Abnormal Labour and Postpartum Care Flashcards
what are the side effects of induction of labour?
- 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
indications for induction of labour?
- diabetes
- post-dates–> term + 7 days
- mother’s health problem that necessitates forward planning of delivery ie DVT treatment
- foetal issues
- growth concerns / oligohydramnios
what is the definition of induction of labour?
attempt made to instigate labour artificially by giving medications and / or by artificial rupture of the membranes (amniotomy)
Classification you would use to aid you in induction of labour?
Bishop’s Score
- used to asess the cervix
- the higher this is, the higher the chance of a successful induction
outline the process of induction
- 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
identify the categories in which things can go wrong in delivery
- Power- contractions
- Passages- birth canal
- Passenger -foetus
progress in labour is evaluated how?
- cervical effacement
- cervical dilation
- descent of foetal head through pelvis
what is SUBOPTIMAL progress characterised by in 1st stage of labour?
- in 1st pregnancy, <0.5cm dilation per hour
- if not 1st pregnancy, <1cm dilation per hour
what may occur if there is inadequate uterine activity?
head will not descend and exert force on cervix –> therefore cervix won’t dilate
how may you increase strength and duration of contractions?
by giving IV Oxytocin
what is it important to exclude before giving IV oxytocin?
whether there is obstruction of labour as oxytocin could cause uterine rupture
outline the 3 main problems of “passage and passenger”
- CPD
- malpresentation
- malposition
what is Cephalo-Pelvic Disproportion (CPD)
- 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
what is malpresentation?
- longotidinal vertex= optimal
- longitudinal breech= can be fixed
- transverse = problematic
what is malposition?
this is when the foetal head is in the incorrect position for labour
- correct= occipito-anterior
what may cause foetal distress in labour?
uterine hyperstimulation as this reduces placental blood flow
how is foetal well-being monitored throughout labour?
- intermittent auscultation of foetal heart
- continuously with CTG
- if abnormality detected; do foetal blood sampling with gives direct pH messurement
- foetal ECG
situations where you advise against labour?
- obstructed birth canal
- specific previous pregnancy complication
- foetal condition
- where labour not safe for mother
- malpresentation
when is a C section done and what are some risks of it?
- MUST be done before cervix fully dilated
- risks:
- infection
- VTE
- bleeding
what are some 3rd stage complications that may arise?
- Retained placenta
- placenta should come out within 1 hr post-partum
- PPH
- Tears
- graze, 1st-4th degree
outline the categories of PPH
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
list the causes of Primary PPH
4 T’s
- Uterine Atony
- Traumatic Tear
- Coagulopathy
- Retained Tissue / placenta
list the causes of secondary PPH
- Endometritis
- Trauma
- Tear
- Tissue
what are the normal occurrences in the post-partum period
- 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
what is immediate post-natal care for high-risk women?
- care in recovery- 15-60min observations
- antibiotic prophylaxis
- thromboprophylaxis
- recovery from anaesthesia monitored
- ensure uterus remains contracted
when should you be suspicious of thromboembolic disease in pregnant women and how would you treat?
- unilateral leg swelling +/- pain
- breathlessness
*always have high index of suspicion in pregnant and postnatal women*
treat w/ LMWH
what are psych sequelae post-pregnancy?
- 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
