Abnormal Labour and Post-Partum Care Flashcards
issues with induction of labour
more painful
higher risk of foetal distress
risk of uterus hyperstimulation
in what conditions would induce labour
• Diabetes – usually before due date
• Post-dates – term + 7 days
• Maternal health problem that necessitates planning of delivery e.g. treatment for DVT
• Foetal reasons e.g. growth concerns, oligohydramnios
o Social/maternal request/pelvic pain/big babies
what is induction of labour?
Induction of labour is when an attempt is made to instigate labour artificially using medications and/or by artificial rupture of membranes (performing an amniotomy).
components of bishops score
dilatation length of cervix (effacement) position consistency station
describe the process of induction of labour
If cervix not dilated and effaced, then vaginal PGs pessaries can be used to ripen the cervix (can use balloon). Once cervix has dilated and effaced, an amniotomy can be performed. Bishop’s score of >=7 is considered favourable for amniotomy. Amniotomy is the artificial rupture of the foetal membranes usually using a sharp device e.g. amniohook. Once amniotomy performed, IV oxytocin can be used to achieve adequate contractions – aim for 4-5 contractions in 10 minutes
causes for inadequate progress of labour
o Cephalopelvic disproportion (CPD) o Malposition o Malpresentation o Inadequate uterine activity o Other reasons for obstruction (e.g. ovarian cyst or fibroid) • Foetal distress
discuss inadequate uterine activity
• If contractions are inadequate the foetal head will not descend and exert on the cervix and the cervix will not dilate
o Need 3-4/10 lasting 45-60 sec
• It is possible to increase the strength and duration of the contractions by giving a synthetic IV oxytocin to the mother – augment the labour. Already in labour but contractions not adequate
• It is important to exclude and obstructed labour in these circumstances as stimulation of an obstructed labour could result in a ruptured uterus which can result in severe maternal and foetal morbidity and even mortality
discuss cephalopelvic disproportion
o Genuine CPG is relatively rare
o It means that the foetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born
o In these circumstances the baby’s head becomes compressed and caput and moulding develop
discuss malposition
o Involves the foetal head being in an incorrect position for labour and relative CPD
occurs
o Occipito-posterior and occipto-transverse
§ OA – occiput to pubic symphysis and facing floor
§ OP – occiput to back and facing roof
§ OT/L – cannot be vaginal birth
o Feel for fontanelle
how is foetal wellbeing in labour determined?
• Intermittent auscultation of the foetal heart
• Cardiotocography
• Foetal blood sampling
o Used when persistently suspicious or pathological CTG
o Provides a direct measurement from baby
§ We can measure pH and base excess (sometimes lactic acid)
§ pH gives a measure of likely hypoxaemia
• Foetal ECG
in what situations would you advise not to labour?
• Obstruction to birth canal o Major placenta praevia, masses • Malpresentations o Transverse, shoulder, hand, ??breech • Medical conditions where labour would not be safe for woman • Specific previous labour complications o Previous uterine rupture • Foetal conditions
risks of C sections
infection, bleeding, visceral injury, and VTE
complications of 3rd stage
• Post-partum haemorrhage o 4T’s § Tone, thrombus, tears and tissue (retained tissue) • Tears o Graze, 1st-4th degree
common problems in the puerperium
infant feeding
bonding
social issues
discuss immediate postnatal care for high risk women
• Care in recovery o 15-60-minute observations o Ensure § Uterus remains contracted and no evidence of abnormal bleeding § Prophylactic antibiotics have been given if appropriate § Appropriate thromboprophylaxis § Recovery from spinal/epidural/GA § Fit for transfer to postnatal ward
