Abnormal labour and postpartum care Flashcards
What are the factors used to diagnose labour?
CErvical effacement
Cervical dilatation
Descent of foetal head through maternal pelvis
What are the risks associated with inducing labour?
Less efficient and more painful
Need foetal monitoring
Hyperstimulation pf uetrus
What are th indications for induction?
Diabetes
7 days after due date
Maternal health problems necessitating planning of delivery
Foetal- growth concerns, oligohydramnios
What is the process of inducing labour?
If no cervical dilatation, use prostaglandin pessaries or Cook balloon
Once cervix dilated and effaced, perform amniotomy
Once amniotomy, consider IV oxytocin, esp in primigravida
What is used to assess the cervix in labour?
Bishop’s score
What would be described as inadequate progress in labour?
Less than 0.5cm dilation an hour in primigravida women
Less than 1cm an hour in parous women
What are the causes of inadequate progress in labour?
Cephalopelvic disproportion Malposition --> relative CPD Malpresentation Inadequate uterine activity Obstruction
What is the treatment of inadequate uterine activity in labour?
IV oxytocin
What is the main cause of foetal distress?
Uterine hyperstimulation
What Is done to monitor foetal distress?
Intermittent auscultation of heart
CTG
Foetal blood sampling if CTG abnormal
Foetal ECG
When would you opt not to labour?
Obstruction Malpresentation Medical condition causing labour to be unsafe Specific previous labour complications Foetal conditions
What are the options once one has opted not to labour?
Assisted/instrumental delivery
C section
What are the 3rd stage complications of labour?
Retained placenta
Post partum haemorrhage
Tears
What health professionals are seen in the post partum stage?
Midwife for first 9-10 days then health visitor
Gp at 6 weeks
What is moniotred for post partum?
Bleeding
Infection
What are the common post partum problems?
HAemorrhage Venous thromboembolism Sepsis Psych disorders Pre-ecclampsia
What is primary PPH?
Blood loss >500ml within 24 hours of delivery
What are the causes of primary PPH?
Tone
Trauma
Tissue
Thrombin
What is secondary PPH?
Blood loss > 500ml from 24 hours to 6 weeks post partum
What are the causes of secondary PPH?
Retained tissue
Endometriosis
Tears/trauma
What are the risks of VTE?
Pregnant/post partum
Epidural
C sectoon
What investigations are done for VTE?
ECG
Leg dopplers
CXR +/- VQ or CTPA
What is the treatment/prophylaxis for VTE?
Low molecular weight heparin
What is done for any pregnant/post partum women with a suspicion of sepsis?
Prompt IV antibiotics
What are the different puerperium psych conditions?
Baby blues
Postnatal depression
Puerperal psychosis
What is baby blues?
Mood decreases 1-3 days after birth due to hormonal changes
What are the symptoms of postnatal depression?
Classical depressive symptoms
Affects function, bonding
What increases risk of postnatal depression?
Personal or FH of affective disorder
What is the treatment of puerperal psychosis?
Inpatient care
What increases the risk of puerperal psychosis?
Personal or FH of affective disorder, bipolar or psychosis
Why is pre-eclampsia still a risk post natally?
Can develop post nasally or worsen several days following delivery
