Abnormal Labour and Postpartum Care

Question 1

What are some indications to induce labour?

Answer 1

Diabetes (usually before due date)
Post dates (term + 7days)
Maternal health problem that necessitates planning for delivery e.g on treatment for DVT
Foetal reasons e.g growth concerns, oligohydramnios, big babies.

Question 2

What is the main risk to the baby being overdue?

Answer 2

Stillbirth

Question 3

What does the induction of labour involve?

Answer 3

Attempt is made to instigate labour artificially using medications or devices to ripen the cervix followed by artificial rupture of membranes.

Question 4

How is Bishop’s score used in the induction of labour?

Answer 4

Used to clinically assess the cervix.
The higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful.

Question 5

What is Bishop’s score?

Answer 5

0 = 0cm dilated, 3 cm length of cervix, posterior position, firm consistency, -3cm station.

1= 1-2cm dilated, 2cm cervix, mid position, medium consistency, -2 station.

2= 3-4cm dilated, 1 cm cervix, anterior position, soft consistency, -1/0 station.

3= 5+ dilated, 0cm cervix, anterior position, soft consistency, +1/+2 station

Question 6

What are some methods of inducing labour?

Answer 6

Vaginal prostaglandin pessaries.

Cook balloon to manually open cervix.

Once cervix is dilated and effected an amniotomy can be performed.

IV oxytocin is then used to achieve adequate contractions. Aim for 4-5 contractions in 10 minutes.

Question 7

What is an Amniotomy?

Answer 7

Artificial rupture of the foetal membranes usually using a sharp device e.g amniohook.

Question 8

What are the 3 Ps that help determine how long labour will last?

Answer 8

Powers - cervical effacement, cervical dilation, descent of foetal head through pelvis.

Passages - cephalopelvic disproportion

Passenger - malposition, malpresentation

Question 9

In the active first stage of labour how is suboptimal progress defined?

Answer 9

Cervical dilation is less than 0.5cm per hour for primigravid women or less than 1cm per hour for parous women.

Question 10

What is Cephalopelvic disproportion?

Answer 10

The foetal head is in the correct position but it is too large to negotiate the maternal pelvis and be born.

Question 11

What is moulding?

Answer 11

Foetal suture lines over lap

Question 12

What is caput?

Answer 12

Diffuse swelling of the scalp caused by pressure of the scalp on the dilating cervix during labour.

Question 13

What is malposition?

Answer 13

When the foetal head is in the incorrect position for labour.
Occipito-posterior and occipital-transverse.

Question 14

What determines foetal well-being during labour?

Answer 14

Intermittent auscultation of the foetal heart.
Cardiotocography
Foetal blood sampling
Foetal ECG

Question 15

When is foetal blood sampling carried out?

Answer 15

Used if there is an abnormal CTG.
Provides a direct measurement from baby of pH and base excess.
pH gives a measure of likely hypoxaemia.

Question 16

What are some situation in which labour is not advised?

Answer 16

Obstruction to birth canal - masses, major placenta praaevia.

Malpresentations - transverse, shoulder, hand, breech ?

Medical conditions where labour would not be safe for woman.

Specific previous labour complications - previous uterine rupture.

Foetal conditions.

Question 17

What are some 3rd stage complications of labour?

Answer 17

Retained placenta
Post Partum Haemorrhage.
Tears

Question 18

What is Puerperium?

Answer 18

The period of approx. 6 weeks after childbirth where the woman’s reproductive organs return to their pre-pregnancy state.

Question 19

What is Primary Postpartum Haemorrhage?

Answer 19

Blood loss of > 500ml within 24hrs of delivery.

Tone of uterus
Trauma
Tissue - retained
Thrombin

Question 20

What is Secondary Postpartum Haemorrhage?

Answer 20

Blood loss of > 500ml from 24 hrs postpartum to 6 weeks.

Causes include retained tissue, endometritis, tears, trauma.

Question 21

What is the relationship between pregnancy and thromboembolic disease?

Answer 21

Pregnancy and postpartum period is a hypercoaguable state.
Pregnant women are 6-10 times more likely to develop thromboembolism.

Appropriate thromboprophylaxis is required to reduce this risk.

Question 22

What are some signs that make you suspicious of thromboembolic disease in women?

Answer 22

Unilateral leg swelling and/or pain
SOB
Chest pain
Unexplained tachycardia

Question 23

How would you treat thromboembolic postpartum women?

Answer 23

Low molecular weight heparin.

Question 24

What is the leading cause of maternal death in the UK?

Answer 24

Sepsis

Question 25

What investigations would you carry out for suspected maternal sepsis?

Answer 25

Blood cultures
LVS
MSSU
wound swabs

Question 26

What are some characteristics of postnatal depression?

Answer 26

Can continue after baby blues or sometime later.
Classical depressive symptoms.
Affects functioning, bonding.
Increased risk in women with personal or family hx of disorder.

Question 27

What are some characteristics of puerperal psychosis?

Answer 27

Serious psychotic illness of the postnatal period.
Rare.
Requires inpatient psychiatric care.
Much more common in women with personal or family hx of affective disorder, bipolar disorder or psychosis.