Abnormal labour and Post-partum care Flashcards
How can labour be induced if it fails to start?
If the cervix is favourable (Bishop’s score of 7 or more), prostaglandins + amniotomy, followed by IV oxytocin to regulate contractions
If the cervix is unfavourable, prostaglandins only
What are the indications for artificial induction of labour?
Diabetes Post dates (term + 7 days) Maternal health problems Fetal reasons - growth concerns - oligohydramnios Other - Social reasons - Maternal request - Pelvic pain - "Big babies"
How is a slow labour managed (inadequate uterine activity)
Increase strength and duration of contractions by giving synthetic IV oxytocin
What is a Kleihauer test?
A test to measure foetal cells in the maternal circulation, to determine the degree of foetal-maternal haemorrhage.
Performed if the mother is rhesus negative and/or has suffered an injury likely to cause fetal bleeding
How long do early post-natal checks continue for?
10 - 28 days, depending on individual mother/baby needs
Midwife for the first 10 days
Health visitor after 10 days
What features of the history should be explored during early post-natal checks?
General emotional and physical wellbeing (mum and baby)
Infant feeding and care; e.g. are they breastfeeding?
Mum’s urinary and bowel function
Lochia (vaginal discharge containing blood, mucus and uterine tissue) - may continue up to 8 weeks
Contraceptive plans
Social issues e.g. partner, other children, finances etc
Describe the physical examination of the mother that should be done during early post-natal checks
Pulse, blood pressure and temperature
- monitor for haemorrhage, anaemia, sepsis
Abdominal examination
- to ensure that the uterus is involuting properly; should not be palpable by day 14
Perineum examination
- check for wound healing/breakdown if trauma during birth
When is the late post-natal check carried out?
Around 6 weeks after birth
What is the purpose of the late post-natal check?
Review the birth, answer questions, consider future births
Assess the baby, and assess mother for tiredness/depression etc
Discuss contraception
Ask whether intercourse has resumed and whether there are any issues
Give some potential post-natal health problems that might be experienced by the mother
Anaemia Bowel problems e.g. constipation Bowel/urinary incontinence Breast problems e.g. nipple pain, breast engorgement, mastitis Psychiatric problems Pyrexia Venous thromboembolism (DVT, PE)
Describe the cause and management of post-natal urinary incontinence
Often due to neurapraxia caused by compression of the pudendal nerve during labour, and will resolve spontaneously.
Some women may need physiotherapy.
When do “baby blues” most commonly occur?
Onset is usually around day 2 post-partum, and lasts around 2-7 days.
Mainly hormonal
What are the possible causes of postnatal depression?
Multifactoral; mainly psychological and/or social rather than physical/hormonal, e.g.
- social isolation
- past history of depression
What are the most common causes of postnatal pyrexia?
UTI
Genital infection
- endometritis (risk of sepsis)
Also, consider DVT / PE
What are the two subtypes of cephalopelvic disproportion?
True and Relative
- true is where the baby’s head is in the correct position but is too large to fit through the pelvis
- relative is usually due to malposition of the baby’s head (occipito-posterior or occipito-transverse)
