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Abnormal Labour Flashcards

1
Q

What are indications for induction of labour?

A

Maternal DM (macrosomia as glucose crosses placenta –> more fat)
Maternal health, e.g. needs Rx for DVT
Foetal health (e.g. IUGR, oligohydramnios)
Late for due date (>42 weeks increases risk of still birth) - offer induction 7-12d past due date
Social/maternal/pelvic pain/big babies

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2
Q

Define induction of labour

A

Using medications/devices to ripen cervix and then artificially rupturing the membranes (amniotomy)

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3
Q

What score is used to determine how ripe the cervix is and how favourable amniotomy would be? Mention the factors looked at in the score

A 
Bishop's score
Don't ever peel cucumbers silly
Dilatation 
Effacement
Position 
Consistency 
Station

Score 7 or more favourable for amniotomy

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4
Q

What is the process of induction of labour?

A

Vaginal Ex to assess cervical ripeness
To ripen cervix - cook’s balloon or prostaglandin pessary
Amniotomy
IV oxytocin to stimulate contraction/contractions may begin themselves after amniotomy

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5
Q

Which method is best for ripening cervix?

A

Cook balloon inflates at Os to open cervix, no risk of hyperstimulation and works within 12-24h
Prostaglandins - initiate contractions, takes 2-3 days and can cause hyperstimulation

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6
Q

If cook balloon and prostaglandins fail to ripen the cervix what can you do?

A

C-section

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7
Q

How do you perform an amniotomy?

A

Amniohook

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8
Q

When giving IV oxytocin to stimulate contractions what are you aiming for?

A

4-5 strong contractions every 10 minutes

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9
Q

What are the 3Ps in abnormal labour?

A

Power - uterine contractions
Passenger - baby
Passage - birth canal

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10
Q

What things may cause inadequate progress through labour?

A 
CPD 
Malpresentation 
Malposition 
Obstruction, e.g. fibroids/ovarian cysts 
Inadequate uterine activity
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11
Q

Define suboptimal progress in labour?

A

Cervical dilatation of
<0.5cm/h in PG
<1cm/h in MG

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12
Q

How often are woman examined during labour?

A

Every 4 hours

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13
Q

Obstructed labour can result in what two things?

A

Maternal exhaustion and dehydration

Uterine rupture, leading to death of mother and baby

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14
Q

How does inadequate uterine contractions –> no cervical dilatation?

A

As foetal head is not exerting pressure on cervix to dilate/efface it

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15
Q

What is treatment for inadequate uterine contractions?

A

IV oxytocin if you are certain of no obstructions (as if you give it and there are obstructions –> uterine rupture)
IV oxytocin increases strength and rate of contractions

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16
Q

In normal labour how many contractions would be expect?

A

3-4 in 10 mins of strong strength

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17
Q

How do we monitor progression of labour?

A

Descent/station (0 = ischial spines, after that its +1)

Cervical dilatation and effacement (VE)

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18
Q

What is cephalopelvic disproportion?

A

Foetal head in correct position but is too large for delivery in relation to size of maternal pelvis

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19
Q

What may cause CPD?

A

Abnormal maternal pelvis shape, shapes don’t match up as opposed to size, macrosomnia, multigravidity, late term pregnancy

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20
Q

What is caput?

A

Swelling around foetal scalp as a result of the pressure of pushing down on the dilating cervix

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21
Q

What is moulding?

A

Foetal skull bones can move over one another to aid birth without damaging the foetal brain

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22
Q

What is presentation?

A

Part of baby presenting to the vagina, e.g. vertex, breech

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23
Q

What is the worst malpresentation and why?

A

Transverse/oblique lie may lead to cord prolapse

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24
Q

What occurs in cord prolapse and how do you treat it?

A

As soon as cord hits cold air –> vasospasm –> baby can’t breath
Emergency c-section

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25
Q

What positions are suitable for vaginal delivery?

A

Occiput anterior - baby born facing floor

Occiput posterior - baby born facing roof (this often req. forceps/vacuum)

26
Q

What positions aren’t suitable for vaginal delivery?

A

Occiput traverse/lateral

Require C-section

27
Q

How can you feel for the baby’s position?

