General anaesthesia Drugs to induce/stop labour Infection Obesity Cervical, vaginal, uterine Blood vessel tears Hematoma Blood clotting disorders Uterine rupture

Postpartum haemorrhage treatment

Erogotamine Uterina massage Balloon tamponade Removal of retained placenta Uterine packing Tying off vessels Surgery to find bleeding cause Hysterectomy

3 types of breech

Frank breech - buttocks first Complete breech - feet first Footing breech - legs first

Management of malposition

Manually change position Forceps Episiotomy C section

What makes breech position more likely

Multiple pregnancy Oligohydramnios/Polyhydramnios Placenta praevia Uterine fibroids

Placenta praevia

Placenta covers cervix opening

Placenta praevia treatment

Bed rest Supervised rest in hospital Blood transfusion C section

Cephalopelvic disproportion

Baby’s head unable to fit through mothers pelvis

Cephalopelvic disproportion management

C section

What increases uterine rupture risk

Previous c section Labour induction Large baby Polyhydramnios Maternal age 35+ Use of instruments in delivery

Uterine rupture management

Deliver at hospital C section Blood transfusion

Uterine rupture signs

Abnormal fetal HR Abdo pain Uterine tenderness PV bleeding Slow progress in labour Rapid HR and low BP in mother

What complications can uterine rupture lead to

Fetal Oxygen deprivation Excessive bleeding Cervix/vaginal tears PP shock Fetal Aspiration of amniotic fluid Infection

Precipitous labour

Labours lasts less than 3 hrs

What increases chance of precipitous labour

Small baby Uterus contracts efficiently and strongly Compliant birth canal

When can precipitous labour starts

1st stage of labour 2nd stage of labour

Complications Of Labour Flashcards

(62 cards)