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Reproduction > Abnormal Labour And Post Partum Care > Flashcards

Abnormal Labour And Post Partum Care Flashcards

1
Q

Induction of labour

A
  • Approx 1 in 5 pregnancies induced
  • Less efficient, more painful
  • Need foetal monitoring
  • Risk of uterine “hyperstimulation” with prostaglandin/oxytocin induction
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2
Q

Indications for induction (IOL)

A
  • Diabetes (usually before due date)
  • Post dates – Term + 7 days
  • Maternal health problem that necessitates planning of delivery e.g. on treatment for DVT
  • Foetal reasons e.g. growth concerns, oligohydramnios
  • You may also see IOL for - social / maternal request / pelvic pain / “big” babies
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3
Q

Process of induction of labour

A
  • If cervix not dilated and effaced (lower Bishop’s score), then vaginal prostaglandin pessaries / Cook Balloon can be used to ripen the cervix
  • Once cervix has dilated and effaced, an amniotomy can be performed
  • Once amniotomy performed, IV oxytocin can be used to achieve adequate contractions – aim for 4-5 contractions in 10 minutes
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4
Q

What ‘Bishop score’ is considered favourable for amniotomy?

A

7

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5
Q

What is an amniotomy?

A

Amniotomy is the artificial rupture of the foetal membranes usually using a sharp device e.g. amniohook

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6
Q

Reasons for inadequate progress of labour

A
  • Cephalopelvic disproportion (CPD)
  • Malposition
  • Malpresentation
  • Inadequate uterine activity
  • Other reasons for obstruction (e.g. ovarian cyst or fibroid)
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7
Q

How is progression in labour evaluated?

A

A combination or abdominal and vaginal examinations to determine:

  • Cervical effacement
  • Cervical dilatation
  • Descent of the foetal head through the maternal pelvis
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8
Q

In the active first stage of labour suboptimal progress is defined as cervical dilatation:

A
  • less than 0.5cm per hour for primigravid women
  • less than 1cm per hour for parous women
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9
Q

Consequences of inadequate uterine activity

A

If contractions are inadequate the fetal head will not descend and exert force on the cervix and the cervix will not dilate.

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10
Q

How is inadequate uterine activity managed?

A
  • It is possible to increase the strength and duration of the contractions by giving a synthetic IV oxytocin to the mother
  • It is important to exclude an obstructed labour in these circumstances as stimulation of an obstructed labour could result in a ruptured uterus
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11
Q

Cephalopelvic disproportion (CPD)

A
  • Genuine CPD is relatively rare
  • It means that the fetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born - caput and moulding develop
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12
Q

Malposition

A
  • Much more common than cephalopelvic disproportion
  • Involves the foetal head being in an incorrect position for labour and ‘relative’ CPD occurs
  • Occipito-posterior & Occipito-transverse
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13
Q

Foetal blood sampling

A
  • Used when abnormal CTG
  • Provides a direct measurement from baby
  • We can measure pH and base excess
    • pH gives a measure of likely hypoxaemia
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14
Q

Situations advise not to labour

A
  • Obstruction to birth canal
  • Major placenta praevia, masses
  • Malpresentations
  • Transverse, shoulder, hand, breech
  • Medical conditions where labour would not be safe for woman
  • Specific previous labour complications
  • Previous uterine rupture
  • Foetal conditions
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15
Q

Instrumental delivery

A
  • Accounts for around 15% of births
  • Forceps and vacuum extraction
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16
Q

Caesarean section

A
  • Essential procedure for the management of obstructed labour or fetal distress before the cervix is fully dilated
  • Average rate in the UK is around 25%
17
Q

Caesarean section risks and benefits

A
  • Carries increased risks of infection, bleeding, visceral injury and VTE compared with vaginal birth
  • Reduced risk of perineal injury compared with vaginal birth
18
Q

3rd stage complications

A
  • Retained placenta
  • Post partum haemorrhage
  • Tears
19
Q

Postnatal Problems

A
  • Post partum haemorrhage
  • Venous thromboembolism
  • Sepsis
  • Psychiatric disorders of the puerperium
  • Pre-eclampsia
20
Q

Primary postpartum haemorrhage

A

Primary = blood loss of >500ml within 24 hrs of delivery Tone, Trauma, Tissue, Thrombin (4 T’s)

21
Q

Secondary postpartum haemorrhage

A

Secondary = blood loss > 500ml from 24 hrs post partum to 6 weeks

Retained tissue, Endometritis (infection), Tears / trauma

22
Q

Lochia

A

Lochia is normal for 3-4 weeks postnatal “should be like a period or less”

23
Q

Thromboembolic disease symptoms

A
  • Suspicious = women with unilateral leg swelling and/or pain and women complaining of SOB or chest pain
  • Sometimes the only sign of a PE will be an unexplained tachycardia
  • May present atypically in pregnancy / postnatally
24
Q

What further increases risk of thromboembolic disease in pregnancy?

A

Immobilisation following spinal anaesthetic / Caesarean section

25
Q

Thromboembolic disease investigations

A
  • D-dimer unreliable in pregnancy
  • ECG
  • Leg Dopplers
  • CXR +/- VQ scan or CTPA (NB: radiation exposure during pregnancy /breast feeding)
26
Q

Thromboembolic disease treatment

A
  • Treat with low molecular weight heparin
  • Warfarin is teratogenic, can be used when breast feeding
27
Q

What to do when you suspect maternal sepsis?

A
  • prompt IV antibiotic administration
  • perform full septic screen - blood cultures, LVS, MSSU, wound swabs
  • antipyretic measures, IV fluids and referral to hospital
28
Q

Baby blues

A
  • Affects most women due to hormonal changes around the time of birth - usually 1-3 days PN
  • Does not affect functioning and requires no specific treatment
29
Q

Postnatal Depression

A
  • Can continue on from baby blues or start sometime later
  • Has classical ‘depressive’ symptoms
  • Affects functioning, bonding and often requires treatment
  • Increased risk in women with personal or family history of affective disorder
30
Q

Puerperal psychosis

A
  • Rare but serious psychotic illness of the postnatal period
  • Women can be a danger to themselves and their babies
  • Requires inpatient psychiatric care
  • Much more common in women with personal or family history of affective disorder, bipolar disorder or psychosis

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