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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
Q

When is fetal blood sampling performed?

A

abnormal CTG

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26
Q

What can we measure with fetal blood sampling?

A

pH and base excess

pH gives a measure of likely hypoxaemia

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27
Q

5 situations where we advise not to labour and examples

A
  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
Q

What % of births are instrumental delivery?

A

15

29
Q

What is meant by instrumental delivery?

A

vacuum extraction and forceps

30
Q

When is caesarean section essential?

A

obstructed labour or fetal distress

before cervix is fully dilated

31
Q

Increased risk with C-section

A

infection, bleeding, visceral injury, VTE

32
Q

Reduced risk with C-section

A

perineal injuries

33
Q

% of C-sections in UK

A

25

34
Q

3rd stage complications

A

retained placenta
PPH
tears

35
Q

4 T’s of PPH

A

tone, thrombin, trauma, tissue

36
Q

How many degrees of tears are there?

A

graze, 1st-4th degree

37
Q

What is the post partum period also known as?

A

puerperium

38
Q

When do mothers start seeing health visitor and not midwife?

A

after day 9/10

39
Q

What do health visitors help with?

A

abnomral bleeding
infection eg breast, wound, endometritis
debrief events around birth

40
Q

What week is the postnatal check at GP?

A

6

41
Q

3 common problems in puerperium?

A

feeding, bonding, social issues

42
Q

What should be considered in the puerperium?

A

contraception

43
Q

5 postnatal problems

A 
PPH
VTE
sepsis 
psychiatric 
pre-eclampsia
44
Q

Primary PPH

A

blood loss >500ml within 24 hours delivery

45
Q

secondary PPH

A

blood loss>500ml from 24 hours post delivery - 6 weeks

46
Q

Lochia is normal for how long?

A

3-4 weeks, like a period or less

47
Q

Lochia

A

lochia is the vaginal discharge after giving birth (puerperium) containing blood, mucus, and uterine tissue

48
Q

How many times more likely are pregnant women to get a thromboembolism?

A

6-10

49
Q

2 ways to reduce VTE risk?

A

high quality risk assessment

thromboprophylaxis

50
Q

When are you suspicious of a woman who might have VTE?

A

unilateral leg swelling and/or pain
SOB/chest pain
unexplained tachycardia

51
Q

Is D-dimer used in pregnancy?

A

no

52
Q

Investigations of VTE in pregnancy

A

ECG
leg dopplers
CXR/VQ scan

53
Q

Treating VTE in pregnancy

A

LMWH - warfarin is teratogenic

54
Q

Can warfarin be used when breastfeeding?

A

Yes

55
Q

What is the leading cause of maternal death in UK?

A

sepsis

56
Q

What should you do if you suspect sepsis?

A

prompt IV antibiotics administration

57
Q

Investigations in sepsis

A

full septic screen - blood cultures, LVS, MSSU, wound swabs

58
Q

Treating sepsis

A

antipyretic measures, IV fluids

59
Q

How many women die from psychiatric problems?

A

1/4 deaths of those dying 6weeks–>1 year

1 in 7 suicide

60
Q

Baby blues

A

lasts 1-3 days due to hormonal changes

does not affect functioning and no treatment needed

61
Q

What does post natal depression affect?

A

functioning, bonding

62
Q

Increased risk factors for postnatal depression

A

personal or FH of affective disorder

63
Q

Danger with puerperal psychosis

A

women danger to themselves and baby - inpatient psynchiatric care

64
Q

Increased risk factors for puerperal psynchosis

A

FH or personal history of bipolar, affective disorder, psychosis

65
Q

When do most eclamptic seizures occur?

A

postnatal period

Year 3 Repro (JK) (33 decks)

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