A

Feel posterior fontanelle

28
Q

What things may cause foetal distress?

A

Hyperstimulation (too many uterine contractions –> less blood going to placenta)
IUGR
Infection

29
Q

How can you monitor foetal stress?

A

Intermittent auscultation of foetal heart in low risk of foetal stress
Cardiotocography if high risk of foetal stress (continuous)

30
Q

How do you interpret CTGs?

A

Accelerations - good
Decelerations may be bad
Flat lines - stress

31
Q

What should you do if you see an abnormal CTG?

A

Foetal blood sample from skull (pH, lactic acid) - acidity may indicate hypoxia
Foetal ECG

32
Q

How do you manage foetal distress?

A

If fully dilated - forceps/vacuum delivery

If <6cm - C-section

33
Q

In which situations would you advise against labour?

A 
Obstruction to birth canal, e.g. placenta previa
Malpresentations
Medical conditions where labour not safe
Prev. labour complications
Foetal conditions
34
Q

What are woman who go through C-sections at increased risk of?

A

Infections, bleeding, visceral damage and VTE

35
Q

What is involved in active manage of 3rd stage of labour?

A

IV oxytocin and CCT

36
Q

How do you manage retained placenta?

A

Take to theatre and remove

37
Q

What are the four cases of PPH?

A

4 Ts
Tone - inability of uterus to clamp down and stop bleeding from placental bed
Trauma - 1st to 4th degree tears
Tissue - retained tissue preventing clamping down of uterus
Thrombin - clotting problems

38
Q

How do you manage tone problems in PPH?

A

IV oxytocin

39
Q

How do you manage trauma problems in PPH?

A

Stiching

40
Q

What is the pueriperium?

A

First 6 weeks after birth

41
Q

When is the switch over between the midwife and health visitor?

A

9-10 days

42
Q

When is the first check by the GP?

A

6-8 weeks

43
Q

What should we be observing from in the puerperium?

A

Bleeding, infection

44
Q

What are the commonest/biggest post-natal complications?

A 
Sepsis
Pre-eclampsia
Thromboembolic events
PPH
Psychiatric dx
45
Q

Define primary PPH

A

> 500ml blood loss within 24h

due to 4Ts

46
Q

Define secondary PPH

A

> 500ml blood loss 24h-6wks

Mostly due to infection (endometritis), retained tissue, trauma

47
Q

What is lochia?

A

Vaginal discharge with blood for 3-4weeks after birth (normal as long as it is the same/less than a normal period)

48
Q

Why is TE events more common in post-partum period?

A

In hypercoagulable state

6-10x more likely to get PE/DVT

49
Q

How do we prevent VTE?

A

Prophylaxis

50
Q

How do we investigate VTE in pregnancy/postpartum?

A

NOT D-Dimer (unreliable)

CXR, CTPA, doppler, ECG, V/Q

51
Q

How do we treat VTE in pregnancy/post-partum?

A

LMWH

52
Q

What does VTE tend to present like in pregnancy/post-partum?

A

May be atypical, e.g. just tachycardia

Be aware of woman with unilateral leg swelling/breathless/chest pain

53
Q

Which new mothers are at increased risk of VTE?

A

Epidurals/immobilisation after C section

54
Q

How should you treat maternal sepsis?

A

IV antibiotics, antipyretics, IV fluids

55
Q

How should you investigate maternal sepsis?

A

Blood cultures, MMSU, LVS (lower vaginal swab), wound swab

56
Q

What is the most common psychiatric problem in the puerperium?

A

Baby blues
Usually req no Rx
Due to hormonal changes

57
Q

What symptoms and RF are assoc with PND?

A

Depressive symptoms
May affect bonding
PPH/FH of affective disorder
Usually req. Rx

58
Q

What is puerperal psychosis?

A

Rare but serious, danger to baby and themselves
Increased risk in those with PPH/FH of psychosis, bipolar disorder, affective disorder
Req. inpatient care

59
Q

When is the highest risk of eclamptic seizures?

A

In post-natal period

60
Q

What is eclampsia?

A

Pre-eclampsia + mal grand seizures/coma

61
Q

What is pre-eclampsia?

A

Gestational HTN and proteinuria

Reproduction (28 decks)

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