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Abnormal Labour and Postpartum Care Flashcards

1
Q

Between 2004 and 2005, how many labours were induced?

A

1 in 3

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2
Q

What are the disadvantages of inducing labour?

A

Less efficient
More painful
Carries higher chance of instrumental delivery or Caesarean section

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3
Q

What are the indications for inducing labour?

A 
Diabetes
Post-dates, term + 7 days 
Maternal health problems that necessitate the planning of the delivery to make changes to medications 
Foetal reasons 
Social reasons
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4
Q

Why might labour be induced in women with diabetes?

A

Usually induced before due date because of risk of bigger babies and stillbirth

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5
Q

Why is labour induced post-term?

A

After a certain point of full-term babies become more at risk of death

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6
Q

What foetal reasons might necessitate induction of labour?

A

Growth concerns

Oligohydramnios

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7
Q

What is induction of labour?

A

When an attempt is made to instigate labour artificially using medications and/or by artificial rupture of membranes (amniotomy)

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8
Q

What is the Bishop’s score?

A

Scoring system used to clinically assess the cervix - the higher the score, the more progressive change there is in the cervix which indicates that induction is likely to be successful
Lower score indicates that induction may be more likely to fail but can still be attempted

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9
Q

When can an amniotomy be performed?

A

Once the cervix has dilated and effaced - cervix needs to be dilated enough to break the waters

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10
Q

What can be used if the cervix is not dilated enough and effaced, but labour needs to be induced?

A

Vaginal prostaglandin pessaries can be used to artificially open the cervix

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11
Q

What Bishop’s score is considered favourable for amniotomy to be performed?

A

7 or more

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12
Q

What is an amniotomy?

A

Artificial rupture of the foetal membranes (waters), usually using a sharp device e.g. amniohook

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13
Q

After an amniotomy is performed, what can be used to achieve adequate contractions?

A

IV oxytocin

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14
Q

What should you aim to achieve in terms of contractions when using IV oxytocin to induce labour?

A

4-5 contractions in 10 minutes

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15
Q

In labour, what are the powers, passages and passenger?

A

Power - contraction
Passages - pelvic tract
Passenger - baby

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16
Q

What might cause inadequate progress in labour?

A 
Cephalopelvic disproportion
Malposition
Malpresentation
Inadequate uterine activity 
Other reasons for obstruction e.g. ovarian cyst or fibroid
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17
Q

How is progress in labour evaluated?

A

By a combination of abdominal and vaginal examinations to determine; cervical effacement, cervical dilatation and descent of the foetal head through the maternal pelvis

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18
Q

In the active first stage of labor, what is suboptimal progress defined as?

A

Cervical dilatation of less than 0.5cm per hour for primigravid women and less than 1cm per hour for parous women

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19
Q

What will happen if contractions are inadequate?

A

The foetal head will not descend and exert force on the cervix, and the cervix will not dilate

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20
Q

What effect will giving synthetic IV oxytocin to the mother have?

A

Increase the strength and duration of the contractions

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21
Q

If there is inadequate uterine activity and you are considering giving the mother IV oxytocin, what is it important to exclude first?

A

Obstructed labour - stimulation of an obstructed labour could result in a ruptured uterus which can result in severe foetal and maternal morbidity and mortality e.g. large baby, abnormal position, uterus struggling

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22
Q

What is cephalopelvic disproportion (CPD)?

A

Genuine CPD is relatively rare
It is where the foetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born
In these circumstances, the baby’s head becomes compressed and caput and moulding develop

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23
Q

What should the baby’s spine be in line with?

A

Baby’s spine should be running in line with the mother’s spine, with head down

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24
Q

What do you need to be aware of in transverse lie?

