Abnormal Labour and Postpartum Care

Question 1

how many labours are induced?

Answer 1

about 1 in 5

Question 2

what are the disadvantages of induction?

Answer 2

• need foetal monitoring

- need for cervical ripening (prostaglandins, balloon)

Question 3

what is induction of labour?

Answer 3

an attempt to instigate labour artificially using medications and/or devices to “ripen cervix” followed usually by artificial rupture of membranes (performing an amniotomy)

Question 4

what score is used to clinically assess the cervix?

Answer 4

Bishop’s score

the higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful.

Question 5

what is there risk of the prostaglandin/oxytocin induction?

Answer 5

hyperstimulation

Question 6

describe the process of induction

Answer 6

• cervix dilated and effaced (Bishop score of 7 or more -> amniotomy)
• amniotomy (artificial rupture of foetal membranes using a sharp device)
• IV oxytocin (achieve adequate contractions, 4 - 5/min)

Question 7

what are the indications for induction?

Answer 7

• diabetes
• post dates
• maternal need for planning of delivery
• foetal reasons (growth concerns, oligohydramnios)
• social/maternal request

Question 8

what are intrapartum complications

Answer 8

• powers
• passages
• passenger

Question 9

how is progress evaluated in labour

Answer 9

combination of abdominal and vaginal examinations to determine:

• cervical effacement
• cervical dilatation
• descent of the fetal head through the maternal pelvis

Question 10

what is considered suboptimal progress in the active first stage of labour?

Answer 10

cervical dilatation:

• <0.5cm per hour for primigravid women
• <1cm per hour for parous women

Question 11

describe intrapartum complications because of power

Answer 11

inadequate uterine activity

• > inadequate contractions
• > foetal head will not descend and exert force on the cervix
• > cervix will not dilate

Question 12

how can the strength and duration of contractions be increased?

Answer 12

synthetic IV oxytocin to the mother

Question 13

what could stimulation of an obstructed labour lead to?

Answer 13

ruptured uterus

Question 14

describe intrapartum complications because of passages

Answer 14

cephalopelvic disproportion
- foetal head is in correct position for labour but too large to negotiate maternal pelvis and be born -> caput and moulding

malpresentation (longituidinal lie with breech presentation, transverse lie with shoulder presentation)

malposition (occipito-posterior, occipito-transverse)

other obstruction

• placenta praevia
• foetal anomaly
• fibroids

Question 15

describe foetal distress

Answer 15

inability of foetus to cope with stresses of labour due to insufficient placental blood flow

causes

• uterine hyperstimulation (too many contractions)
• hypoxia
• infection
• cord prolapse
• placental abruption
• vasa praevia

Question 16

what is foetal monitoring during labour

Answer 16

intermittent auscultation of the foetal heart

cardiotocography (if abnormal -> foetal blood sampling)

foetal blood sampling (speculum to take foetal scalp blood sample -> pH (likely hypoxaemia), base excess, lactic acid)

foetal ECG

Question 17

describe operative delivery

Answer 17

instrumental (forceps/ventouse)

caesarean section (planned/emergency)

Question 18

what are some 3rd stage complications of pregnancy

Answer 18

retained placenta

post partum haemorrhage
- 4Ts (tone, thrombosis, tissue, thrombin)

tears
- graze, 1st °, 2nd °, 3rd ° (anal sphincter complex), 4th° (rectal mucosa)