Chapter 8: Complications During Labour & Birth

Complications During Labour & Birth explains the use of the Bishop score to assess cervical readiness and describes various methods for cervical ripening, including mechanical dilators and pharmacological agents like prostaglandins, alongside the administration of oxytocin and the performance of amniotomy (artificial rupture of membranes). The text outlines critical obstetrical procedures such as amnioinfusion to relieve umbilical cord compression, external cephalic version to correct breech presentations, and operative vaginal births facilitated by forceps or vacuum extraction. A significant portion is dedicated to Caesarean birth, discussing indications, contraindications, the differences between skin and uterine incisions (such as low transverse versus classic), and the management of vaginal birth after Caesarean (VBAC). The chapter further explores abnormal labour patterns, or dystocia, analyzing causes related to the "five Ps"—powers, passenger, passageway, position, and psyche—and distinguishing between hypertonic and hypotonic uterine dysfunction. It addresses challenges related to fetal size, such as macrosomia and shoulder dystocia, as well as multifetal pregnancies and precipitate labour. The management of premature rupture of membranes (PROM) and preterm labour is examined, emphasizing the use of tocolytics like magnesium sulphate for fetal neuroprotection and glucocorticoids to accelerate fetal lung maturity. Finally, the summary covers life-threatening obstetrical emergencies, including umbilical cord prolapse, uterine rupture, placenta accreta, and amniotic fluid embolism (anaphylactoid syndrome), highlighting the urgent need for rapid nursing assessment and multidisciplinary intervention to ensure maternal and fetal safety.