A

Placental position

Umbilical cord filling space

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25
What positions can a baby lie in in the uterus?
Longitudinal Oblique Transverse
26
What positions carry risks of cord or placenta filling space?
Oblique and transverse
27
What is malposition?
Involves the foetal head being in an incorrect position for labour and a relative CPD occurs
28
What is the normal position for delivery?
Occipito-anterior Occipito-posterior and occipito-transverse are abnormal
29
Why is it important to avoid causing too many contractions?
This can result in foetal distress due to insufficient placental blood flow
30
How is foetal wellbeing in labour determined?
Intermittent auscultation of the foetal heart Cardiotocography (CTG) - more high risk labour, monitors baby's heart and contractions Foetal blood sampling Foetal ECG
31
When is foetal blood sampling used?
When persistently suspicious or pathological CTG
32
What does foetal blood sampling measure?
Provides a direct measurement from the baby Can measure pH and base excess pH gives measure of likely hypoxaemia
33
In what situations is labour not advised?
Obstruction to birth canal e.g. major placenta praevia, masses Malpresentation - transverse, shoulder, hand, breech Medical conditions where labour wouldn't be safe for the mother e.g. CVS conditions Specific previous labour complications e.g. previous uterine rupture Foetal conditions
34
What percentage of first births involve assisted/instrumental delivery?
Around 15%
35
What is used in assisted/instrumental delivery?
Forceps | Vacuum extraction
36
What is the essential procedure for the management of obstructed labour or foetal distress before the cervix is fully dilated?
Caesarean section
37
What are the risks of Caesarean sections?
Increased risks of infection, bleeding, visceral injury and VTE compared with vaginal birth
38
What is there a reduced risk of in Caesarean section compared to vaginal birth?
Reduced risk of perineal injury with C-section
39
What is the average rate of C-section in the UK?
25%
40
What are the third stage complications?
Retained placenta Post-partum haemorrhage Tears
41
What are the degrees of tears?
First degree - vaginal mucosa Second degree - perineal muscle Third degree - anal sphincter muscles Fourth degree - into rectal mucosa
42
What is the normal puerperium period?
6 weeks after birth
43
What are the normal procedures for the postpartum period?
See midwife for 9-10 days then referred to health visitor Continue to observe for signs of abnormal bleeding Observe for evidence of infection Debrief events around birth, especially if emergency CS 6 week postnatal check at GP
44
What are some common problems in the postpartum period?
Problems with infant feeding Problems with bonding Social issues e.g. with partner, other children, financial
45
What is the immediate postnatal care for high risk women?
Care in recovery 15-60 minute observations Ensure uterus remains contracted and there is no evidence of abnormal bleeding Prophylactic antibiotics given if appropriate Appropriate thromboprophylaxis Recovery from spinal/epidural/general anaesthetic Fit for transfer to postnatal ward
46
What are some serious postnatal problems?
``` Postpartum haemorrhage Venous thromboembolism Sepsis Psychiatric disorders of the puerperium Pre-eclampsia ```
47
What is primary postpartum haemorrhage?
Blood loss of > 500ml within 24 hours of delivery
48
What is secondary postpartum haemorrhage?
Blood loss of > 500ml from 24 hours postpartum up to 6 weeks after birth
49
What are the 4 Ts in postpartum haemorrhage?
Tissue - retained Tone - more acute/primary, uterus not contracted back to normal Thrombin Trauma
50
What are the causes of primary postpartum haemorrhage?
``` Uterine atony Local causes e.g. traumatic tears to perineum/vagina/cervix Retained tissue/placenta Coagulopathy Tone, trauma, tissue, thrombin ```
51
What are the causes of secondary postpartum haemorrhage?
Retained tissue Endometritis Tears/trauma All women will have bleeding for 2-4 weeks after delivery, but this should be "like a period or less"
52
Why is there an increased risk of thromboembolic disease in pregnancy and the postpartum period?
Pregnancy and the immediate postpartum period is a hypercoagulable state
53
What is the increased risk of developing thromboembolism (DVT or PE) in pregnant women?
Pregnant women are 6-10 times more likely to develop thromboembolism for up to 6 weeks after delivery
54
What is required to reduce thromboembolism risk?
High quality risk assessment and appropriate thromboprophylaxis
55
When should you be suspicious of DVT/PE in a pregnant woman?
May be relatively asymptomatic compared to non-pregnant counterparts Suspicious in; - women with unilateral leg swelling and/or pain - SOB or chest pain Unexplained tachycardia may be the only sign of a PE May also present atypically in pregnancy/postnatally Always have high index of suspicion
56
What will further increase the risk of thromboembolism in pregnancy/postpartum?
Immobilisation following spinal anaesthetic/Caesarean section
57
What is the investigation for suspected thromboembolism in pregnancy?
ECG Doppler scan of legs CXR and/or V/Q scan or CTPA V/Q generally done first due to risk from radiation exposure
58
How do you treat thromboembolism in pregnancy?
Low molecular weight heparin
59
What is the treatment for sepsis in pregnancy?
Prompt IV antibiotic administration Antipyretic measures IV fluids Referral to hospital if you are concerned a pregnant or postnatal woman is septic
60
What is the investigation for sepsis in pregnancy?
Full septic screen - blood cultures - LVS - MSSU - wound swabs
61
What number of women who died between 6 weeks and one year after pregnancy died from mental health-related causes (MMBRACE report 2015)?
Almost a quarter | 1 in 7 of these died from suicide
62
Who should manage any concerns about a pregnant/postpartum woman's mental health?
Dedicated perinatal mental health team
63
What are the 'baby blues'?
Affects most women due to hormonal changes around the time of birth, usually occurs 1-3 days postnatally for a few days only, does not affect functioning and requires no specific treatment
64
What are the features of postnatal depression?
Can continue from baby blues or can start some time later Classic depressive symptoms Affects functioning and bonding Often requires treatment Increased risk in women with personal or family history of affective disorder
65
What are the features of puerperal psychosis?
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 a personal or family history of affective disorder, bipolar disorder or psychosis
66
When do most eclamptic seizures occur?
In the postnatal period

Reproductive System (33 decks)

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