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Year 3 Repro (JK) > Abnormal labour and postpartum care > Flashcards

Abnormal labour and postpartum care Flashcards

1
Q

Approx how many pregnancies are induced?

A

1 in 5

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2
Q

Is induction more or less efficient and painful?

A

less efficient, more painful

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3
Q

Risk associated with IOL

A

uterine hyper stimulation with prostaglandins and oxytocin

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4
Q

5 main reasons for IOL and examples

A

diabetes
post dates - term + 7
maternal health problems eg on treatment for DVT
fetal reasons eg growth concerns, oligohydramnios
social/maternal request/pelvic pain/big babies

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5
Q

What does induction involve?

A

medications or devices to ripen the cervix

artificial rupture of membranes

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6
Q

amniotomy

A

artificial rupture of membranes

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7
Q

What does the Bishop’s score tell us?

A

clinically assess the cervix

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8
Q

The higher the Bishop’s score…

A

the more progressive change in the cervix and indicates that induction is likely to be successful

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9
Q

5 component parts of Bishop’s score

A 
dilation 
cervical effacement 
position 
consistency 
station
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10
Q

If there is a low Bishop’s score what can be used to ripen the cervix?

A

cook balloon or prostaglandin pessaries

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11
Q

What bishop’s score is considered favourable for an amniotomy?

A

7 or more

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12
Q

What is used to perform an amniotomy?

A

amniohook

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13
Q

What is given after amniotomy to achieve adequate contractions?

A

IV oxytocin

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14
Q

What is the aim for number of contractions after amniotomy?

A

4-5 in 10 minutes

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15
Q

5 reasons for inadequate progress

A 
CPD 
malposition 
malpresentation 
inadequate uterine activity 
other reasons for obstruction eg fibroid
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16
Q

Progress in labour depends on what 3 things?

A

cervical effacement
cervical dilation
descent of fetal head through pelvis

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17
Q

active first stage of labour sub-optimal progress for primigravid and parous women is..

A 
prima = less than 0.5cm/hour
parous = less than 1cm/hour
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18
Q

How do we increase the strength and duration of contractions?

A

IV oxytocin

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19
Q

Why is it important to exclude obstructed labout before administering IV oxytocin?

A

could result in ruptured uterus

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20
Q

What is cephalopelvic disproportion?

A

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

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21
Q

What is malposition?

A

fetal hea din incorrect position for labour and relative CPD occurs

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22
Q

2 posiitons of malposition

A

occipito-posterior and occipito-transverse

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23
Q

What can hyper stimulation do to the fetus?

A

fetal distress due to insufficient placental blood flow

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24
Q

4 ways to determine fetal well being in labour

A
  1. intermittent auscultation of fetal heart
  2. CTG
  3. fetal blood sampling
  4. Fetal ECG
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25
When is fetal blood sampling performed?
abnormal CTG
26
What can we measure with fetal blood sampling?
pH and base excess | pH gives a measure of likely hypoxaemia
27
5 situations where we advise not to labour and examples
1. obstruction to birth canal eg major placenta praevia 2. malpresentations eg transverse, shoulder, breech 3. medical conditions where labour not safe for women 4. specific previous labour complications eg previous uterine rupture 5. fetal conditions
28
What % of births are instrumental delivery?
15
29
What is meant by instrumental delivery?
vacuum extraction and forceps
30
When is caesarean section essential?
obstructed labour or fetal distress | before cervix is fully dilated
31
Increased risk with C-section
infection, bleeding, visceral injury, VTE
32
Reduced risk with C-section
perineal injuries
33
% of C-sections in UK
25
34
3rd stage complications
retained placenta PPH tears
35
4 T's of PPH
tone, thrombin, trauma, tissue
36
How many degrees of tears are there?
graze, 1st-4th degree
37
What is the post partum period also known as?
puerperium
38
When do mothers start seeing health visitor and not midwife?
after day 9/10
39
What do health visitors help with?
abnomral bleeding infection eg breast, wound, endometritis debrief events around birth
40
What week is the postnatal check at GP?
6
41
3 common problems in puerperium?
feeding, bonding, social issues
42
What should be considered in the puerperium?
contraception
43
5 postnatal problems
``` PPH VTE sepsis psychiatric pre-eclampsia ```
44
Primary PPH
blood loss >500ml within 24 hours delivery
45
secondary PPH
blood loss>500ml from 24 hours post delivery - 6 weeks
46
Lochia is normal for how long?
3-4 weeks, like a period or less
47
Lochia
lochia is the vaginal discharge after giving birth (puerperium) containing blood, mucus, and uterine tissue
48
How many times more likely are pregnant women to get a thromboembolism?
6-10
49
2 ways to reduce VTE risk?
high quality risk assessment | thromboprophylaxis
50
When are you suspicious of a woman who might have VTE?
unilateral leg swelling and/or pain SOB/chest pain unexplained tachycardia
51
Is D-dimer used in pregnancy?
no
52
Investigations of VTE in pregnancy
ECG leg dopplers CXR/VQ scan
53
Treating VTE in pregnancy
LMWH - warfarin is teratogenic
54
Can warfarin be used when breastfeeding?
Yes
55
What is the leading cause of maternal death in UK?
sepsis
56
What should you do if you suspect sepsis?
prompt IV antibiotics administration
57
Investigations in sepsis
full septic screen - blood cultures, LVS, MSSU, wound swabs
58
Treating sepsis
antipyretic measures, IV fluids
59
How many women die from psychiatric problems?
1/4 deaths of those dying 6weeks-->1 year | 1 in 7 suicide
60
Baby blues
lasts 1-3 days due to hormonal changes | does not affect functioning and no treatment needed
61
What does post natal depression affect?
functioning, bonding
62
Increased risk factors for postnatal depression
personal or FH of affective disorder
63
Danger with puerperal psychosis
women danger to themselves and baby - inpatient psynchiatric care
64
Increased risk factors for puerperal psynchosis
FH or personal history of bipolar, affective disorder, psychosis
65
When do most eclamptic seizures occur?
postnatal period

Year 3 Repro (JK) (33 decks)

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