Abnormal Labour + Birth

Question 1

How many pregnancies are induced?

Answer 1

1 in 5
Less efficient and more painful
Needs fetal monitoring
Risk of hyperstimulation of PGI’s and oxytocin

Question 2

What are the indications for induction?

Answer 2

Diabetes
Term +7 days
Maternal health problems
Fetal reasons

Question 3

What does induction involve?

Answer 3

Ripen the cervix followed by artificial rupture of membranes

Question 4

What is the Bishop’s score?

Answer 4

Used to assess the cervix, higher score = more progressive change the more likely induction is to be successful

Question 5

What is the process for the induction of labour?

Answer 5

Cervix not dilated = pessaries or balloons to open the cervix
A bishops score (7+) for amniotomy
IV oxytocin can be used to achieve adequate contractions (4-5/10mins)

Question 6

How is progress in labour evaluated?

Answer 6

Cervical effacement
Cervical dilation
Descent of the fetal head through the pelvis

Question 7

What happens in inadequate uterine activity

Answer 7

Fetal head will not descend and the cervix will not dilate

Synthetic IV oxytocin is given

Question 8

What is cephalopelvic disproportion?

Answer 8

The fetal head is in the correct position but is too large to negotiate the maternal pelvis

Question 9

What is the correct presentation and position?

Answer 9

Should be longitudinal with cephalic presentation with occiput anterior position

Question 10

How is fetal wellbeing determined in labour?

Answer 10

Auscultation of the fetal heart
Cardiotocography
Fetal blood sampling (pH and base excess)
Fetal ECG

Question 11

What situations is labour not advised in?

Answer 11

Obstruction to birth canal
Malpresentations
Medical conditions where labour would not be safe for women
Specific previous labour complications
Fetal conditions

Question 12

What can be used in assisted delivery

Answer 12

Forceps
Vacuum extraction
Caesarian section

Question 13

What is a 3rd stage complication?

Answer 13

Retained placenta
Post partum haemorrhage
Tears

Question 14

What happens in the normal post partum period?

Answer 14

See midwife for first 9-10 days and then the health visitor

All women 6 weeks visit GP

Question 15

What are common post partum problems?

Answer 15

PP haemorrhage (PPH)
-Primary = >500ml within 24hrs (tone, trauma, tissue and thrombin - 4T’s)
-Secondary = >500ml from 24hrs to 6 weeks (retained tissue, endometritis, tears and trauma)
Venous thromboembolism (6-10 times more likely)
Sepsis
Psychiatric problems
Infant feeding
Bonding
Social issues (partner, other child, financial)

Question 16

When is the hearing test and spot test normally done in a newborn?

Answer 16

5-8 days

Question 17

Pregnancy and blood

Answer 17

Thromboembolic disease = 6-10x more likely to get a DVT

Need prophylaxis