Abnormal Labour and Postpartum Care

Question 1

what are the side effects of induction of labour?

Answer 1

• increased pain / less efficient contractions
• increased chance of requiring epidural
• may cause uterine hyperstimulation
• increased chance of causing foetal distress
• increased risk of instrumental delivery

Question 2

indications for induction of labour?

Answer 2

• diabetes
• post-dates–> term + 7 days
• mother’s health problem that necessitates forward planning of delivery ie DVT treatment
• foetal issues
  
  • growth concerns / oligohydramnios

Question 3

what is the definition of induction of labour?

Answer 3

attempt made to instigate labour artificially by giving medications and / or by artificial rupture of the membranes (amniotomy)

Question 4

Classification you would use to aid you in induction of labour?

Answer 4

Bishop’s Score

• used to asess the cervix
• the higher this is, the higher the chance of a successful induction

Question 5

outline the process of induction

Answer 5

• if cervix not effaced / dilated (low Bishop’s score), give either:
  
  • Vaginal Prostaglandin Pessaries
  • Cook Balloon
• to ripen (open up) the cervix
• once the cervix has dilated (Bishop’s score > 7)
  
  • Amniotomy
• then, give IV oxytocin to induce contractions
  
  • aim for 4-5 every 10minutes

Question 6

identify the categories in which things can go wrong in delivery

Answer 6

• Power- contractions
• Passages- birth canal
• Passenger -foetus

Question 7

progress in labour is evaluated how?

Answer 7

• cervical effacement
• cervical dilation
• descent of foetal head through pelvis

Question 8

what is SUBOPTIMAL progress characterised by in 1st stage of labour?

Answer 8

• in 1st pregnancy, <0.5cm dilation per hour
• if not 1st pregnancy, <1cm dilation per hour

Question 9

what may occur if there is inadequate uterine activity?

Answer 9

head will not descend and exert force on cervix –> therefore cervix won’t dilate

Question 10

how may you increase strength and duration of contractions?

Answer 10

by giving IV Oxytocin

Question 11

what is it important to exclude before giving IV oxytocin?

Answer 11

whether there is obstruction of labour as oxytocin could cause uterine rupture

Question 12

outline the 3 main problems of “passage and passenger”

Answer 12

• CPD
• malpresentation
• malposition

Question 13

what is Cephalo-Pelvic Disproportion (CPD)

Answer 13

• this is when the baby’s head is too big to fit throught he mother’s pelvis
• baby’s head becomes compressed and caput / moulding develop

Question 14

what is malpresentation?

Answer 14

• longotidinal vertex= optimal
• longitudinal breech= can be fixed
• transverse = problematic

Question 15

what is malposition?

Answer 15

this is when the foetal head is in the incorrect position for labour

• correct= occipito-anterior

Question 16

what may cause foetal distress in labour?

Answer 16

uterine hyperstimulation as this reduces placental blood flow

Question 17

how is foetal well-being monitored throughout labour?

Answer 17

• intermittent auscultation of foetal heart
• continuously with CTG
  
  • if abnormality detected; do foetal blood sampling with gives direct pH messurement
• foetal ECG

Question 18

situations where you advise against labour?

Answer 18

• obstructed birth canal
• specific previous pregnancy complication
• foetal condition
• where labour not safe for mother
• malpresentation

Question 19

when is a C section done and what are some risks of it?

Answer 19

• MUST be done before cervix fully dilated
• risks:
  
  • infection
  • VTE
  • bleeding

Question 20

what are some 3rd stage complications that may arise?

Answer 20

• Retained placenta
  
  • placenta should come out within 1 hr post-partum
• PPH
• Tears
  
  • graze, 1st-4th degree

Question 21

outline the categories of PPH

Answer 21

Primary

• Blood loss of >500ml that occurs within 24h of delivery

Secondary

• Blood loss of >500ml that occurs between 24h and 6 weeks of delivery

Question 22

list the causes of Primary PPH

Answer 22

4 T’s

• Uterine Atony
• Traumatic Tear
• Coagulopathy
• Retained Tissue / placenta

Question 23

list the causes of secondary PPH

Answer 23

• Endometritis
• Trauma
• Tear
• Tissue

Question 24

what are the normal occurrences in the post-partum period

Answer 24

• see midwife for first 9-10 days, then health visitor
  
  • looking for infection / signs of abnormal bleeding
• post-partum 6 week check-up at GP
• consider contraception

Question 25

what is immediate post-natal care for high-risk women?

Answer 25

• care in recovery- 15-60min observations
• antibiotic prophylaxis
• thromboprophylaxis
• recovery from anaesthesia monitored
• ensure uterus remains contracted

Question 26

when should you be suspicious of thromboembolic disease in pregnant women and how would you treat?

Answer 26

• unilateral leg swelling +/- pain
• breathlessness

*always have high index of suspicion in pregnant and postnatal women*

treat w/ LMWH

Question 27

what are psych sequelae post-pregnancy?

Answer 27

• baby blues
  
  • usually occurs days 1-3 and goes away after a few days
• post-natal depression
  
  • increased risk if positive FH of affective disorders
• Puerperal Psychosis
  
  • ​much more common if positive FH of affective disorders