Abnormal Labour and post partum care Flashcards
Approximately how many pregnancies need induced labour?
1 in 5
What are indications for induction of labour?
Diabetes
7 days + past due date
Maternal health problems necessitates delivery - treatment for DVT
Fetal reasons - Growth concerns, oligohydraminos
What is involved in induction of labour?
Attempts are made to ‘ripen’ the cervix using medications or devices followed by artificial rupture of membranes
What is the Bishop’s score?
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
What are the 5 components of Bishop’s score?
Dilatation (cm) Length of cervix - effacement Position Consistency Station
What is station in Bishop’s score?
The position of the fetal head in relation to the pelvic bones
How is dilatation scored in Bishop’s score?
0cm - 0
1-2cm - 1
3-4 cm - 2
5+cm - 3
How is effacement scored in Bishop’s score?
3cm - 0
2cm - 1
1cm - 2
0cm - 3
How is position scored in Bishop’s score?
Posterior - 0
Mid - 1
Anterior 2
How is consistency scored in Bishop’s score?
Firm - 0
Medium - 1
Soft - 2
How is station scored in Bishop’s score?
-3cm - 0
-2cm - 1
-1-0cm - 2
+1-+2cm - 3
What is used to ripen the cervix if Bishop’s score is low?
Vaginal prostaglandin pessaries
Cook balloon
What Bishop’s score is favourable of an amniotomy?
7 or more
What is an amniotomy?
Artificial rupture of the fetal membranes usually using a sharp device
What is used to ahieve contractions after amniotomy?
IV oxytocin
What is generally used for an amniotomy?
Amniohook
What is considered suboptimal progress in the first stage of labour?
Less than 0.5cm per hour for primagravid women or less than 1cm per hour for parous women
How is progress in labour evaluated?
Cervical effacement
Cervical dilatation
Descent of fetal head through the pelvis
What happens if there is inadequate uterine activity?
Inadequate contractions will cause the fetal head to not descend and exert force on the cervix therefore it will not dilate
How can strength and duration of contractions be increased?
Synthetic IV oxytocin
Why is it important to exclude obstructed labour with inadequate uterine activity?
Stimulation of obstructed labour could result in ruptured uterus
What is cephalopelvic disproportion?
Fetal head is in the correct position but is too large to negotiate the maternal pelvis and be born
What 3 orientations are there for the baby’s lie?
Longitudinal
Oblique
Transverse
How is fetal wellbeing in labour determined?
Intermittent auscultation of fetal heart
Cardiotocography
Fetal blood sampling
Fetal ECG
When is fetal blood sampling done?
When there is an abnormal cardiotocography
What can fetal blood sampling be used to assess?
pH and base excess
Likely hypoxaemia
What situations would contraindicate labour?
Obstruction to birth canal
Malpresentations ie transverse lie
Medical conditions where labour would not be safe for the woman
Specific previous labour complications
What instruments can be used to assist in birth?
Forceps
Vacuum extraction
When is an emergency caesarean necessary?
Obstructed labour or fetal distress
Should be done before cervix is fully dilated
What are risks of Caesarean section?
Risk of infection
Bleeding
Visceral injury
VTE
What are complications of third stage labour?
Retained placenta
Post partum haemorrhage
Tears
How long will a woman see the midwife after giving birth?
First 9-10 days
What is done in the first 9-10 days postpartum?
Observe for signs of abnormal bleeding
Observe for evidence of infection
Debrief events around birth
What issues can be presented at the 6 week postnatal check?
Problems with infant feeding
Problems with bonding
Social issues - partner, other children, financial issues
What is primary and secondary post partum haemorrhage?
Primary - blood loss >500mls within 24 hours of delivery
Secondary - Blood loss >500mls from 24hrs post partum to 6 weeks
Why is thromboembolic disease more likely after pregnancy?
Immediate post partum period is hypercoagulable state - pregnant women are 6-10 times more likely to develop thromboembolism
What raises suspicions of thromboembolic disease in pregnancy?
Unilateral leg swelling and/or pain
SOB or chest pain
Only sign of PE will be an unexplained tachycardia
What are examples of psychiatric problems?
Postnatal depression
Puerperal psychosis
