Intrapartum & Postpartum Care

Question 1

Breastfeeding reduces the mothers risk of which diseases?

Answer 1

1) Breast, Uterine and Ovarian cancers
2) Type 2 diabetes
3) Osteoporosis

Question 2

What other health benefits does breastfeeding provide to the mother?

Answer 2

• Increased resilience to stress
• Improves quality of sleep

Question 3

What is the NHS Grampian and WHO recommendation for breastfeeding?

Answer 3

Exclusive breastfeeding for the first 6 months to achieve optimal growth, development and health followed by nutritionally adequate complementary foods whilst breastfeeding continues for up to 2 years of age

Question 4

What are the different phases of the 1st stage of labour and their associated cervical dilatation?

Answer 4

1 - Latent phase (0-3cms)

2 - Active phase (3-7cms)

3 - Transition (7-10cms)

Question 5

What is the 2nd stage of labour?

Answer 5

• Full dilatation of the cervix to 10cm
• Pushing begins
• Baby moves from uterus into vagina

Question 6

What is the 3rd stage of labour?

Answer 6

Delivery of the placenta

Question 7

How far apart are contractions in the early stages of labour (0-4cm dilated)?

Answer 7

5-30 minutes

Question 8

How far apart are contractions during active labour (3-7cms)?

Answer 8

2-5 minutes

Question 9

How far apart are contractions during the transition/2nd phase of labour (8-10cm dilatation)?

Answer 9

1-3 minutes

Question 10

What is shoulder dystocia and what are its associated dangers?

Answer 10

Shoulder dystocia - one of the childs shoulders becomes stuck behind the mothers pubic bone

Dangers of shoulder dystocia:

• Umbilical cord entrapment
• Inability of childs chest to expand properly
• Severe brain damage or death due to hypoxia
• Brachial plexus damage

Question 11

How is shoulder dystocia managed?

Answer 11

HELPERR

H - Call for Help

E - Evaluate for Episiotomy

L - Legs (McRoberts position)

P - Suprapubic Pressure

E - Enter Manouvers (Internal rotation(

R - Remove the posterior arm

R - Roll the patient (onto all fours)

Question 12

What are the causes of PPH?

Answer 12

Remember 4T’s

Thrombin (failure of clotting) - Pre-eclampsia, placental abruption, pyrexia in labour

Tissue - Retained placenta, placenta accreta, retained products of conception

Tone - Placenta praevia, over distension of uterus

Trauma - C-section, Episiotomy, Macrosomia

Other causes - Asian ethnicity, anaemia, induction, BMI > 35

Question 13

What are the different types of PPH?

Answer 13

Primary - in 1st 24hours after delivery > 500ml blood (common 1/20 woman), severe haemorrhage = >2000ml

Secondary - >24 hours to up to 6 weeks post delivery

Question 14

How is PPH managed?

Answer 14

1 - Call for help

2 - ABCDE

3 - Empty bladder

4 - Oxytocin, carboprost, misoprostol

OR

5 - Surgical

6 - Fluid replacement +- blood products

Question 15

What is cord prolapse?

Answer 15

The descent of the umbilical cord through the cervix alongside or past the presenting part of the baby

Question 16

What are monozygotic and dizygotic twins known as and how many eggs and sperms do they have?

Answer 16

Monozygotic (Identical) - 1 egg and 1 sperm

Dizygotic (non-identical) - 2 eggs and 2 sperm

Question 17

What do the amnion and chorion layers of the embryo do?

Answer 17

Amnion - warmth and protection

Chorion - Nutrition

Question 18

Which drugs can be used to induce labour?

Answer 18

1 - Prostaglanding analogues e.g. misoprostol (encourages cervical dilatation)

2 - Oxytocin (initiates contractions and increases frequency and force of contractions)

Question 19

Which antihypertensive drugs are contraindicated in pregnant woman?

Answer 19

ACE Inhibitors

Angiotensin receptor blockers

Spironolactone

Question 20

What are the analgesia options available to woman during labour?

Answer 20

Non-pharmacological - Breathing exercises, aromatherapy, warm baths

Simple Analgesia - Paracetamol, Dihydrocodeine, Aspirin

Analgesia:

1) Entonox (Nitrous Oxide & Oxygen) which can be self-administered during contractions by inhaling through mouthpiece
2) Opiates (morphine, diamorphine

Local anaesthesia:

1) Pudendal nerve block for forceps delivery
2) For suturing an episiotomy or vaginal tear

Epidural anaesthesia

Spinal anasthesia - used for most C-sections