Abnormal Labour and Postpartum Care Flashcards
What are the disadvantages of inducing labour?
Less efficient, more painful
Risk of uterine “hyperstimulation” with prostaglandin/oxytocin induction
Indications for induction
Diabetes
Post dates – Term + 7 days
Maternal health problem that necessitates planning of delivery e.g. on treatment for DVT
Fetal reasons e.g. growth concerns, oligohydramnios
Oligohydramnios
Deficiency of amniotic fluid
What is induction of labour?
When an attempt is made to instigate labour artificially using medications and/or devices to “ripen cervix” followed usually by artificial rupture of membranes
How is the cervix clinically assessed?
Bishop’s score
Is a higher or lower Bishop’s score indicative of induction?
The higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful
How can a cervix be ripened for a lower Bishop’s score?
Vaginal prostaglandin pessaries / Cook Balloon
What is an amniotomy?
The artificial rupture of the foetal membranes (“waters”) usually using a sharp device
What are the stages of induction?
Cervical ripening
Amniotomy
IV oxytocin
What are the types of causes of problems in labour?
Passge
Powers
Passenger
What is determined by an evaluation of progress in labour (by a combination or abdominal and vaginal examinations)?
Cervical effacement
Cervical dilatation
Descent of the fetal head through the maternal pelvis
What is suboptimal progress of labour for primigravid women? Parous women?
Less than 0.5cm per hour for primigravid women
Less than 1cm per hour for parous women
What will happen if contractions are inadequate?
The foetal head will not descend and exert force on the cervix and the cervix will not dilate
How can the strength and duration of contractions be increased?
Giving synthetic IV oxytocin
Whta could an obstructed labour lead to?
Ruptured uterus
Cephalopelvic disproportion (CPD)
Foetal head is in the correct position for labour but is too large to negotiate the maternal pelvis
What is malposition?
Involves the foetal head being in an incorrect position for labour and “relative” CPD occurs
Occipito-posterior/transverse
Malpresentation
Longitudinal lie (breech presentation) Transverse lie (shoulder presentation)
How is foetal wellbeing in labour determined?
Intermittent auscultation of the fetal heart
Cardiotocography
Fetal blood sampling
Fetal ECG
How does too many contractions result in foetal distress?
Insufficient placental blood flow
When is foetal blood sampling used?
When abnormal CTG
What can pH show about the baby?
Likely hypoxaemia
When is labour not advised?
Obstruction to birth canal
Medical conditions where labour would not be safe for woman
Specific previous labour complications
Fetal conditions
What are some obstructions to the birth canal?
Major placenta praevia
Masses
Specific previous labour complications
Previous uterine rupture
What risks does C section carry?
Infection
Bleeding
Visceral injury
VTE
What is the advantage of C section?
Reduced risk of perineal injury compared to vaginal birth
3rd stage complications
Retained placenta
Post partum haemorrhage
Post natal problems
Post partum haemorrhage Venous thromboembolism Sepsis Psychiatric disorders of the puerperium Pre-eclampsia
What are the 4 T’s of PPH?
Tone
Trauma
Tissue
Thrombin
What is pre-eclampsia?
A disorder of pregnancy in which there is high blood pressure and either large amounts of protein in the urine or other organ dysfunction. Onset may be before, during, or after delivery
What is eclampsia?
The onset of seizures (convulsions) in a woman with pre-eclampsia
