Abnormal Labour and Postpartum Care Flashcards
What proportion of deliveries are induced?
1 in 5
What risks are associated with induced labour?
Uterine hyperstimulation with prostaglandin/oxytocin induction
What are the indications for induction of labour?
Diabetes Post-term 7 days Maternal health problems Fetal reasons Big babies Planned birth
What are the foetal indications for induction of labour?
Growth concerns
Oligohydramnios
What score is used for induction of labour?
Bishop’s score
What is Bishop’s score?
Assessment of change in the cervix - indicates whether induction is likely to be successful
How is labour induced?
Low bishop's score: - Vaginal prostaglandin/Cook Balloon Cervix dilated: - Amniotomy - IV oxytocin
What is the target contraction rate?
4-5 contractions in 10 minutes
What risk is associated with the use of pessaries in induction?
Too many contractions
What are the 3 Ps of labour?
Powers
Passages
Passenger
What factors can lead to inadequate progress in labour?
Cephalopelvic disproportion Malposition Malpresentation Inadequate uterine activity Fetal distress
How is progress in labour evaluated?
Cervical effacement
Cervical dilation
Descent of fetal head through maternal pelvis
How is suboptimal progress defined?
Cervical dilation
Primigravid women: 0.5cm/hr
Parous women: 1cm/hr
How can the strength of uterine activity be increased?
IV oxytocin
What are the 3 types of lie?
Longitudinal
Oblique
Transverse
Which lies typically cause malposition?
Occipito-posterior
Occipito-transverse
Fetal well being in labour is determined by what?
Intermittent auscultation of fetal heart
Cardiotocography (CTG)
Fetal blood sampling
Fetal ECG
What risk is associated with uterine hyperstimulation?
Fetal distress due to insufficient placental blood flow
What is the normal heartrate of a baby?
110-160 with a degree of variability
When is a fetal blood sample taken?
Abnormal CTG
What is measured in the fetal blood sample?
pH and base excess
pH gives a measure of likely hypoxaemia
When should labour be advised against?
Obstruction of birth canal Malpresentations Medical conditions where labour would not be safe Previous uterine rupture Fetal conditions
How common is instrumental delivery?
15% of births
What are the main types of instrumental delivery?
Vacuum
Forceps
When is C-section essential?
Obstructed labour
Fetal distress
What are the risks associated with C-section?
Infection
Bleeding
Visceral injury
VTE
C-section reduces the risk of what?
Perineal injury
What is the rate of C-section in the UK?
25%
What are the most common types of 3rd stage complications?
Retained placenta
Post-partum haemorrhage
Tears
What are the causes of primary post-partum haemorrhage?
4T's: Tone Trauma Tissue Thrombin
How is the post-partum period managed?
Midwife for first 9-10 days
All women 6 week postnatal check at GP
Consider contraception
What common problems are seen in the post-partum period?
Infant feeding
Bonding
Social issues
What does the midwife/health visitor monitor in the post-partum period?
Observe for signs of abnormal bleeding
Evidence of infection
Debrief events around birth
What are the most common post-natal problems?
Post-partum haemorrhage Venous thromboembolism Sepsis Psychiatric disorders of puerperium Pre-eclampsia
What are the main types of postpartum haemorrhage?
Primary (4T’s) (>500mls within 24hrs of delivery)
Secondary (>500mls from 24hrs to 6wks post-partum)
What are the main causes of secondary postpartum haemorrhage?
Retained tissue
Endometritis
Tears/Trauma
Why is thromboembolism more common post-partum?
Hypercoagulable state
6-10x more likely to develop thromboembolism
How is thromboembolism managed in post-partum period?
Risk assessement
Thromboprophylaxis
When should thromboembolic disease be considered in the post-partum period?
Women with unilateral leg swelling/pain
Chest pain
Shortness of breath
Unexplained tachycardia
What factors in pregnancy can increase the risk of thromboembolic disease?
Immobilisation post c-section, epidural
How is thromboembolic disease risk investigated in mothers?
D-DIMER UNRELIABLE IN PREGNANCY
ECG
Dopplers (legs)
CXR/VQ scan/CTPA
How is thromboembolic disease treated in mothers?
LMW Heparin
WARFARIN IS TERATOGENIC
How should suspected sepsis be managed in mothers?
Prompt IV antibiotics
Full septic screen
Antipyretics
IV fluids
What should be taken in a full septic screen?
Blood cultures
LVS
MSSU
Wound swabs
How does postnatal depression affect mothers?
Functioning
Bonding
Requires treatment
What is puerperal psychosis?
Psychosis in post-natal period
Requires inpatient psychiatric care
Puerperal psychosis is more common in which patients?
PMH/FH of affective disorder, bipolar disorder, psychosis
When do most eclamptic seizures occur?
Post-natal period
