Abnormal labour and postpartum care Flashcards
Approx how many pregnancies are induced?
1 in 5
Is induction more or less efficient and painful?
less efficient, more painful
Risk associated with IOL
uterine hyper stimulation with prostaglandins and oxytocin
5 main reasons for IOL and examples
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
What does induction involve?
medications or devices to ripen the cervix
artificial rupture of membranes
amniotomy
artificial rupture of membranes
What does the Bishop’s score tell us?
clinically assess the cervix
The higher the Bishop’s score…
the more progressive change in the cervix and indicates that induction is likely to be successful
5 component parts of Bishop’s score
dilation cervical effacement position consistency station
If there is a low Bishop’s score what can be used to ripen the cervix?
cook balloon or prostaglandin pessaries
What bishop’s score is considered favourable for an amniotomy?
7 or more
What is used to perform an amniotomy?
amniohook
What is given after amniotomy to achieve adequate contractions?
IV oxytocin
What is the aim for number of contractions after amniotomy?
4-5 in 10 minutes
5 reasons for inadequate progress
CPD malposition malpresentation inadequate uterine activity other reasons for obstruction eg fibroid
Progress in labour depends on what 3 things?
cervical effacement
cervical dilation
descent of fetal head through pelvis
active first stage of labour sub-optimal progress for primigravid and parous women is..
prima = less than 0.5cm/hour parous = less than 1cm/hour
How do we increase the strength and duration of contractions?
IV oxytocin
Why is it important to exclude obstructed labout before administering IV oxytocin?
could result in ruptured uterus
What is cephalopelvic disproportion?
Fetal head in correct position but is too large to negotiate the maternal pelvis
What is malposition?
fetal hea din incorrect position for labour and relative CPD occurs
2 posiitons of malposition
occipito-posterior and occipito-transverse
What can hyper stimulation do to the fetus?
fetal distress due to insufficient placental blood flow
4 ways to determine fetal well being in labour
- intermittent auscultation of fetal heart
- CTG
- fetal blood sampling
- Fetal ECG
When is fetal blood sampling performed?
abnormal CTG
What can we measure with fetal blood sampling?
pH and base excess
pH gives a measure of likely hypoxaemia
5 situations where we advise not to labour and examples
- obstruction to birth canal eg major placenta praevia
- malpresentations eg transverse, shoulder, breech
- medical conditions where labour not safe for women
- specific previous labour complications eg previous uterine rupture
- fetal conditions
What % of births are instrumental delivery?
15
What is meant by instrumental delivery?
vacuum extraction and forceps
When is caesarean section essential?
obstructed labour or fetal distress
before cervix is fully dilated
Increased risk with C-section
infection, bleeding, visceral injury, VTE
Reduced risk with C-section
perineal injuries
% of C-sections in UK
25
3rd stage complications
retained placenta
PPH
tears
4 T’s of PPH
tone, thrombin, trauma, tissue
How many degrees of tears are there?
graze, 1st-4th degree
What is the post partum period also known as?
puerperium
When do mothers start seeing health visitor and not midwife?
after day 9/10
What do health visitors help with?
abnomral bleeding
infection eg breast, wound, endometritis
debrief events around birth
What week is the postnatal check at GP?
6
3 common problems in puerperium?
feeding, bonding, social issues
What should be considered in the puerperium?
contraception
5 postnatal problems
PPH VTE sepsis psychiatric pre-eclampsia
Primary PPH
blood loss >500ml within 24 hours delivery
secondary PPH
blood loss>500ml from 24 hours post delivery - 6 weeks
Lochia is normal for how long?
3-4 weeks, like a period or less
Lochia
lochia is the vaginal discharge after giving birth (puerperium) containing blood, mucus, and uterine tissue
How many times more likely are pregnant women to get a thromboembolism?
6-10
2 ways to reduce VTE risk?
high quality risk assessment
thromboprophylaxis
When are you suspicious of a woman who might have VTE?
unilateral leg swelling and/or pain
SOB/chest pain
unexplained tachycardia
Is D-dimer used in pregnancy?
no
Investigations of VTE in pregnancy
ECG
leg dopplers
CXR/VQ scan
Treating VTE in pregnancy
LMWH - warfarin is teratogenic
Can warfarin be used when breastfeeding?
Yes
What is the leading cause of maternal death in UK?
sepsis
What should you do if you suspect sepsis?
prompt IV antibiotics administration
Investigations in sepsis
full septic screen - blood cultures, LVS, MSSU, wound swabs
Treating sepsis
antipyretic measures, IV fluids
How many women die from psychiatric problems?
1/4 deaths of those dying 6weeks–>1 year
1 in 7 suicide
Baby blues
lasts 1-3 days due to hormonal changes
does not affect functioning and no treatment needed
What does post natal depression affect?
functioning, bonding
Increased risk factors for postnatal depression
personal or FH of affective disorder
Danger with puerperal psychosis
women danger to themselves and baby - inpatient psynchiatric care
Increased risk factors for puerperal psynchosis
FH or personal history of bipolar, affective disorder, psychosis
When do most eclamptic seizures occur?
postnatal period
