Abnormal labour

Question 1

what are indications for induction of labour?

Answer 1

diabetes (usually before due date)
post dates (term + 7 days)
maternal health problems that necessitates planning i.e. treatment for DVT
foetal reasons i.e. oligohydramnios, growth concerns

also social, maternal request, pelvic pain, big babies

Question 2

what is uterine hyper stimulation?

Answer 2

series of single contractions lasting 2 minutes or more
OR
contraction frequency of 5 more more in 10 minutes

Question 3

what score is used to assess the cervix?

Answer 3

Bishop’s score

Question 4

if the cervix is not dilated (low Bishop score), what is used to ripen (open) the cervix?

Answer 4

vaginal prostaglandin pessaries or Cook Balloon

Question 5

what is an amniotomy?

Answer 5

artificial rupture of the foetal membranes using a sharp device called an amniohook

Question 6

at what bishop score is an amniotomy favourable?

Answer 6

7 or more

Question 7

once an amniotomy has been performed in the induction of labour, what medication is given to achieve adequate contractions?

Answer 7

IV oxytocin

Question 8

what are the 2 types of cephalopelvic disproportion?

Answer 8

1) genuine CPD
- foetus is in the correct position but the head is too big to pass through maternal pelvis

2) relative CPD
- foetal head is in the incorrect position for labour

Question 9

what is a foetal complication of uterine hyper stimulation and how does this occur?

Answer 9

foetal distress due to insufficient placental blood flow

Question 10

how is foetal health assessed during labour?

Answer 10

cardiotocography
intermittent auscultation of the heart
foetal blood sampling
foetal ECG

Question 11

if there is risk of hypoxia to the foetus how can we test this?

Answer 11

foetal blood sampling

- shows pH

Question 12

give examples of situations where you would advise not to labour.

Answer 12

obstruction to birth canal
- major placenta praevia, masses

malpresentations
- transverse, breech

medical conditions where labour wouldn’t be safe for the mother

previous uterine rupture

foetal conditions

Question 13

give 5 postnatal problems.

Answer 13

post partum haemorrhage
venous thromboembolism
sepsis
psychiatric disorders of the puerperium 
pre eclampsia

Question 14

what are the 4 T’s of post partum haemorrhage?

Answer 14

tone - uterine atony
trauma - lacerations, rupture
tissue - retained placenta
thrombin - coagulopathy

Question 15

what is defined as primary post partum haemorrhage?

Answer 15

blood loss > 5000ml within 24 hours of delivery

Question 16

what is defined as secondary post partum haemorrhage?

Answer 16

blood loss > 500mls form 24hrs post partum to 6 weeks

Question 17

a woman who previously gave birth 2 weeks ago presents with uni lateral leg pain and swelling.
what is the likely diagnosis?

Answer 17

DVT
- pregnancy and immediate post partum period is a hypercoaguable state
pregnant women are 6-10 times more likely to develop a DVT or PE

Question 18

what are the 2 main psychiatric problems which can affect post partum women?

Answer 18

post nata depression

puerperal psychosis

Question 19

what is puerperal psychosis?

Answer 19

rare but serious psychotic illness in the post natal period
can be a danger to themselves and their babies
more common in women with personal or FH of affective disorder, bipolar or psychosis

Question 20

if there is inadequate uterine activity, what can be given to increase strength and duration of contractions?

Answer 20

IV oxytocin

Question 21

what are causes of premature labour?

Answer 21

infection 
trauma
abnormal insertion of placenta
cervical incompetence 
fibroids 
maternal smoking 
twins

Question 22

what is the bishop score?

Answer 22

assesses the readiness of the cervix for induction of labour

Question 23

what scoring system is used to assess the readiness of the cervix for induction of labour?

Answer 23

bishop score