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Repro > Abnormal Labour and Postpartum Care > Flashcards

Abnormal Labour and Postpartum Care Flashcards

1
Q

Characteristics of failure to start labour

A
  • 1 in 5 pregnancies induced
  • Less efficient, more painful
  • Need foetal monitoring
  • Risk of uterine ‘hyperstimulation’ with prostaglandin/oxytocin induction
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2
Q

Indications for induction of labour

A
  • Diabetes (usually before due date)
  • Post date - term + 7 days
  • maternal health problems that necessitate planning of delivery e.g. treatment of DVT
  • Foetal reasons - growth concerns, oligohydramnios
  • Other
    • Social/maternal request/pelvic pain/’big’ babies
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3
Q

What is induction of labour

A
  • An attempt is made to instigate labour artificially using medications and/or devices to ‘ripen cervix’ followed usually by artificial rupture of membranes (performing an amniotomy)
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4
Q

What score is used to assess the cervix in labour

A
  • Bishop’s - the higher the score the more progressive change there is in the cervix and indicates that induction is likely to be successful
  • Cervix Assessment

0

1

2

3

Dilation (cm)

0

1-2

3-4

5+

Length if cervix (effacement) (cm)

3

2

1

0

Position

Posterior

Mid

Anterior

Consistency

Firm

Medium

Soft

Station (cm)

  • 3
  • 2
  • 1,0

+1, +2

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5
Q

How is labour induced if low Bishop’s score

A
  • Cervix not dilated and effaced
  • Vaginal prostaglandin pessaries/Cook Balloon can be used to ripen (open) cervix
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6
Q

What can be performed once the cervix is dilated and effaced

A
  • Amniotomy
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7
Q

What Bishop’s score is considered favourable for amniotomy

A
  • 7 or more
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8
Q

What is an amniotomy

A
  • Artificial ruptire of foetal membranes (‘waters’)
  • Usually a sharp device e.g. amniohook
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9
Q

In induction of labour what happens once the amniotomy has been performed

A
  • IV oxytocin can be used to achieve adequate contractions - aim for 4-5 in 10 mins
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10
Q

What are the stages of labour

A

*

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11
Q

What progress problems can occur during labour

A
  • Cephalopelvic disproportion (CPD)
  • Malposition - head in wrong position (occipito-posterior, occipito-transverse)
  • Malrepresentation (lie)
  • Inadequate uterine activity
  • Other reasons for obstruction (e.g. ovarian cyst of fibroid)
  • Foetal disease
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12
Q

How is progress of labour evaluated

A
  • Combination of abdominal and vaginal examinations to determine
    • Cervical effacement
    • Cervical dilatation
    • Descent of the foetal head through the maternal pelvis
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13
Q

What is considered suboptimal progress in the first stage of labour

A
  • defined by cervical dilation
    • <0.5cm per hour in primigravid
    • <1cm per hour for parous women
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14
Q

what happens if contractions are not adequate

A
  • The foetal head will not descend and exert force on the cervix and the cervix will not dilate
  • Important to check no obstruction as stimulation can result in ruptured uterus
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15
Q

What is cephalopelvic disproportion

A
  • Foetal head is in the correct position but is too large to negotiate the maternal pelvis
  • Caput and moulding develop
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16
Q

What can cause foetal distress

A
  • too many contractions (uterine hyper-stimulation) due to lack of blood flow to the placenta
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17
Q

How is foetal well-being monitored during labour

A
  • Intermittent auscultation of the foetal heart
  • Cardiotocography (CTG)
  • Foetal blood sampling
    • Used when abnormal CTG
    • Provides direct measurements
      • pH and base excess - measure hypoxia
  • Foetal ECG
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18
Q

When would advise not to labour be given

A
  • Obstruction of birth canal
    • Major placenta praevia, masses
  • Misrepresentations
    • Transverse, should, hand, breech
  • Medical conditions where labour would not be safe
  • Specific previous labour complications
    • Previous uterine rupture
  • Foetal conditions
19
Q

