Abnormal Labour and Postpartum Care

Question 1

What proportion of deliveries are induced?

Answer 1

1 in 5

Question 2

What risks are associated with induced labour?

Answer 2

Uterine hyperstimulation with prostaglandin/oxytocin induction

Question 3

What are the indications for induction of labour?

Answer 3

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

Question 4

What are the foetal indications for induction of labour?

Answer 4

Growth concerns

Oligohydramnios

Question 5

What score is used for induction of labour?

Answer 5

Bishop’s score

Question 6

What is Bishop’s score?

Answer 6

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

Question 7

How is labour induced?

Answer 7

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

Question 8

What is the target contraction rate?

Answer 8

4-5 contractions in 10 minutes

Question 9

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

Answer 9

Too many contractions

Question 10

What are the 3 Ps of labour?

Answer 10

Powers
Passages
Passenger

Question 11

What factors can lead to inadequate progress in labour?

Answer 11

Cephalopelvic disproportion 
Malposition
Malpresentation
Inadequate uterine activity
Fetal distress

Question 12

How is progress in labour evaluated?

Answer 12

Cervical effacement
Cervical dilation
Descent of fetal head through maternal pelvis

Question 13

How is suboptimal progress defined?

Answer 13

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

Question 14

How can the strength of uterine activity be increased?

Answer 14

IV oxytocin

Question 15

What are the 3 types of lie?

Answer 15

Longitudinal
Oblique
Transverse

Question 16

Which lies typically cause malposition?

Answer 16

Occipito-posterior

Occipito-transverse

Question 17

Fetal well being in labour is determined by what?

Answer 17

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

Question 18

What risk is associated with uterine hyperstimulation?

Answer 18

Fetal distress due to insufficient placental blood flow

Question 19

What is the normal heartrate of a baby?

Answer 19

110-160 with a degree of variability

Question 20

When is a fetal blood sample taken?

Answer 20

Abnormal CTG

Question 21

What is measured in the fetal blood sample?

Answer 21

pH and base excess

pH gives a measure of likely hypoxaemia

Question 22

When should labour be advised against?

Answer 22

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

Question 23

How common is instrumental delivery?

Answer 23

15% of births

Question 24

What are the main types of instrumental delivery?

Answer 24

Vacuum

Forceps

Question 25

When is C-section essential?

Answer 25

Obstructed labour | Fetal distress

Question 26

What are the risks associated with C-section?

Answer 26

Infection Bleeding Visceral injury VTE

Question 27

C-section reduces the risk of what?

Answer 27

Perineal injury

Question 28

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

Answer 28

25%

Question 29

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

Answer 29

Retained placenta Post-partum haemorrhage Tears

Question 30

What are the causes of primary post-partum haemorrhage?

Answer 30

``` 4T's: Tone Trauma Tissue Thrombin ```

Question 31

How is the post-partum period managed?

Answer 31

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

Question 32

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

Answer 32

Infant feeding Bonding Social issues

Question 33

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

Answer 33

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

Question 34

What are the most common post-natal problems?

Answer 34

``` Post-partum haemorrhage Venous thromboembolism Sepsis Psychiatric disorders of puerperium Pre-eclampsia ```

Question 35

What are the main types of postpartum haemorrhage?

Answer 35

Primary (4T's) (>500mls within 24hrs of delivery) | Secondary (>500mls from 24hrs to 6wks post-partum)

Question 36

What are the main causes of secondary postpartum haemorrhage?

Answer 36

Retained tissue Endometritis Tears/Trauma

Question 37

Why is thromboembolism more common post-partum?

Answer 37

Hypercoagulable state | 6-10x more likely to develop thromboembolism

Question 38

How is thromboembolism managed in post-partum period?

Answer 38

Risk assessement | Thromboprophylaxis

Question 39

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

Answer 39

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

Question 40

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

Answer 40

Immobilisation post c-section, epidural

Question 41

How is thromboembolic disease risk investigated in mothers?

Answer 41

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

Question 42

How is thromboembolic disease treated in mothers?

Answer 42

LMW Heparin | WARFARIN IS TERATOGENIC

Question 43

How should suspected sepsis be managed in mothers?

Answer 43

Prompt IV antibiotics Full septic screen Antipyretics IV fluids

Question 44

What should be taken in a full septic screen?

Answer 44

Blood cultures LVS MSSU Wound swabs

Question 45

How does postnatal depression affect mothers?

Answer 45

Functioning Bonding Requires treatment

Question 46

What is puerperal psychosis?

Answer 46

Psychosis in post-natal period | Requires inpatient psychiatric care

Question 47

Puerperal psychosis is more common in which patients?

Answer 47

PMH/FH of affective disorder, bipolar disorder, psychosis

Question 48

When do most eclamptic seizures occur?

Answer 48

Post-natal period