FAILURE TO PROGRESS AND SHOULDER DYSTOCIA Flashcards Preview

OB/GYN > FAILURE TO PROGRESS AND SHOULDER DYSTOCIA > Flashcards

Flashcards in FAILURE TO PROGRESS AND SHOULDER DYSTOCIA Deck (20):
1

What are the three factors that determine the rate of progression in labour?

Passages

Passenger

Power

2

What are the factors associated with the passages (bony pelvis and soft tissue) that might lead to labour failing to progress?

Abnormal shaped pelvis
Cephalopelvic disproportion
Uterine/cervical fibroids
Cervical stenosis
Circumcision

3

What are the factors associated the fetus (passenger) that might lead to labour failing to progress?

Fetal size - macrosomia
Fetal abnormality
Fetal malpresentation
Fetal malposition

4

What are the factors associated with power or push that might lead to labour failing to progress?

Lack of coordinated regular strong uterine contractions

5

What are the normal rates of progression in terms of cervical dilation?

Primip - 0.5 - 1 cm/h

Multip - 1 - 2 cm/h

6

What are the causes of a woman having abnormal shaped pelvis, which might lead to her labour failing to progress?

Conditions:
Osteogenesis imperfecta
Ectopia vesicae
Dislocation of the hip at birth

Acquired:
Kyphosis of thoracic or lumbar spine
Scoliosis of spine
Spondylolisthesis
Pelvic fractures
Rickets/osteomalacia
Poliomyelitis in childhood

7

What conditions lead to macrosomia?

Diabetes
Hydrops fetalis - rhesus isoimmunization or parvovirus infection

8

What vertex presentations might lead to failure to progress in labour?

Occipito-posterior position
Occipito-transverse position

9

What proportion of vertex presentations will be occipito-posterior?

20%

10

How do we manage a fetus presenting in the occipito-posterior position?

Most will rotate spontaneously

Those that don't will either still deliver without problems, or can be turned manually or with an instrument.

11

What properties of contractions suggest inefficient uterine action?

Uncoordinated contractions

Fewer than 3-4 in 10 min

Lasting less than 60s

Delivering a pressure of less than 40 mmHg (recorded using a pressure catheter)

12

How do we manage a patient whose labour is failing to progress due to inefficient contractions?

Artificial rupture of membranes

Use of IV syntocinon - caution must be exercised in multiparous patient

13

How does artificial rupture of membrane help labour along?

Thought to release prostaglandins.

14

Why is it important to monitor fetus after administration of IV syntocinon?

If contractions become too frequent this can reduce oxygen exchange in the placental bed and lead to fetal hypoxia.

15

What might prompt a physician to consider delivery by caesarian section?

Presence of good contractions over several hours without significant progression in terms of cervical dilatation

16

What is shoulder dystocia?

This is when the head has been delivered but the shoulders (specifically the anterior shoulder) is unable to pass into the pelvic inlet.

17

What are the complications of shoulder dystocia?

Erb's palsy

Hypoxia due to cord compression whilst in the vagina

18

What is Erb's palsy?

Damage to nerve roots C4, C5 and C6 leading to paralysis of the arm

19

How is shoulder dystocia managed?

Do not pull on the head - leads to damage of brachial plexus

Lie patient flat and try following steps until they work:

Put them in McRoberts position, if this does not work then

Apply suprapubic pressure to dislodge and deliver anterior shoulder, if this does not work then

Use internal rotation techniques to try and rotate anterior shoulder from under pubic symphysis

Deliver posterior arm

20

What is McRoberts position?

Hyperflex the mother's knees onto her abdomen with her hips apart and apply suprapubic pressure