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Systems: Reproduction AB > Abnormal Labour and Postpartum Care > Flashcards

Abnormal Labour and Postpartum Care Flashcards

1
Q

How many labours are induced?

A

About 1 in 5 fail to start and require induction

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2
Q

What are the disadvantages of induction?

A
  • Less efficient
  • More painful
  • Need foetal monitroing
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3
Q

What is there risk of the prostaglandin/oxytocin induction?

A

Hyperstimulation

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4
Q

What are the indications for induction?

A
  • Diabetes (usually before due date)
  • Post dates – Term + 7 days
  • Maternal health problem that necessitates planning of delivery e.g. on treatment for DVT
  • Foetal reasons e.g. growth concerns, oligohydramnios
  • Social, maternal request, pelvic pain or big babies
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5
Q

What are the 3 components of induction?

A
  • Ripen cervix
  • Artificially rupture membranes
  • Oxytocin
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6
Q

What is induction of labour?

A

Induction of labour is when an attempt is made to instigate labour artificially using medications and/or devices to “ripen cervix” followed usually by artificial rupture of membranes (performing an amniotomy)

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7
Q

What score is used to clinically assess the cervix?

A

Bishop’s score
-The higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful.

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8
Q

What is a Bishop score of 0?

A

Dilatation:
0cm

Length of cervix (effacement):
3cm

Position:
Posterior

Consistency:
Firm

Station:
-3cm

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9
Q

What is a Bishop score of 1?

A

Dilatation:
1-2cm

Length of cervix :(effacement)
2cm

Position:
Mid

Consistency:
Medium

Station:
-2cm

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10
Q

What is a Bishop score of 2?

A

Dilatation:
3-4cm

Length of cervix(effacement):
1cm

Position:
Anterior

Consistency:
Soft

Station:
-1,0

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11
Q

What is a Bishop score of 3?

A

Dilatation:
5+cm

Length of cervix(effacement):
0cm

Station:
+1,+2cm

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12
Q

When is amniotomy considered favourably?

A

Bishop score of 7 or more (once cervix has dilated and effaced)

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13
Q

What is an amniotomy?

A

Amniotomy is the artificial rupture of the foetal membranes (“waters”) usually using a sharp device e.g. amniohook

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14
Q

How can the cervix be ripened when there is a low Bishop score (not dilated or effaced)?

A
  • Vaginal prostaglandin pessaries

- Cook balloon

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15
Q

After an amniotomy is performed, how are contractions induced?

A
  • IV oxytocin us used to achieve adequate contractions

- Aim for 4-5 contractions in 10 minutes

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16
Q

What can cause inadequate progress during labour?

A
  • Cephalopelvic disproportion (CPD)
  • Malposition
  • Malpresentation
  • Inadequate uterine activity
  • Other reasons for obstruction (e.g. ovarian cyst or fibroid)
  • Foetal distress
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17
Q

How is progress of labour assessed?

A

Combination of abdominal and vaginal examinations to determine:

  • Cervical effacement
  • Cervical dilatation
  • Descent of the fetal head through the maternal pelvis
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18
Q

What is considered suboptimal progress in the active first stage of labour?

A

Cervical dilatation:

  • Less than 0.5cm per hour for primigravid women
  • Less than 1cm per hour for parous women
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19
Q

What happens if the uterine contractions are inadequate?

A

If contractions are inadequate the foetal head will not descend and exert force on the cervix and the cervix will not dilate.

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20
Q

How can the strength and duration of contractions be increased?

A

By giving synthetic IV oxytocin to the mother

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21
Q

What could stimulation of an obstructed labour lead to?

A

A rupture uterus

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22
Q

What problems may there be with the baby and the passage?

A
  • Cephalopelvic disproportion
  • Malpresentation
  • Malposition
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23
Q

What is cephalopelvic disproportion?

A
  • Genuinely rare
  • It means that the foetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born!
  • Caput and moulding develop
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24
Q

Why is cord prolapse a medical emergency?

A
  • Once the cord hits the air it spasms and stops pulsating

- Can result in death of the baby

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25
Q

Give examples of malpresentation.

A
  • Longitudinal lie but breech presentation

- Transverse lie with shoulder presentation

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26
Q

What way can a baby lie?

A
  • Longitudinal
  • Oblique
  • Transverse
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27
Q

What is malposition?

A
  • Much more common
  • Involves the fetal head being in an incorrect position for labour and ‘relative’ CPD occurs
  • Occipito-posterior & Occipito-transverse
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28
Q

What positions can a baby be in?

A
  • Occipito anterior
  • Occipito posterior
  • Left occipito transverse
  • Right occipito transverse
  • ROA
  • LOA
  • ROP
  • LOP
29
Q

Why is it important to avoid too many contractions?

A

Can result in foetal distress due to insufficient placental blood flow.

30
Q

What is foetal wellbeing during labour determined by?

A
  • Intermittent auscultation of the foetal heart
  • Cardiotocography
  • Foetal blood sampling
  • Foetal ECG
31
Q

When is foetal blood sampling carried out?

A

When there is an abnormal CTG

32
Q

What can a foetal blood sample tells us?

A

Direct measurement from baby

  • Measure pH and base excess
  • pH gives a measure of likely hypoxaemia
33
Q

When should a mother be advised not to labour?

