Abnormal Labour and post partum care

Question 1

Approximately how many pregnancies need induced labour?

Answer 1

1 in 5

Question 2

What are indications for induction of labour?

Answer 2

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

Question 3

What is involved in induction of labour?

Answer 3

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

Question 4

What is the Bishop’s score?

Answer 4

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

Question 5

What are the 5 components of Bishop’s score?

Answer 5

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

Question 6

What is station in Bishop’s score?

Answer 6

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

Question 7

How is dilatation scored in Bishop’s score?

Answer 7

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

Question 8

How is effacement scored in Bishop’s score?

Answer 8

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

Question 9

How is position scored in Bishop’s score?

Answer 9

Posterior - 0
Mid - 1
Anterior 2

Question 10

How is consistency scored in Bishop’s score?

Answer 10

Firm - 0
Medium - 1
Soft - 2

Question 11

How is station scored in Bishop’s score?

Answer 11

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

Question 12

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

Answer 12

Vaginal prostaglandin pessaries

Cook balloon

Question 13

What Bishop’s score is favourable of an amniotomy?

Answer 13

7 or more

Question 14

What is an amniotomy?

Answer 14

Artificial rupture of the fetal membranes usually using a sharp device

Question 15

What is used to ahieve contractions after amniotomy?

Answer 15

IV oxytocin

Question 16

What is generally used for an amniotomy?

Answer 16

Amniohook

Question 17

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

Answer 17

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

Question 18

How is progress in labour evaluated?

Answer 18

Cervical effacement
Cervical dilatation
Descent of fetal head through the pelvis

Question 19

What happens if there is inadequate uterine activity?

Answer 19

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

Question 20

How can strength and duration of contractions be increased?

Answer 20

Synthetic IV oxytocin

Question 21

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

Answer 21

Stimulation of obstructed labour could result in ruptured uterus

Question 22

What is cephalopelvic disproportion?

Answer 22

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

Question 23

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

Answer 23

Longitudinal
Oblique
Transverse

Question 24

How is fetal wellbeing in labour determined?

Answer 24

Intermittent auscultation of fetal heart
Cardiotocography
Fetal blood sampling
Fetal ECG

Question 25

When is fetal blood sampling done?

Answer 25

When there is an abnormal cardiotocography

Question 26

What can fetal blood sampling be used to assess?

Answer 26

pH and base excess | Likely hypoxaemia

Question 27

What situations would contraindicate labour?

Answer 27

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

Question 28

What instruments can be used to assist in birth?

Answer 28

Forceps | Vacuum extraction

Question 29

When is an emergency caesarean necessary?

Answer 29

Obstructed labour or fetal distress | Should be done before cervix is fully dilated

Question 30

What are risks of Caesarean section?

Answer 30

Risk of infection Bleeding Visceral injury VTE

Question 31

What are complications of third stage labour?

Answer 31

Retained placenta Post partum haemorrhage Tears

Question 32

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

Answer 32

First 9-10 days

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

What is primary and secondary post partum haemorrhage?

Answer 35

Primary - blood loss >500mls within 24 hours of delivery | Secondary - Blood loss >500mls from 24hrs post partum to 6 weeks

Question 36

Why is thromboembolic disease more likely after pregnancy?

Answer 36

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

Question 37

What raises suspicions of thromboembolic disease in pregnancy?

Answer 37

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

Question 38

What are examples of psychiatric problems?

Answer 38

Postnatal depression | Puerperal psychosis