Abnormal Labour and Post Partum Care Flashcards
when would you advise not to labour?
> certain foetal conditions
specific previous labour complications (previous uterine rupture)
maternal medical conditions
malpresentation
obstruction in the birth canal (masses or major placenta previa)
what problems can failing to start labour cause?
> less efficient
more painful
risk of uterine hyperstimulation
what indications of induction of labour are there?
> diabetes
term + 7 days
maternal health issues like DVT treatment
foetal reasons (oligohydramnios and growth concerns)
describe the bishops score
used to clinically assess the cervix > dilatation > position > station > consistency > length
what should you monitor in failure to start labour?
the foetus
if labour has failed to start and the cervix is not effaced or dilated how would you proceed?
the cervix needs to ripen
> vaginal prostaglandin pessaries
> cook balloon
if labour has not started but the cervix is dilated and affected (with a score of 7) how may you proceed?
perform an amniotomy (artificial rupture of the foetal membranes with sharp device then use IV oxytocin to achieve contractions
how would you assess progress of the pregnancy?
> cervical effacement
cervical dilation
descent of the foetal head through the maternal pelvis
what would be suboptimal progress in primigravid?
<0.5cm per hour
what would be suboptimal progress in a parus woman?
<1cm per hour
what is the effect of inadequate uterine activity?
contractions are inadequate the foetal head will no descend to exert force on the cervix
how would you manage inadequate uterine activity?
> exclude obstructed labour
> IV OXYTOCIN to increase strength and duration of contractions
what is cephalopelvic disproportion?
foetal head is in the correct position but is too large for the maternal pelvis
what is malpresentation?
the baby is not in vertex position
> longitudinal: breech
> transverse: arm, leg, shoulder
> umbilical cord EMERGENCY
what is malposition?
foetal head in the incorrect position for labour
give 2 examples of a malposition
> occipito-transverse
> occipito-posterior
what causes foetal distress?
uterine hyperstimulation causing insufficient placental blood flow
what is foetal distress determined by?
> intermittent auscultation of foetal heart
cardiotocography
foetal ecg
foetal blood sampling when GTG is abnormal (measuring base excesses and pH)
what complications can arise in 3rd stage of labour?
> retained placenta
postpartum haemorrhage
tears
what causes of post partum haemorrhage are there?
> tone
trauma
tissue
thrombin
describe a 1st degree tear
superficial no muscle damage
describe a second degree tear
involving the perineal muscles
describe a 3rd degree tear
involving the anal sphincter
what is involved in a 4th degree tear?
rectal mucous
what is the management of foetal distress?
C-section to decrease the risk of perineal injury
what complications are associated with c sections?
> venousthromboembolism
visceral injury
increased bleeding
increased infection
what hypertensive disorder can occur in the post partum period?
eclamptic seizure
what psychiatric problems can occur in the post partum period?
> postnatal depression
baby blues
puerperal risks
what factors increase the risk of developing postnatal depression?
> family history
> personal history
what increases the risk of developing puerperal psychosis?
> psychosis
family history
personal history
bipolar
what is the management of puerperal psychosis?
inpatient psychiatric care
what are the baby blues?
hormonal changes around the time of birth 1-3 days post natally
what is the leading cause of maternal death?
maternal sepsis
what would make you suspicious of a thromboembolic disease?
> unilateral leg swelling (+/- pain)
shortness of breath/chest pain
unexplained tachycardia
what investigations would you carry out if you suspected a thromboembolic episode?
> ECG
leg dopplers
chest xray + v/q scan
how is post partum thromboembolic disease treated?
low molecular weight heparin
define primary post partum haemorrhage
blood loss over 500mls within 24hrs of delivery
define secondary post partum haemorrhage
blood loss over 500mls from 24 hrs post partum to 6 weeks
what is lochia?
normal bleeding 3-4 weeks post Nataly that is a period or less
post partum period women are in a hypo or hyper coagulable state?
hyper
what check ups do mum and baby receive post-nataly?
> midwife in first 9-10 days
referred to health visitor
GP 6 week check up
