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3rd Year - Reproductive Diseases > 3.2. Labour - Abnormal Labour and Post-Partum Care > Flashcards

3.2. Labour - Abnormal Labour and Post-Partum Care Flashcards

1
Q

What happens if there is a Failure to start Labour?

A

Induction of Labour will occur

Note - 1 in 5 pregnancies are induced, it is common

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2
Q

What are the disadvantages of Induction of Labour?

A
  1. Less Efficient - Higher Risk of Foetal Distress / Hyperstimulation of the Uterus
  2. More Painful - Higher chance of requiring Anaesthetic (Epidural)
  3. Higher chance of Instrumental Delivery (15%) / Caesarean Section (22%)
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3
Q

What are the indications for the Induction of Labour?

A
  1. Diabetes (usually before Due Date)
  2. Post-dates - Term + 7 days
  3. Maternal Health Problems (e.g. DVT)
  4. Foetal Reasons - Growth Concerns / Oligohydramnios
  5. Rare - Social / Maternal Request / Pelvic Pain / “Big” Babies
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4
Q

What is involved in Induction of Labour?

A

An attempt is made to instigate Labour, using Medications and / or Artificial Rupture of Membranes (Amniotomy)

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5
Q

What Score is used to Clinically assess the Cervix, for Cervical Ripening?

A

Bishop’s Score:
The Higher the score, the more progressive change there is in the Cervix - indicates induction is likely to be successful

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6
Q

When can an Amniotomy be performed, in Induction of Labour?

A

Once the Cervix has Dilated and Effaced

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7
Q

What does Bishops Score take into account?

A
  1. Dilation (cm) - 0 / 1-2 / 3-4 / 5+
  2. Length of Cervix (cm) (Effacement) - 3 / 2 / 1 / 0
  3. Position - Posterior / Middle / Anterior
  4. Consistency - Firm / Medium / Soft
  5. Station (cm) - -3 / -2 / -1, 0 / +1, +2
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8
Q

What is the Process of Induction of Labour?

A
  1. If Cervix not Dilated / Effaced (Low Bishop’s Score), Vaginal Prostaglandin Pessaries used to “Ripen” the Cervix
  2. Once Cervix is Dilated and Effaced, Amniotomy is Performed (Bishop’s Score > 7)
  3. I.V. Oxytocin used to achieve adequate contractions
    Note - Aim for 4-5 contractions in 10 minutes
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9
Q

How is progress of Labour Evaluated?

A

Combination of Abdominal and Vaginal Examinations to determine:

  1. Cervical Effacement
  2. Cervical Dilation
  3. Descent of the Foetal Head through the Maternal Pelvis
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10
Q

What is Suboptimal Progress, during the first stage of Labour?

A

Cervical Dilation of less than:

  1. O.5cm / hour for a Primigravid (1st Pregnancy) Woman
  2. 1cm / hour for a Parous (Previous Pregnancy) Woman
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11
Q

How are the Strength and Duration of Contractions increased?

A

By giving I.V. Synthetic Oxytocin

Note - it is important to exclude obstructed labour first - could lead to ruptured Uterus

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12
Q

What can cause Inadequate Progress of Labour?

A
  1. Cephalopelvic Disproportion (CPD)
  2. Malpostion
  3. Malpresentation
  4. Inadequate Uterine Activity
  5. Other reasons for Obstruction (Cyst / Fibroid)
    Note - This leads to Foetal Distress
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13
Q

What is Cephalopelvic Disproportion?

A

The Foetal Head is in the Correct Position for Labour but is too Large to negotiate the Maternal Pelvis and be Born

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14
Q

What happen to the baby in Cephalopelvic Disproportion?

A

The Babies head becomes compressed and Caput and Moulding develop

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15
Q

What is Malpresentation?

A

The Foetal Head is in an incorrect position for Labour (and so Relative Cephalopelvic Disproportion occurs)

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16
Q

What are the forms of Malpresentation?

A
  1. Longitudinal Lie - Vertex Position (Baby’s Back to the Side of the Uterus)
  2. Lonitudinal Lie - Breech Position (Baby’s Head is Superior-most)
  3. Transverse Lie - Shoulder Presentation
    Note - The baby should be in the Longitudinal Lie, with its Back to the Anterior Uterus, and its Head Inferior-most to be delivered first
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17
Q

What can happen as a Result of Inadequate Uterine Activity?

A

Foetal Head will not Descend and Exert Force onto the Cervix - so the Cervix will not Dilate

18
Q

How can Uterine Hyper-Stimulation cause Foetal Distress?

A

This can lead to insufficient placental blood flow

19
Q

What is Foetal Well-Being, in Labour, determined by?

A
  1. Intermittent Auscultation of the Foetal Heart
  2. Cardiotocography (CTG)
  3. Foetal Blood Sampling
  4. Foetal ECG
20
Q

When is Foetal Blood Sampling used?

A
  1. Persistently Suspicious

2. Pathological Cardiotocography

21
Q

What does Foetal Blood Sampling provide?

