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Abnormal Labour Flashcards

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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
What positions are suitable for vaginal delivery?
Occiput anterior - baby born facing floor | Occiput posterior - baby born facing roof (this often req. forceps/vacuum)
26
What positions aren't suitable for vaginal delivery?
Occiput traverse/lateral | Require C-section
27
How can you feel for the baby's position?
Feel posterior fontanelle
28
What things may cause foetal distress?
Hyperstimulation (too many uterine contractions --> less blood going to placenta) IUGR Infection
29
How can you monitor foetal stress?
Intermittent auscultation of foetal heart in low risk of foetal stress Cardiotocography if high risk of foetal stress (continuous)
30
How do you interpret CTGs?
Accelerations - good Decelerations may be bad Flat lines - stress
31
What should you do if you see an abnormal CTG?
Foetal blood sample from skull (pH, lactic acid) - acidity may indicate hypoxia Foetal ECG
32
How do you manage foetal distress?
If fully dilated - forceps/vacuum delivery | If <6cm - C-section
33
In which situations would you advise against labour?
``` Obstruction to birth canal, e.g. placenta previa Malpresentations Medical conditions where labour not safe Prev. labour complications Foetal conditions ```
34
What are woman who go through C-sections at increased risk of?
Infections, bleeding, visceral damage and VTE
35
What is involved in active manage of 3rd stage of labour?
IV oxytocin and CCT
36
How do you manage retained placenta?
Take to theatre and remove
37
What are the four cases of PPH?
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
How do you manage tone problems in PPH?
IV oxytocin
39
How do you manage trauma problems in PPH?
Stiching
40
What is the pueriperium?
First 6 weeks after birth
41
When is the switch over between the midwife and health visitor?
9-10 days
42
When is the first check by the GP?
6-8 weeks
43
What should we be observing from in the puerperium?
Bleeding, infection
44
What are the commonest/biggest post-natal complications?
``` Sepsis Pre-eclampsia Thromboembolic events PPH Psychiatric dx ```
45
Define primary PPH
>500ml blood loss within 24h | due to 4Ts
46
Define secondary PPH
>500ml blood loss 24h-6wks | Mostly due to infection (endometritis), retained tissue, trauma
47
What is lochia?
Vaginal discharge with blood for 3-4weeks after birth (normal as long as it is the same/less than a normal period)
48
Why is TE events more common in post-partum period?
In hypercoagulable state | 6-10x more likely to get PE/DVT
49
How do we prevent VTE?
Prophylaxis
50
How do we investigate VTE in pregnancy/postpartum?
NOT D-Dimer (unreliable) | CXR, CTPA, doppler, ECG, V/Q
51
How do we treat VTE in pregnancy/post-partum?
LMWH
52
What does VTE tend to present like in pregnancy/post-partum?
May be atypical, e.g. just tachycardia | Be aware of woman with unilateral leg swelling/breathless/chest pain
53
Which new mothers are at increased risk of VTE?
Epidurals/immobilisation after C section
54
How should you treat maternal sepsis?
IV antibiotics, antipyretics, IV fluids
55
How should you investigate maternal sepsis?
Blood cultures, MMSU, LVS (lower vaginal swab), wound swab
56
What is the most common psychiatric problem in the puerperium?
Baby blues Usually req no Rx Due to hormonal changes
57
What symptoms and RF are assoc with PND?
Depressive symptoms May affect bonding PPH/FH of affective disorder Usually req. Rx
58
What is puerperal psychosis?
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
When is the highest risk of eclamptic seizures?
In post-natal period
60
What is eclampsia?
Pre-eclampsia + mal grand seizures/coma
61
What is pre-eclampsia?
Gestational HTN and proteinuria

Reproduction (28 decks)

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