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Reproductive system > Abnormal Labour and post partum care > Flashcards

Abnormal Labour and post partum care Flashcards

1
Q

Approximately how many pregnancies need induced labour?

A

1 in 5

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2
Q

What are indications for induction of labour?

A

Diabetes
7 days + past due date
Maternal health problems necessitates delivery - treatment for DVT
Fetal reasons - Growth concerns, oligohydraminos

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3
Q

What is involved in induction of labour?

A

Attempts are made to ‘ripen’ the cervix using medications or devices followed by artificial rupture of membranes

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4
Q

What is the Bishop’s score?

A

Score to clinically assess the cervix, the higher the score the more progressive change there is in the cervix and the more likely induction is to be successful

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5
Q

What are the 5 components of Bishop’s score?

A 
Dilatation (cm)
Length of cervix - effacement
Position
Consistency
Station
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6
Q

What is station in Bishop’s score?

A

The position of the fetal head in relation to the pelvic bones

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7
Q

How is dilatation scored in Bishop’s score?

A

0cm - 0
1-2cm - 1
3-4 cm - 2
5+cm - 3

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8
Q

How is effacement scored in Bishop’s score?

A

3cm - 0
2cm - 1
1cm - 2
0cm - 3

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9
Q

How is position scored in Bishop’s score?

A

Posterior - 0
Mid - 1
Anterior 2

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10
Q

How is consistency scored in Bishop’s score?

A

Firm - 0
Medium - 1
Soft - 2

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11
Q

How is station scored in Bishop’s score?

A

-3cm - 0
-2cm - 1
-1-0cm - 2
+1-+2cm - 3

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12
Q

What is used to ripen the cervix if Bishop’s score is low?

A

Vaginal prostaglandin pessaries

Cook balloon

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13
Q

What Bishop’s score is favourable of an amniotomy?

A

7 or more

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14
Q

What is an amniotomy?

A

Artificial rupture of the fetal membranes usually using a sharp device

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15
Q

What is used to ahieve contractions after amniotomy?

A

IV oxytocin

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16
Q

What is generally used for an amniotomy?

A

Amniohook

17
Q

What is considered suboptimal progress in the first stage of labour?

A

Less than 0.5cm per hour for primagravid women or less than 1cm per hour for parous women

18
Q

How is progress in labour evaluated?

A

Cervical effacement
Cervical dilatation
Descent of fetal head through the pelvis

19
Q

What happens if there is inadequate uterine activity?

A

Inadequate contractions will cause the fetal head to not descend and exert force on the cervix therefore it will not dilate

20
Q

How can strength and duration of contractions be increased?

A

Synthetic IV oxytocin

21
Q

Why is it important to exclude obstructed labour with inadequate uterine activity?

A

Stimulation of obstructed labour could result in ruptured uterus

22
Q

What is cephalopelvic disproportion?

A

Fetal head is in the correct position but is too large to negotiate the maternal pelvis and be born

23
Q

What 3 orientations are there for the baby’s lie?

A

Longitudinal
Oblique
Transverse

24
Q

How is fetal wellbeing in labour determined?

A

Intermittent auscultation of fetal heart
Cardiotocography
Fetal blood sampling
Fetal ECG

25
Q

When is fetal blood sampling done?

A

When there is an abnormal cardiotocography

26
Q

What can fetal blood sampling be used to assess?

A

pH and base excess

Likely hypoxaemia

27
Q

What situations would contraindicate labour?

A

Obstruction to birth canal
Malpresentations ie transverse lie
Medical conditions where labour would not be safe for the woman
Specific previous labour complications

28
Q

What instruments can be used to assist in birth?

A

Forceps

Vacuum extraction

29
Q

When is an emergency caesarean necessary?

A

Obstructed labour or fetal distress

Should be done before cervix is fully dilated

30
Q

What are risks of Caesarean section?

A

Risk of infection
Bleeding
Visceral injury
VTE

31
Q

What are complications of third stage labour?

A

Retained placenta
Post partum haemorrhage
Tears

32
Q

How long will a woman see the midwife after giving birth?

A

First 9-10 days

33
Q

What is done in the first 9-10 days postpartum?

A

Observe for signs of abnormal bleeding
Observe for evidence of infection
Debrief events around birth

34
Q

What issues can be presented at the 6 week postnatal check?

A

Problems with infant feeding
Problems with bonding
Social issues - partner, other children, financial issues

35
Q

What is primary and secondary post partum haemorrhage?

A

Primary - blood loss >500mls within 24 hours of delivery

Secondary - Blood loss >500mls from 24hrs post partum to 6 weeks

36
Q

Why is thromboembolic disease more likely after pregnancy?

A

Immediate post partum period is hypercoagulable state - pregnant women are 6-10 times more likely to develop thromboembolism

37
Q

What raises suspicions of thromboembolic disease in pregnancy?

A

Unilateral leg swelling and/or pain
SOB or chest pain
Only sign of PE will be an unexplained tachycardia

38
Q

What are examples of psychiatric problems?

A

Postnatal depression

Puerperal psychosis

Reproductive system (26 decks)

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