A

Direct Measurements of the Baby’s:

  1. pH and Base Excess
  2. Hypoxaemia (due to pH)
22
Q

What situations would it be best to advise against Labour?

A
  1. Obstruction to the Birth Canal (Masses / Major Placenta Praevia)
  2. Malpresentations
  3. Medical conditions where Labour would not be safe for the Woman
  4. Specific Previous Labour Complications (Previous Uterine Rupture)
  5. Foetal Conditions
23
Q

What is the options if Labour is ill-advised?

A
  1. Caesarian Section

2. Assisted / Instrumental Delivery (15% of Births)

24
Q

What are the Risks associated with a Caesarian Section?

A
  1. Infection
  2. Bleeding
  3. Visceral Injury
  4. Venous Thromboembolism
25
Q

What are regarded as “3rd Stage” Complications of Pregnancy?

A
  1. Retained Placenta
  2. Post-Partum Haemorrhage (4 T’s)
  3. Tears - Graze / 1st / 2nd / 3rd / 4th Degree
26
Q

What check-ups normally happen in the Post-Partum (Puerperium) Period?

A
  1. See Midwife for the first 9-10 days, the the Health Visitor
  2. All women have a 6 week Post-Natal Check at the GP
27
Q

What is the purpose of seeing the Midwife (and then the Health Visitor)?

A
  1. Continue to observe for signs of Abnormal Bleeding
  2. Observe for Evidence of Infection
  3. Debrief events around Birth
28
Q

What are common problems which will present at the 6 week Post-Natal Check (with the GP)?

A
  1. Problems with Infant Feeding
  2. Problems with Bonding
  3. Social Issues (Partner / Other Children / Financial Issues)
  4. Contraception
29
Q

What is involved in the immediate Post-Natal Care for High Risk Women?

A

15 - 60 minute observations to check for:

  1. Uterus remains contracted and no evidence of Abnormal Bleeding
  2. Prophylactic Antibiotics
  3. Appropriate Thromboprophylaxis
  4. Recovery from Spinal / Epidural / General Anaesthesia
  5. Fit for transfer to Post-Natal Ward
30
Q

What are the major Post-Natal Problems?

A
  1. Post-Partum Haemorrhage
  2. Venous Thromboembolism
  3. Sepsis
  4. Psychiatric Disorders of the Post-Partum (Puerperium) Period
  5. Pre-Eclampsia
31
Q

What are the 2 types of Post-Partum Haemorrhage?

A
  1. Primary - >500ml Blood Loss within 24 hours

2. Secondary - >500ml Blood Loss from 24 hours Post-Partum to 6 weeks

32
Q

What are the causes of Primary Post-Partum Haemorrhage?

Note - 4T’s

A
  1. Tone - Uterine Atony
  2. Trauma - Tears to the Perineum / Vagina / Cervix
  3. Tissue - Retained Tissue / Placenta
  4. Thrombin - Coagulopathy
33
Q

What are the causes of Secondary Post-Partum Haemorrhage?

A
  1. Retained Tissue
  2. Endometritis (Infection)
  3. Tears / Trauma
34
Q

What are the major Thromboembolic Diseases to be concerned of during Pregnancy / immediate Post-Partum?

A

Pregnancy and the Immediate Post-Partum Period is a Hypercoaguable State, and you are worried for:

  1. Deep Vein Thrombosis Formation (Unilateral Leg Swelling / Pain)
  2. Pulmonary Embolism (Dyspnoea / Chest Pain / Tachycardia)
35
Q

What is used to investigate the risk of Thromboembolic Disease?

A
  1. ECG
  2. Leg Dopplers
  3. Chest X-Ray +/- Ventilation-Perfusion Scan
36
Q

How is Thromboembolic Disease treated?

A
  1. Thromboprophylaxis
  2. Low-Molecular Weight Heparin
    Note - Do not treat with Warfarin as it is Teratogenic
37
Q

How should any Maternal Woman be treated if Sepsis is Suspected?

A
  1. Prompt I.V. Antibiotics Administration
  2. Perofrm a Full Septic Screen
    Note - Sepsis may present Atypically
38
Q

Who deals with significant concerns about a Womans mental health around pregnancy?

A

Dedicated Peri-Natal Mental Health Team

39
Q

What are the “Baby Blues”?

A
  1. Hormonal changes around the time of Birth - 1-3 days post-natally
  2. Does not affect functioning and requires no specific treatment
40
Q

What is Post-Natal Depression?

A
  1. It can continue on from the “Baby Blues” or start some time later
  2. Classical Depressive Symptoms
  3. Increase risk in women with Personal / Family History of Affective Disorder
41
Q

What is Pueperal Psychosis?

A
  1. Serious Psychotic Illness of the Post-Natal Period
  2. Women can be a danger to themselves and their baby
  3. Requires inpatient Psychiatric Care
  4. Much more common in women with personal or family history of affective disorder, bipolar disorder or psychosis
42
Q

When do most Eclamptic Seizures occur?

A

In the Post-Natal Period

Note - Pre-eclampsia can develop post-natally or may worsen several days following delivery

3rd Year - Reproductive Diseases (41 decks)

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