A
  • Obstruction to birth canal (Major placenta praevia, masses)
  • Malpresentations (Transverse, shoulder, hand, ??breech)
  • Medical conditions where labour would not be safe for woman
  • Specific previous labour complications such as previous uterine rupture
  • Foetal conditions
34
Q

How many births are assisted by instrumental delivery?

A

About 15%

35
Q

What types of instrumental deliveries are there?

A
  • Forceps

- Vacuum

36
Q

In what cases is caesarean section an essential procedure?

A

For the management of obstructed labour or foetal distress before the cervix is fully dilated

37
Q

What are the risks associated with C section?

A
  • Infection
  • Bleeding
  • Visceral injury
  • VTE
38
Q

What is there reduced risk of with C section?

A

Perineal injury

39
Q

How many babies are born via C section?

A

About 25%

40
Q

What are some 3rd stage complications?

A
  • Retained placenta
  • Post partum haemorrhage
  • Tears
41
Q

What are the 4Ts of post partum haemorrhage?

A
  • Tone
  • Thrombosis
  • Tissue
  • Thrombin
42
Q

What is the puerperium?

A

The first 6 weeks of the post partum period

43
Q

What happens to the mother during the puerperium?

A

Sees midwife after 9-10 days and the HV

  • Continue to observe for signs of abnormal bleeding
  • Observe for evidence of infection (Wound / Endometritis / Breast)
  • Debrief events around birth (especially if emergency CS)

Postnatal check at GP (6 weeks)

Consider contaception

44
Q

What common problems are there during the puerperium?

A
  • Problems with infant feeding
  • Problems with bonding
  • Social issues
45
Q

What post-natal problems may occur?

A
  • Post partum haemorrhage
  • Venous thromboembolism
  • Sepsis
  • Psychiatric disorders of the puerperium
  • Don’t forget pre-eclampsia
46
Q

What is primary postpartum haemorrhage?

A

Blood loss of >500ml within 24 hours of delivery

47
Q

What causes primary postpartum haemorrhage?

A
  • Tone
  • Tissue
  • Thrombin
  • Trauma
48
Q

What is secondary postpartum haemorrhage?

A

Blood loss of >500ml from 24 hours post partum to 6 weeks

49
Q

What causes secondary post partum haemorrhage?

A
  • Retained tissue
  • Endometriosis (infection)
  • Tears/ trauma
50
Q

When is lochia (mixed vaginal discharge) normal?

A

Normal for 3-4 weeks post-natal

51
Q

What is the association between pregnancy and postpartum period and VTE?

A
  • Pregnancy and the immediate post partum period is a hypercoagulable state
  • Pregnant women 6-10 times more likely to develop thromboembolism (DVT or PE)
  • High quality risk assessment and appropriate thromboprophylaxis is required to reduce this risk
52
Q

When should you be suspicious of VTE?

A
  • Women with unilateral leg swelling and/ or pain
  • Women with SOB or chest pain
  • May present atypically
53
Q

What can sometimes be the only sign of PE?

A

Unexplained tachycardia

54
Q

What test is unreliable in pregnancy?

A

D-dimer

55
Q

How should thromboembolic disease be investigated in pregnancy?

A
  • ECG
  • Leg Dopplers
  • CXR +/- VQ scan or CTPA (NB: radiation exposure during pregnancy /breast feeding)
56
Q

How should thromboembolic disease be treated in pregnancy?

A
  • Low molecular weight heparin

- WARFARIN IS TERATOGENIC

57
Q

What increases risk of VTE following birth?

A

Immobilisation following spinal anaesthetic or C section

58
Q

What is the leading cause of maternal death in the UK?

A

Sepsis

59
Q

What should you do in any women you suspect sepsis?

A
  • Prompt IV antibiotics administration
  • Antipyretic measures
  • Refer to hospital if not already there
60
Q

What should bed

one if sepsis is suspected?

A

Perform full septic screen

  • Blood cultures
  • LVS
  • MSSU
  • Wound swabs
61
Q

How can maternal sepsis present?

A

Atypically

62
Q

What is the prevalence of postpartum psychiatric problems?

A
  • 1/4 of women who died between 6 weeks and 1 year after pregnancy died form mental-health related causes
  • 1 in 7 by suicide
63
Q

What is the prevalence of the baby blues?

A
  • Affects most women due to hormonal changes around the time of birth – usually 1-3 days PN
  • Does not affect functioning and requires no specific treatment
64
Q

How does post natal depression present?

A
  • Can continue on from baby blues or start sometime later
  • Has classical ‘depressive’ symptoms
  • Affects functioning, bonding and often requires treatment
65
Q

Who is at increased risk of postnatal depression?

A

Women with a personal of family history of affective disorder

66
Q

What is puerpal psychosis?

A
  • 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 personal or family history of affective disorder, bipolar disorder or psychosis
67
Q

When do most eclamptic seizures occur?

A

Postnatal period

68
Q

When can pre-eclampsia develop?

A
  • During pregnancy

- Can develop postnatally or may worsen several days following delivery

69
Q

Who are labour problems particularly common in?

A

Primigravid women

Systems: Reproduction AB (35 decks)

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