Abnormal labour Flashcards
what are indications for induction of labour?
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
what is uterine hyper stimulation?
series of single contractions lasting 2 minutes or more
OR
contraction frequency of 5 more more in 10 minutes
what score is used to assess the cervix?
Bishop’s score
if the cervix is not dilated (low Bishop score), what is used to ripen (open) the cervix?
vaginal prostaglandin pessaries or Cook Balloon
what is an amniotomy?
artificial rupture of the foetal membranes using a sharp device called an amniohook
at what bishop score is an amniotomy favourable?
7 or more
once an amniotomy has been performed in the induction of labour, what medication is given to achieve adequate contractions?
IV oxytocin
what are the 2 types of cephalopelvic disproportion?
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
what is a foetal complication of uterine hyper stimulation and how does this occur?
foetal distress due to insufficient placental blood flow
how is foetal health assessed during labour?
cardiotocography
intermittent auscultation of the heart
foetal blood sampling
foetal ECG
if there is risk of hypoxia to the foetus how can we test this?
foetal blood sampling
- shows pH
give examples of situations where you would advise not to labour.
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
give 5 postnatal problems.
post partum haemorrhage venous thromboembolism sepsis psychiatric disorders of the puerperium pre eclampsia
what are the 4 T’s of post partum haemorrhage?
tone - uterine atony
trauma - lacerations, rupture
tissue - retained placenta
thrombin - coagulopathy
what is defined as primary post partum haemorrhage?
blood loss > 5000ml within 24 hours of delivery
what is defined as secondary post partum haemorrhage?
blood loss > 500mls form 24hrs post partum to 6 weeks
a woman who previously gave birth 2 weeks ago presents with uni lateral leg pain and swelling.
what is the likely diagnosis?
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
what are the 2 main psychiatric problems which can affect post partum women?
post nata depression
puerperal psychosis
what is puerperal psychosis?
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
if there is inadequate uterine activity, what can be given to increase strength and duration of contractions?
IV oxytocin
what are causes of premature labour?
infection trauma abnormal insertion of placenta cervical incompetence fibroids maternal smoking twins
what is the bishop score?
assesses the readiness of the cervix for induction of labour
what scoring system is used to assess the readiness of the cervix for induction of labour?
bishop score
