abnormal labour

Question 1

how many labours are induced?

Answer 1

about 1 in 5

Question 2

what are the disadvantages of induction?

Answer 2

• need foetal monitoring

- need for cervical ripening (prostaglandins, balloon)

Question 3

what is there risk of the prostaglandin/oxytocin induction?

Answer 3

hyperstimulation

Question 4

what are the indications for induction?

Answer 4

• diabetes
• post dates
• maternal need for planning of delivery
• foetal reasons (growth concerns, oligohydramnios)
• social/maternal request

Question 5

describe the process of induction

Answer 5

cervix dilated and effaced
amniotomy
IV oxytocin

Question 6

what is induction of labour?

Answer 6

an attempt to instigate labour artificially
using medications/devices to “ripen cervix”
and artificial rupture of membranes (performing an amniotomy)

Question 7

what score is used to clinically assess the cervix?

Answer 7

Bishop’s score

the higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful.

Question 8

how is progress evaluated in labour

Answer 8

• cervical effacement
• cervical dilatation
• descent of the fetal head through the maternal pelvis

Question 9

describe intrapartum complications because of power

Answer 9

inadequate uterine activity

• > inadequate contractions
• > foetal head will not descend and exert force on the cervix
• > cervix will not dilate

Question 10

how can the strength and duration of contractions be increased?

Answer 10

synthetic IV oxytocin to the mother

Question 11

what could stimulation of an obstructed labour lead to?

Answer 11

ruptured uterus

Question 12

describe intrapartum complications because of passages

Answer 12

cephalopelvic disproportion

• foetal head in correct position but too large to negotiate maternal pelvis
• caput and moulding develop

other obstruction

• placenta praevia
• foetal anomaly
• fibroids

Question 13

describe intrapartum complications because of passengers

Answer 13

malpresentation

• longituidinal lie with breech presentation
• longituidinal lie with vertex presentation
• transverse lie with shoulder presentation

malposition

• occipito-posterior
• occipito-transverse

Question 14

describe foetal distress

Answer 14

inability of foetus to cope with stresses of labour due to insufficient placental blood flow

causes

• uterine hyperstimulation (too many contractions)
• hypoxia
• infection
• cord prolapse
• placental abruption
• vasa praevia

Question 15

what is foetal monitoring during labour

Answer 15

intermittent auscultation of the foetal heart

cardiotocography (if abnormal -> foetal blood sampling)

foetal blood sampling: pH (measure of hypoxaemia), base excess, lactic acid

foetal ECG

Question 16

describe operative delivery

Answer 16

instrumental (forceps/ventouse)

caesarean section (planned/emergency)

Question 17

what are some 3rd stage complications of pregnancy

Answer 17

retained placenta

post partum haemorrhage
- 4Ts (tone, thrombosis, tissue, thrombin)

tears
- graze, 1st °, 2nd °, 3rd ° (anal sphincter complex), 4th° (rectal mucosa)

Question 18

what are intrapartum complications

Answer 18

• powers
• passages
• passenger