risk factors increasing the risk of labor dystocia
- obesity
- diabetes
- multiparty
- maternal pelvic size
- cephalopelvic disproportion
- presentation/position
variations with Passenger that may slow labor:
- macrosomnia
- shoulder dystocia
- presentation
- position
cephalo-pelvic disproportion (CPD)
- fetal head too large to pass through the pelvis
- can be due to large fetus, malposition
cues of macrosomia fetus
- SFH larger than weeks of gestation
- mom did not experience fetal descent or groping into pelvis (lightning)
- excess weight gain
- partner is above average height and weight
difference between a caput and cephalohematoma
- caput crosses suture lines and cephalhematoma does not
cues for shoulder dystocia
- only shows during second stage of Labour
- slow crowning
- difficulty delivering face
- head recoils to perineum (turtle)
- no restitution and external rotation
- failure for shoulders to descend
shoulder dystocia results when:
- fetus is too large
- or maternal pelvis is too small
- 50-60% of cases occur with fetuses less than 4000g
what are the 4 P’s to avoid if shoulder dystocia is a concern
- DO NOT
- pull on the head
- Push on the fundus
- Pivot or rotate the head
- Panci
what does ALARMER stand for
- Ask for help
- Lift legs (McRoberts Maneuver)
- Anterior shoulder disimpaction (pressure on pelvis or Rubin maneuver vaginal)
- Rotation of posterior arm (woods maneuver - rotate fetus)
- Manual removal of posterior arm
- Episiotomy
- Roll onto all fours
malpresentation
- breech, footling
- may try to turn baby (ECV)
- can be assessed by leopoldo maneuver
malposition
- most common is a occiput posterior position (OP, ROP, or LOP)
Variations with Passage (soft tissue obstructions:)
- placenta previa, uterine fibroids, tumors, full bladder, full rectum
Passage: persistent cervical lip
- cervical effacement does not occur with dilation
- associated with OP positioning
- causes edema and dilation resistance
position and psyche variances
- need to encourage movement and position changes as much as possible
- cathecholmines can cause dysfunctional labour due to increased stress response
what is the first medical intervention considered when labour is not progressing?
- augment labour by an artificial rupture of membranes (ARM) or amniotomy - allowing the head to descend more
- IS ONLY DONE IF PRESENTING PART IS ENGAGED
what is the most common method to augment labour?
- synthetic oxytocin used to induce labour (start contractions)
- most commonly associated with adverse events
maternal risks with oxytocin:
-tachysystole
- placental abruption
- uterine abruption
- uterine rupture
- ceasarean birth
- PPH
Fetal risks with oxytocin
- poor oxygenation
- abnormal FHR
- hypoxemia
- acidosis
what is tachysystole
- 5 or more contractions in 10 minutes over 30 mins
- resting tone less than 30 seconds
- contraction lasting over 90 seconds
what is the most common reason for ceasarean births?
- labour dystocia
other indications for cesareans are:
- fetal distress, breech presentation, malposition/presentation, placenta previa, abruptioplacenta, active herpes, maternal request
