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Reproduction Pathology > Abnormal Labour and Post Partum Care > Flashcards

Abnormal Labour and Post Partum Care Flashcards

1
Q

Risks of induction of labour

A

less efficiency
more pain
need for foetal monitoring
uterine hyperstimulation with prostaglandin/oxytocin induction

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2
Q

Induction of Labour definition

A

An attempt is made to instigate labour artificially using medications and/or devices to “ripen cervix” followed usually by artificial rupture of membranes (amniotomy)

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3
Q

Predispositions to labour not starting

A

High BMI

Previous labour where induction is needed

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4
Q

Indications for induction of labour

A

Diabetes (big babies)
Post dates - term + 7 days
Maternal Health problem that necessitates planning of delivery e.g. treatment of DVT
Foetal reasons e.g. growth concerns, oligohydroamnios
Social reasons
Maternal request
Pelvic pain

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5
Q

What score is used to clinically assess the cervix?

A

Bishops score

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6
Q

What is used to induce labour when the cervix is not dilated and effaced and therefore has a lower bishops score?

A

Vaginal prostaglandin pessaries

Cook balloon

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7
Q

What do vaginal prostaglandin pessaries and cook balloons do?

A

Ripen (open) the cervix

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8
Q

How long can vaginal prostaglandins take to open the cervix?

A

2-3 days

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9
Q

How long does mechanical cook balloon take to work?

A

Up to 24 hours

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10
Q

What induction of labour is used when the cervix is dilated and effaced?

A

Amniotomy

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11
Q

What Bishops score is considered favourable for amniotomy?

A

7 or more

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12
Q

The bishops score includes…

A 
Dilatation 
Length of cervix (effacement)
Position 
Consistency 
Station
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13
Q

Definition of amniotomy

A

Artificial rupture of foetal membranes (“waters”) usually using a sharp device e.g. amniohook

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14
Q

What is used in induction of labour after amniotomy is performed?

A

IV oxytocin to achieve adequate contractions

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15
Q

What is IV oxytocin used for in induction of labour?

A

After amniotomy to achieve adequate contractions

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16
Q

Overall process of induction of labour

A
  1. Ripen/Soften cervix
  2. Break waters/membranes
  3. IV oxytocin for contractions
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17
Q

Causes of inadequate process in labour

A 
Cephalopelvic disproportion (CPD)
Malposition 
Malpresentation 
Inadequate uterine activity
Obstruction e.g. fibroid or ovarian cyst
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18
Q

Problems in labour are due to the 3Ps….

A

Powers
Passenger
Passages

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19
Q

Powers mean….

A

Contractions

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20
Q

Passages mean….

A

Birth canal

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21
Q

Passenger means….

A

Baby

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22
Q

Station definition

A

How the baby is coming through the pelvis = a measurement of the descent of the babys head

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23
Q

Definition of Cephalopelvic disproportion (CPD)

A

Foetal head is in the correct position for descent but it is too large for negotiating the maternal pelvis to be born

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24
Q

What is presentation?

A

The bit of the baby presenting to the vagina

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25
Q

Longitudinal lie meaning

A

The spine of the baby is parallel to the mothers spine

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26
Q

The result of a transverse lie is that….

A

A variety of different presentations can result

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27
Q

Malposition definition

A

Involves foetal head being in an incorrect position and ‘relative’ CPD occurs

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28
Q

Position that is normal for the presenting part of the baby

A

Occipito-anterior

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29
Q

The position of the baby is determined by

A

Vaginal exam

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30
Q

Management of foetal distress

A 
Delivery the baby the quickest way 
- forceps
- instrumental 
- vacuum 
If not fully dilated 
- C section
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31
Q

Feotal well being in labour is determined by

A

Intermittent auscultation of the foetal heart
Cardiotography
Foetal blood sampling (hypoxaemia)
Feotal ECG

32
Q

When is foetal blood sampling done?

A

When there is an abnormal CTG

33
Q

Situations where labour is not advised

A

Obstruction to the birth canal (masses, major placenta praevia)
Malpresentations
Medical conditions where labour would not be safe for the women (rare)
Specific previous labour complications e.g. previous uterine rupture
Foetal conditions

34
Q

Types of instrumental/assisted delivery

A 
Forceps 
Vacuum extraction (cup)
35
Q

C section is essential management for

A

obstructed labour
failure to progress in labour
fetal distress before the cervix is fully dilated

36
Q

Risks of C section

A

infection
bleeding
visceral injury
VTE

37
Q

Retaine placenta definition

A

Complication of the 3rd stage of labour in which the placenta has not undergone placental expulsion within 30 mins when the 3rd stage of labour has been managed actively.

