Abnormal Labour

Question 1

What is an amniotomy?

Answer 1

when you induce labour by artificially rupturing the fetal membranes using a sharp device (amniohook)

(‘breaking you water’)

Question 2

if the cervix is not dilated or effaced - what kind of bishops score would this woman have?

Answer 2

low bishops score

Question 3

what is the bishops score used for?

Answer 3

to assess the cervix clinically

(higher the score, the more progressive change there is in the cervix - therefore the induction is more likely to be successful)

Question 4

indications for the induction of labour

Answer 4

diabetes

post dates (+7 days)

maternal health problems (eg DVT treatment)

fetal abnormalities (growth, oligohydraminos)

pelvic pain/ big baby etc

Question 5

what is a favourable Bishop’s score for an amniotomy?

Answer 5

7 or higher

Question 6

once the amniotomy is performed - what is used to achieve adequate contractions?

Answer 6

IV oxytocin

Question 7

effacement

Answer 7

the cervix gets shorter and thinner

at 100% effacement the cervix should be paper thin

Question 8

dilation

Answer 8

cervix opening up to let the baby through

Question 9

cephalopelvic disproportion

Answer 9

babys head is too large to fit through pelvis

Question 10

3 large tests that determine the progress of labour

Answer 10

cervical effacement

cervical dilation

descent of fetal head in to the maternal pelvis

Question 11

what are the 4 main ways to detemine fetal well being during labour?

Answer 11

intermittment auscultation of the fetal heart

cardiotocography

fetal blood sampling

fetal ECG

Question 12

what does a cardiotocography (CTG) do?

Answer 12

can monitor babys HR AND can monitor contractions

Question 13

what is fetal blood sampling used?

Answer 13

when there is an abnormal CTG

Question 14

in what situations would you NOT advise labour?

Answer 14

obstruction to birth canal (placenta praevia/masses)

malpresentations (transverse/ ??breech/ shoulder (oblique!!!))

medical/ fetal conditions

uterine rupture

Question 15

what are ways to assist deliver using instruments?

Answer 15

forceps

vacuum

Question 16

% of c section in the UK out of all births

Answer 16

25%

Question 17

when is C section used?

Answer 17

when managing an obstructed labour or fetal distress before the cervix is fully dilated

Question 18

post partum period (when getting back to normality) what 2 big things need to be monitored?

Answer 18

observe for signs of abnormal bleeding

observe for evidence infection

Question 19

major post-partum problems

Answer 19

postpartum haemorrhage

venous thromboembolism

sepsis

psychiatric disorder of the puerperium

pre-eclampsia

Question 20

primary post-partum haemorrhage

Answer 20

blood loss of >500ml within 24 hours of delivery

Question 21

secondary post-partum haemorrhage

Answer 21

blood loss of >500ml between 24 hours and up to 6 weeks post partum

Question 22

causes of primary post partum haemorrhage

Answer 22

4 T’s

thrombin

trauma

tone

tissue

Question 23

causes of secondary post partum haemorrhage

Answer 23

retained tissue

endometritis (infection)

tears/ trauma

Question 24

women are at an increased risk of postnatal depression if:

Answer 24

FH or personal history of affective disorder

Question 25

what is the leading cause of maternal death in the UK?

Answer 25

maternal sepsis

Question 26

what tests would you do when investigating maternal sepsis?

Answer 26

MSSU

LVS

blood cultures

wound swabs

Question 27

signs of thromboembolic disease in pregnancy/ post partum

Answer 27

SOB or chest pain

unilateral leg swelling and/or pain

unexplained tachycardia (PE)

Question 28

puerperium

Answer 28

period of 6 weeks after birth during which reproductive organs return to normal condition

Question 29

what are the 3 main stages in the induction of labour?

Answer 29

1. RIPEN the cervix
2. amniotomy (after effaced and dilated)
3. IV oxytocin to induce contractions (aim for 4-5 contractions in 10 minutes)

Question 30

how do you ripen the cervix during the induction of labour?

Answer 30

prostaglandin pessaries

cook balloon

Question 31

why is IV oxytocin given to pregnant women when inducing labour?

Answer 31

to induce contraction

aim for 4-5 contractions in 10 minutes

Question 32

hyper-stimulation of the uterus can result in what?

Answer 32

fetal distress