Labour problems Flashcards
(56 cards)
Problems with power and failure to progress in labour
Inefficient uterine action
Normal uterine contraction rate
45-60 second long contractions every 2-3 minutes in active labour. During delivery can slow to 60-90sec duration every 3-5mins
Mums likely to have Inefficient uterine action
Nulliparous
Management of Inefficient uterine action at different labour stages
1st stage = Augmentation via artificial rupture of membranes/amniotomy or oxytocin infusion. Exclude malpresentation!
2nd stage passive = nulliparous women given oxytocin infusion if delayed by 2hrs.
2nd stage active = if delay over 1hr consider episiotomy or instrumental delivery depending on fetal position.
Adverse effects of augmentation of labour
Hyperactive uterine action, fetal distress, increase risk of uterine rupture of previous C/S
Contraindications for augmentation in prolonged labour
Placenta or vasa previa Umbilical cord presentation Prior classical uterine incision Active genital herpes infection Pelvic structural deformities Invasive cervical cancer
Problems with passage and failure to progress in labour
Obstruction from abnomral pelvic architecture, pelvic mass (fibroid or tumour), cephalo-pelvic disproportion.
Causes of an abnormal pelvic architecture
Rickets, osteomalacia, spinal abnormality (scoliosis), polio
Problems with passenger and failure to progress in labour
Macrosomia
Poor presentation (breech, occiput-posterior, brow, occiput-transverse, face)
Fetal hydrocephalus.
Bishops Score
Less than 5 = labour unlikely to happen without intervention.
Over 5= labour will occur spontaneously.
Comprised of = Cervical dilation, length of cervix, station of head above ischial spines, cervical consistency, position of cervix.
Methods for inducing labour
Membrane sweep - releases prostaglandins and separates the amniotic membranes from the walls of the cervix.
Vaginal PGE2
Amniotomy plus/minus oxytocin.
Use of prostaglandin gel
Tablet or gel - Can give 2nd dose after 6hrs but subsequent ones not useful.
Pessary release - one over 24hrs.
Assess Bishop score after 6hrs.
Surgical methods for inducing labour
Amniotomy, add oxytocin infusion if no progress after 2hrs.
Examples of indications for inducing labour
Prolonged pregnancy (over42weeks), IUGR, antepartum haemorrrhage, preterm rupture of membranes, pre-eclampsia, gestational diabetes, in-utero death.
Cord prolapse definition
umbilical cord descends before fetus.
Complications of cord prolapse
Compression of cord and cord spasms
Fetal hypoxia
Cerebral palsy and irreversible fetal damage - death.
Risk factors for cord prolapse
Premature, breech presentation, abnormal lie, polyhydramnios, multiple pregnancy esp not the first baby delivered, placenta praevia, artificial rupture of membranes.
Clinical features of cord prolapse
No features in mum, unless see or feel prolapsed cord.
Fetus will have bradycardia.
Investigations and management of cord prolapse
Vaginal examination
DELIVER THE BABY - c-section ASAP, try not to handle cord too much but could push back to avoid compression.
Shoulder dystocia definition
Failure for the anterior shoulder to pass under the symphysis pubis after delivery of the fetal head that requires specific manoeuvres to facilitate delivery
Risk factors for shoulder dystocia
Previous history Macrosomia DM High maternal BMI Induction of labour Prolonged 1st or 2nd phase of labour Use of oxytocin
Signs of shoulder dystocia in birth
Difficulty delivery face and chin, failure of restitution of head, failure of shoulders to descend, retracting head = turtle neck sign.
Management of shoulder dystocia
Call for help! McRobert's Manoeuvre (thighs to abdo) Suprapubic pressure Consider episiotomy or internal manouevers e.g. rotation. Discourage maternal pushing.
Complications of shoulder dystocia
Maternal = PPH, perineal tears, bladder injury. Baby = brachial plexus injury (Erb's palsy), hypoxia, clavicle or humerus fracture.
