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Yr 3 - Reproduction > Abnormal Labour and Postpartum Care > Flashcards

Abnormal Labour and Postpartum Care Flashcards

1
Q

What proportion of deliveries are induced?

A

1 in 5

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2
Q

What risks are associated with induced labour?

A

Uterine hyperstimulation with prostaglandin/oxytocin induction

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3
Q

What are the indications for induction of labour?

A 
Diabetes
Post-term 7 days
Maternal health problems
Fetal reasons
Big babies
Planned birth
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4
Q

What are the foetal indications for induction of labour?

A

Growth concerns

Oligohydramnios

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5
Q

What score is used for induction of labour?

A

Bishop’s score

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6
Q

What is Bishop’s score?

A

Assessment of change in the cervix - indicates whether induction is likely to be successful

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7
Q

How is labour induced?

A 
Low bishop's score:
 - Vaginal prostaglandin/Cook Balloon
Cervix dilated: 
 - Amniotomy
 - IV oxytocin
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8
Q

What is the target contraction rate?

A

4-5 contractions in 10 minutes

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9
Q

What risk is associated with the use of pessaries in induction?

A

Too many contractions

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10
Q

What are the 3 Ps of labour?

A

Powers
Passages
Passenger

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11
Q

What factors can lead to inadequate progress in labour?

A 
Cephalopelvic disproportion 
Malposition
Malpresentation
Inadequate uterine activity
Fetal distress
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12
Q

How is progress in labour evaluated?

A

Cervical effacement
Cervical dilation
Descent of fetal head through maternal pelvis

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13
Q

How is suboptimal progress defined?

A

Cervical dilation
Primigravid women: 0.5cm/hr
Parous women: 1cm/hr

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14
Q

How can the strength of uterine activity be increased?

A

IV oxytocin

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15
Q

What are the 3 types of lie?

A

Longitudinal
Oblique
Transverse

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16
Q

Which lies typically cause malposition?

A

Occipito-posterior

Occipito-transverse

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17
Q

Fetal well being in labour is determined by what?

A

Intermittent auscultation of fetal heart
Cardiotocography (CTG)
Fetal blood sampling
Fetal ECG

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18
Q

What risk is associated with uterine hyperstimulation?

A

Fetal distress due to insufficient placental blood flow

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19
Q

What is the normal heartrate of a baby?

A

110-160 with a degree of variability

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20
Q

When is a fetal blood sample taken?

A

Abnormal CTG

21
Q

What is measured in the fetal blood sample?

A

pH and base excess

pH gives a measure of likely hypoxaemia

22
Q

When should labour be advised against?

A 
Obstruction of birth canal
Malpresentations
Medical conditions where labour would not be safe
Previous uterine rupture
Fetal conditions
23
Q

How common is instrumental delivery?

A

15% of births

24
Q

What are the main types of instrumental delivery?

A

Vacuum

Forceps

25
Q

When is C-section essential?

A

Obstructed labour

Fetal distress

26
Q

What are the risks associated with C-section?

A

Infection
Bleeding
Visceral injury
VTE

27
Q

C-section reduces the risk of what?

A

Perineal injury

28
Q

What is the rate of C-section in the UK?

A

25%

29
Q

What are the most common types of 3rd stage complications?

A

Retained placenta
Post-partum haemorrhage
Tears

30
Q

What are the causes of primary post-partum haemorrhage?

A 
4T's:
Tone 
Trauma 
Tissue 
Thrombin
31
Q

How is the post-partum period managed?

A

Midwife for first 9-10 days
All women 6 week postnatal check at GP
Consider contraception

32
Q

What common problems are seen in the post-partum period?

A

Infant feeding
Bonding
Social issues

33
Q

What does the midwife/health visitor monitor in the post-partum period?

A

Observe for signs of abnormal bleeding
Evidence of infection
Debrief events around birth

34
Q

What are the most common post-natal problems?

A 
Post-partum haemorrhage
Venous thromboembolism
Sepsis
Psychiatric disorders of puerperium
Pre-eclampsia
35
Q

What are the main types of postpartum haemorrhage?

A

Primary (4T’s) (>500mls within 24hrs of delivery)

Secondary (>500mls from 24hrs to 6wks post-partum)

36
Q

What are the main causes of secondary postpartum haemorrhage?

A

Retained tissue
Endometritis
Tears/Trauma

37
Q

Why is thromboembolism more common post-partum?

A

Hypercoagulable state

6-10x more likely to develop thromboembolism

38
Q

How is thromboembolism managed in post-partum period?

A

Risk assessement

Thromboprophylaxis

39
Q

When should thromboembolic disease be considered in the post-partum period?

A

Women with unilateral leg swelling/pain
Chest pain
Shortness of breath
Unexplained tachycardia

40
Q

What factors in pregnancy can increase the risk of thromboembolic disease?

A

Immobilisation post c-section, epidural

41
Q

How is thromboembolic disease risk investigated in mothers?

A

D-DIMER UNRELIABLE IN PREGNANCY
ECG
Dopplers (legs)
CXR/VQ scan/CTPA

42
Q

How is thromboembolic disease treated in mothers?

A

LMW Heparin

WARFARIN IS TERATOGENIC

43
Q

How should suspected sepsis be managed in mothers?

A

Prompt IV antibiotics
Full septic screen
Antipyretics
IV fluids

44
Q

What should be taken in a full septic screen?

A

Blood cultures
LVS
MSSU
Wound swabs

45
Q

How does postnatal depression affect mothers?

A

Functioning
Bonding
Requires treatment

46
Q

What is puerperal psychosis?

A

Psychosis in post-natal period

Requires inpatient psychiatric care

47
Q

Puerperal psychosis is more common in which patients?

A

PMH/FH of affective disorder, bipolar disorder, psychosis

48
Q

When do most eclamptic seizures occur?

A

Post-natal period

Yr 3 - Reproduction (37 decks)

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