38
Q

What is retaine placenta a common cause of

A

PPH

39
Q

Causes of PPH (THE 4TS)

A

Tone
Trauma (Tears)
Tissue
Thrombus

40
Q

Another name for the post partum period

A

Puerperium

41
Q

Post natal problems

A 
PPH
VTE
sepsis 
psychiatric disorders of the puerperium 
Pre-eclampsia
42
Q

Types of PPH

A

Primary

Secondary

43
Q

Primary PPH definition

A

Blood loss >500ml within 24 hours (the 4Ts)

44
Q

Secondary PPH definition

A

Blood loss >500ml from 24 hours post partum to 6 weeks (due to e.g. endometritis, retained tissue, tears/trauma etc)

45
Q

Normal bleeding post partum

A

Should be like a period or less for 3-4 weeks

46
Q

Symptoms that increase suspicion of thromboembolic disease in post partum women

A

Women with unilateral leg swelling and/or pain and women complaining of SOB or chest pain

47
Q

What investigation can you NOT use to investigate thromboembolic disease in pregnancy/post partum?

A

D dimer

48
Q

Investigations for thromboembolic disease in pregnancy/post partum

A

ECG
Leg dopplers
CXR +/- VQ scan or CTPA

49
Q

Treatment of thromboembolic disease in pregnancy

A

LWMH

50
Q

Warfarin in pregnancy/post partum

A

SHOULD NOT BE USED IN PREGNANCY = teratogenic

Can be used in breastfeeding

51
Q

Psychiatric problems post natally

A

Baby blues
Post natal depression
Puerperal psychosis

52
Q

Labour problems are most common in what type of women?

A

Primigravid

53
Q

Vaginal birth after a previous C section is contraindicated in who?

A

Previous vertical (classical) Caesarean scars
Previous episodes of uterine rupture
Patients with other contraindications to vaginal birth (e.g. placenta praevia)

54
Q

Definition of lochia

A

Vaginal discharge after giving birth, containing blood, mucus and uterine tissue

55
Q

How long does lochia last for?

A

4 - 6 weeks after childbirth

56
Q

What Bishops score indicates that labour is unlikely to start without induction?

A

< 5

57
Q

What Bishops score indicates that labour is likely to happen spontaneously?

A

> 9

58
Q

Risk factors for breech presentation

A 
Uterine malformations, fibroids
Placenta praevia
Polyhydramnios or oligohydramnios
Foetal abnormality (e.g. CNS malformation, chromosomal problem)
Prematurity
59
Q

What is more common in breech presentations?

A

Cord prolapse

60
Q

Management of breech presentation

A

If < 36 weeks foetus still may turn spontaneously
If breech at 36 weeks = external cephalic version (ECV)
Breech in delivery = planned C section or vaginal

61
Q

Contraindications to external cephalic version

A 
Where C section is required
APH in last 7 days
Abnormal CTG
Major uterine abnormality
Ruptured membranes
Multiple pregnancy
62
Q

What can be used to improve the effectiveness of Macroberts manouvre?

A

Suprapubic pressure

63
Q

What is the Macroberts manouvre done for?

A

Shoulder dystocia

64
Q

What does the macroberts manouvre involve?

A

Mother moving onto her back and hypeflexing and abducting the hips, bringing her thighs towards the abdomen

65
Q

Management of PPH

A
  1. Group and save vs cross match
  2. Syntometrin
  3. Give 2nd syntometrin if > 500ml
  4. Fluids and call senior
  5. Carboprost
  6. Theatre
  7. Balloon inserted that puts pressure on spinal arteries
  8. B lynch suture
  9. Tie of uterine or iliac arteries
  10. Subtotal/total hysterectomy (last resort)
66
Q

When is a B lynch suture more common?

A

C section

67
Q

What should be done if the macroberts manoeuvre doesn’t work for shoulder dystocia?

A

Wood screw manoeuvre

68
Q

What does the wood screw manoeuvre involve?

A

Hand in vagina and rotate foetus 180 degrees to dislodge the anterior shoulder from the symphysis pubis

69
Q

Only contraindication to epidural

A

Coagulopathy

70
Q

What is given to all women with premature prerupture of membranes? (PPROM)

A

10 Days erythromycin

71
Q

What is puerperal pyrexia?

A

Temp >38C in 1st 14 days following delivery

72
Q

Causes of puerperal pyrexia

A 
Endometriosis
UTI
Wound infection (perineal tears / C section)
Mastitis
VTE
73
Q

Most common cause of peurperal pyrexia

A

Endometriosis

74
Q

What is the treatment if endometriosis causes peurperal pyrexia?

A

IV Ax

75
Q

Can trimethoprim be used in breastfeeding?

A

Yes

76
Q

What food should be especially avoided in pregnancy and why?

A

Liver - as contains high levels of vitamin A which is a teratogen

77
Q

In induced labour, what can an epidural help with?

A

Lowering high BP

Reproduction Pathology (28 decks)

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