Abnormal Labour and Postpartum Care Flashcards
(37 cards)
How many labours are induced?
1 in 5 labours.
What are the potential drawbacks for inducing a labour?
- Induced labours are largely thought to be less efficient than a natural labour. - Induced labour is more painful, requiring greater pain relief for women too. - Induced labour can cause foetal distress, particularly due to “hypercontractions” - with IV oxytocin.
What are the indications to induce labour?
- Diabetes
- Post dates - Term + 7 days
- Maternal health problem that necessitates planning of delivery e.g. on treatment for DVT.
- Foetal reasons
- distress
- growth concerns
- oligohydraminos (less amniotic fluid)
Others include:
- Social reasons
- maternal request
- pelvic pain
- “big” babies
What does the induction of labour involve?
- Vaginal examination to determine the “ripeness” of the cervix - (effacement etc.)
- Open cervix, either through the use of medications or devices.
- Artificial rupture of the membranes using a hook (break the waters) - Amniotomy.
- Use of IV Oxytocin to start contractions.
What is Bishop’s Score?
A score used to clinically asses the cervix. The higher the score the more progressive change there is in the cervix and indicates that induction is likely to be successful.
How does the woman Bishop’s Score dictate about her induction into labour?
Lower Bishops Score (not dilated and effaced) - use of vaginal prostaglandins and pessaries/ Cook Balloon used to open the cervix.
What are the 3 P’s in terms of the factors of Labour? Give an example of them.
Powers
- inadequate progress (contraction number, strength etc. - inadequate uterine activity)
Passages
- Cephalopelvic disproportion (CPD) (Head of baby and passage aren’t compatible)
- Ovarian cyst or fibroid (obstruction)
Passenger
- Fetal distress
- Malposition/Malpresentation
How is the progress of labour determined?
Evaluated by a combination of abdominal and vaginal examination to determine: - Cervical effacement - Cervical dilation - Descent of the fetal head through the maternal pelvis.
What is suboptimal progress defined as in terms of cervical dilation?
- Less than 0.5cm per hour for primigravid women. - Less than 1cm per hour for parous women.
Generally outline “inadequate uterine activity” How is it treated? What much be ensured prior to this treatement?
- Inadequate contractions mean the fetal head will not descend and exert force on the cervix, meaning the cervix will not dilate. - Strength and duration of contractions will be increased by giving a synthetic IV oxytocin to the mother. - It is very important to exclude an obstructed labour as stimulation of an obstructed labour can result in a ruptured uterus.
Generally outline Cephalopelvic disproportion (CPD).
- Relatively rare - Means that the foetal head is in the correct position for labour but it is too large to negotiate the maternal pelvis. - Caput (swelling) and moulding can develop.
What are malposition and malpresentation?
Malposition - baby is in the wrong position, such as transverse or breech. Malpresentation - the foetal head is in the incorrect position for labour and “relative” CPD occurs (This is quite common)
What is cord prolapse?
EMERGENCY The umbilical cord protrudes through the cervix, this is an emergency as it hits the cold air, contracts and circulation to the foetus stops.
What are the 3 types of lie the foetus can be found in?
Longitudinal - cephalic or breech Transverse Oblique
Generally outline foetal distress.
Foetuses are well equipped to deal with stresses of labour. But not all of them are able to cope. Too many contractions (uterine hyper-stimulation) for example can result in foetal distress due to insufficient placental blood flow.
How can foetal well being during labour be determined?
- Intermittent auscultation of the fetal heart - Cardiotocography - Fetal blood sampling - Fetal ECG (CTG)
When is foetal blood sampling used and what does it measure?
Used when there is an abnormal CTG. It provides a direct measurement from the baby. - measure pH and base excess - pH gives a measure of likely hypoxaemia (if acidic for example)
What are the scenarios in which it is not advisable to induce labour?
- Obstructed birth canal
- Major placenta praevia (grows over cervix opening)
- Masses
- Malpresentations
- Transverse
- Shoulder
- Hand
- Breech
- Medical conditions where labour wouldn’t be safe for woman.
- Specific previous labour complications.
- Previous uterine rupture
- Foetal conditions.
What % of births are assisted/instrumental births>
15%
Generally outline Caesarian section in abnormal labour.
- An essential procedure used to manage obstructed labour or fetal distress before cervix is fully dilated.
- Carries increased infection, bledding, viceral injury and VTE risk than normal vaginal birth.
- Reduced risk of perineal injury compared with vaginal birth.
What are the common 3rd stage of labour complications?
- Retained placenta - may require controlled cord traction. - Post partum haemorrhage - Tears (Ranging from graze, 1st degree tear up to 4th degree tear)
What occurs in the postpartum period for the women? (in terms of GP, obs, checks etc..) Common problems??
Sees midwife for 1st 9-10 days, then a health visitor. - Observe signs of abnormal bleeding - Observe signs of infection (wound, endometritis, breast) - Debrief events around birth - All women have 6 week postnatal check at the GP - Consider contraception Common problems: - Problems with infant feeding - Problems with bonding - Social issues (partner, other children & financial)
What are the most common postnatal problems?
Post partum haemorrhage Venous thromboembolism Sepsis Psychiatric disorders post partum Pre-eclampsia - can present late in post partum too!
What is the difference in Primary and Secondary PPH? The 4 Ts?
Primary Post Partum Haemorrhage - Blood loss of >500ml within 24 hours of delivery 4 T’s - Tone, Trauma, Tissue, Thrombin Secondary - Blood loss >500ml from 24 hrs post partum to 6 weeks (retained tissue, endometritis (infection), tears/trauma
