Abnormal Labour and Post Partum Care

Question 1

when would you advise not to labour?

Answer 1

> certain foetal conditions
specific previous labour complications (previous uterine rupture)
maternal medical conditions
malpresentation
obstruction in the birth canal (masses or major placenta previa)

Question 2

what problems can failing to start labour cause?

Answer 2

> less efficient
more painful
risk of uterine hyperstimulation

Question 3

what indications of induction of labour are there?

Answer 3

> diabetes
term + 7 days
maternal health issues like DVT treatment
foetal reasons (oligohydramnios and growth concerns)

Question 4

describe the bishops score

Answer 4

used to clinically assess the cervix
> dilatation
> position
> station
> consistency
> length

Question 5

what should you monitor in failure to start labour?

Answer 5

the foetus

Question 6

if labour has failed to start and the cervix is not effaced or dilated how would you proceed?

Answer 6

the cervix needs to ripen
> vaginal prostaglandin pessaries
> cook balloon

Question 7

if labour has not started but the cervix is dilated and affected (with a score of 7) how may you proceed?

Answer 7

perform an amniotomy (artificial rupture of the foetal membranes with sharp device then use IV oxytocin to achieve contractions

Question 8

how would you assess progress of the pregnancy?

Answer 8

> cervical effacement
cervical dilation
descent of the foetal head through the maternal pelvis

Question 9

what would be suboptimal progress in primigravid?

Answer 9

<0.5cm per hour

Question 10

what would be suboptimal progress in a parus woman?

Answer 10

<1cm per hour

Question 11

what is the effect of inadequate uterine activity?

Answer 11

contractions are inadequate the foetal head will no descend to exert force on the cervix

Question 12

how would you manage inadequate uterine activity?

Answer 12

> exclude obstructed labour

> IV OXYTOCIN to increase strength and duration of contractions

Question 13

what is cephalopelvic disproportion?

Answer 13

foetal head is in the correct position but is too large for the maternal pelvis

Question 14

what is malpresentation?

Answer 14

the baby is not in vertex position
> longitudinal: breech
> transverse: arm, leg, shoulder
> umbilical cord EMERGENCY

Question 15

what is malposition?

Answer 15

foetal head in the incorrect position for labour

Question 16

give 2 examples of a malposition

Answer 16

> occipito-transverse

> occipito-posterior

Question 17

what causes foetal distress?

Answer 17

uterine hyperstimulation causing insufficient placental blood flow

Question 18

what is foetal distress determined by?

Answer 18

> intermittent auscultation of foetal heart
cardiotocography
foetal ecg
foetal blood sampling when GTG is abnormal (measuring base excesses and pH)

Question 19

what complications can arise in 3rd stage of labour?

Answer 19

> retained placenta
postpartum haemorrhage
tears

Question 20

what causes of post partum haemorrhage are there?

Answer 20

> tone
trauma
tissue
thrombin

Question 21

describe a 1st degree tear

Answer 21

superficial no muscle damage

Question 22

describe a second degree tear

Answer 22

involving the perineal muscles

Question 23

describe a 3rd degree tear

Answer 23

involving the anal sphincter

Question 24

what is involved in a 4th degree tear?

Answer 24

rectal mucous

Question 25

what is the management of foetal distress?

Answer 25

C-section to decrease the risk of perineal injury

Question 26

what complications are associated with c sections?

Answer 26

> venousthromboembolism > visceral injury > increased bleeding > increased infection

Question 27

what hypertensive disorder can occur in the post partum period?

Answer 27

eclamptic seizure

Question 28

what psychiatric problems can occur in the post partum period?

Answer 28

> postnatal depression > baby blues > puerperal risks

Question 29

what factors increase the risk of developing postnatal depression?

Answer 29

> family history | > personal history

Question 30

what increases the risk of developing puerperal psychosis?

Answer 30

> psychosis > family history > personal history > bipolar

Question 31

what is the management of puerperal psychosis?

Answer 31

inpatient psychiatric care

Question 32

what are the baby blues?

Answer 32

hormonal changes around the time of birth 1-3 days post natally

Question 33

what is the leading cause of maternal death?

Answer 33

maternal sepsis

Question 34

what would make you suspicious of a thromboembolic disease?

Answer 34

> unilateral leg swelling (+/- pain) > shortness of breath/chest pain > unexplained tachycardia

Question 35

what investigations would you carry out if you suspected a thromboembolic episode?

Answer 35

> ECG > leg dopplers > chest xray + v/q scan

Question 36

how is post partum thromboembolic disease treated?

Answer 36

low molecular weight heparin

Question 37

define primary post partum haemorrhage

Answer 37

blood loss over 500mls within 24hrs of delivery

Question 38

define secondary post partum haemorrhage

Answer 38

blood loss over 500mls from 24 hrs post partum to 6 weeks

Question 39

what is lochia?

Answer 39

normal bleeding 3-4 weeks post Nataly that is a period or less

Question 40

post partum period women are in a hypo or hyper coagulable state?

Answer 40

hyper

Question 41

what check ups do mum and baby receive post-nataly?

Answer 41

> midwife in first 9-10 days > referred to health visitor > GP 6 week check up