Types of assisted/instrumental delivery

A
  • 15% of all births
  • Forceps
  • Vacuum extraction
20
Q

When is C-section essential

A
  • Obstructed labour or foetal distress before cervix is fully dilated
  • UK rate 25%
21
Q

Risks of C-section

A
  • Infections
  • Bleeding
  • Visceral injury
  • VTE
22
Q

Benefits of C-section

A
  • Reduced risk of perineal injury
23
Q

3rd stage labour complications

A
  • Retained placenta
  • Post-partum haemorrhage
  • Tears
24
Q

What are the causes of post-partum haemorrhage

A
  • 4Ts
    • Trauma
    • Tissue
    • Tone
    • Thrombin
25
Q

Types of tears in labour

A
  • Graze
  • 1st degree
  • 2nd degree
  • 3rd degree
  • 4th degree
26
Q

What is the postpartum period of time called

A
  • puerperium
27
Q

Why is the midwife/health visitor seen for 9-10 days after birth

A
  • Observe for signs of abnormal bleeding
  • Observe for evidence of infection
    • Wound/endometritis/breast
  • Debrief events around birth (especially if emergency C-section)
28
Q

When do all women have a postnatal check up

A
  • 6 weeks at GP
29
Q

What are the common postnatal problems picked up on checkup (non-medical)

A
  • Problems with feeding
  • Problems with bonding
  • Social issues (partner, other children, financial)
30
Q

What are some postnatal problems (medical)

A
  • Post-partum haemorrhage
  • VTE
  • Sepsis
  • Psychiatric disorders of the puerperium
  • Pre-eclampsia
31
Q

Types of post partum haemorrhage

A
  • Primary - blood loss of >500ml within 24hrs of delivery
  • Secondary - blood loss of >500mls from 24hrs postpartum to 6 weeks
  • Lochia is normal for 3-4 weeks (normal period or less)
32
Q

Why is thromboembolic disease more of a risk when pregnant

A
  • Pregnancy and the postpartum period is a hypercoagulable state
  • 6-10x more likely to develop TE
33
Q

What is suspicious of thromboembolic disease

A
  • Unilateral leg swelling and/or pain
  • SOB
  • Chest pain
  • Tachycardia
  • May present atypically
34
Q

What further increases the risk of VTE in pregnancy

A
  • Immobilisation - spinal anaesthetic, C-section
35
Q

How should VTE be investigated in pregnancy

A
  • D-dimer unreliable
  • ECG
  • Leg doppler
  • CXR +/- VQ scan (radiation exposure during pregnancy/breast feeding)
36
Q

How should VTE be treated in pregnancy

A
  • Low molecular weight heparin
  • Warfarin is teratogenic, can be used in breastfeeding
37
Q

What is the leading cause of maternal death in the UK

A
  • Sepsis
  • May present atypically
38
Q

What is the treatment for maternal sepsis

A
  • Prompt IV antibiotics
  • Antipyretic measure
  • IV fluids
39
Q

How is maternal sepsis investigated

A
  • Full septic screen - blood cultures, LVS, MSSU, wound swabs
40
Q

What are the baby blues

A
  • Affect most women due to hormonal changes around the time of birth - after 1-3 days
41
Q

What is postnatal depression

A
  • Can continue from baby blues or start sometime later
  • Has classical depressive symptoms
  • Affects functioning, bonding and often requires treatment
  • Increased risk if personal or family history of affective disorder
42
Q

What is puerperal psychosis

A
  • rare but serious illness
  • Can be a danger to themselves and their baby
  • Inpatient psychiatric care
  • More common in women with personal/family history of affective disorder, bipolar, psychosis
43
Q

What occurs in postpartum hypertensive disorders

A
  • Most eclamptic seizures occur in the post-natal period
  • Pre-eclampsia can develop postnatally or may worsen several days following delivery

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