Abnormal Labour and Postpartum Care

Question 1

What are the indications for induction of labour?

Answer 1

Diabetes, post dates (+ 7 days), maternal health problem that necessitates planning of delivery, fetal reasons e.g. growth concerns and social/ maternal request/ pelvic pain/ big babies

Question 2

Which scoring system is used to clinically asses the cervix (higher the score the more likely induction is to be successful)?

Answer 2

Bishop’s Score

Question 3

What is the process for the induction of labour?

Answer 3

• Dilation of cervix with prostaglandin pessaries/balloon if necessary
• Amniotomy (artificial rupture of fetal membranes)
• IV oxytocin (to achieve adequate contractions)

Question 4

What are the causes for inadequate progress of labour?

Answer 4

Cephalopelvic disproportion, malposition, malpresentation, inadequate uterine activity and other reasons (e.g. cyst, fibroid)

Question 5

How is the wellbeing of the fetus monitored during labour?

Answer 5

Intermittent auscultation of the fetal heart, cardiotocography, fetal blood sampling and fetal ECG

Question 6

When is fetal blood sampling used and what does it do?

Answer 6

• Used when abnormal CTG

- Provides a measurement of pH and base excess (gives a measure of likely hypoxaemia)

Question 7

In what situations would you advise not to labour?

Answer 7

Obstruction to birth canal, malpresentations, medical conditions where labour would not be safe for woman, specific previous labour complications and fetal conditions

Question 8

What are the risks associated with c-sections?

Answer 8

Increased risks of infection, bleeding, visceral injury and VTE compared with vaginal birth

Question 9

What are the 3rd stage complications?

Answer 9

Retained placenta, post partum haemorrhage and tears

Question 10

What are the common postnatal problems?

Answer 10

Post partum haemorrhage, VTE, sepsis, psychiatric disorders and pre-eclampsia

Question 11

What is the difference between primary and secondary postpartum haemorrhage?

Answer 11

• Primary: blood loss of > 500ml within 24hrs of delivery

- Secondary: blood loss > 500ml from 24hrs post delivery to 6 weeks

Question 12

What are the four T’s of post partum haemorrhage?

Answer 12

Tone, trauma, tissue and thrombin

Question 13

What is the treatment for thromboembolic disease during pregnancy?

Answer 13

Low molecular weight heparin