Prolonged Labour (Failure to Progress) |
Labour lasting longer than 20 hours in primigravidas or 14 hours in multiparas, often due to weak contractions or fetal malposition. |
- Administer oxytocin to strengthen contractions
- Consider assisted delivery (e.g., forceps or vacuum) or Caesarean section if no progress
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Fetal Distress |
Signs of fetal compromise such as abnormal fetal heart rate patterns or meconium-stained amniotic fluid, indicating insufficient oxygen. |
- Continuous fetal monitoring
- Immediate intervention (e.g., oxygen, IV fluids for the mother)
- Emergency Caesarean section if fetal distress persists
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Shoulder Dystocia |
Difficulty delivering the baby's shoulder after the head has delivered, often due to large fetal size (macrosomia). |
- McRoberts maneuver (maternal leg flexion and abduction)
- Suprapubic pressure to assist with delivery
- Consider episiotomy or operative delivery if necessary
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Postpartum Haemorrhage (PPH) |
Excessive bleeding after delivery, typically more than 500 mL following vaginal birth or 1,000 mL after Caesarean section. Common causes include uterine atony, retained placenta, or genital tract trauma. |
- Administer uterotonics (e.g., oxytocin, misoprostol)
- Perform uterine massage to promote contraction
- Surgical interventions if bleeding persists (e.g., uterine artery ligation or hysterectomy)
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Umbilical Cord Prolapse |
Occurs when the umbilical cord slips into the vagina ahead of the baby, leading to cord compression and reduced blood flow to the fetus. |
- Emergency Caesarean section
- Position the mother to relieve pressure on the cord (e.g., knee-chest position)
- Immediate manual elevation of the presenting part to relieve cord compression
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Uterine Rupture |
A rare but serious complication where the uterine wall tears, often along a previous Caesarean scar, leading to severe maternal and fetal complications. |
- Immediate Caesarean section
- Resuscitation with IV fluids and blood transfusion
- Emergency laparotomy and possible hysterectomy
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Breech Presentation |
When the baby’s buttocks or feet are positioned to be delivered first instead of the head. |
- Attempt external cephalic version (manually turning the baby)
- Consider Caesarean section for delivery
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Amniotic Fluid Embolism |
Rare but life-threatening condition where amniotic fluid enters the mother’s bloodstream, causing a severe allergic reaction. |
- Immediate supportive care in ICU (oxygenation, blood pressure stabilization)
- Intubation and mechanical ventilation
- Blood transfusion and correction of clotting abnormalities
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Cephalopelvic Disproportion (CPD) |
Occurs when the baby’s head is too large to pass through the mother’s pelvis, leading to labour obstruction. |
- Planned Caesarean section if CPD is diagnosed before labour
- In-labour Caesarean if CPD is identified during labour
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