Abnormal Labour and Postpartum Care

Question 1

Approximately how many pregnancies require an induced labour?

Answer 1

1/5

Question 2

What are some indications for induction?

Answer 2

• diabetes
• post dates (term + 7 days)
• maternal health problems
• fetal reasons (e.g. growth concerns, oligohydramnios)

Question 3

What is the Bishop’s Score?

Answer 3

• used to clinically assess the cervix
• inc. score, inc. progressive change in cervix, indication of a likely successful induction

Question 4

What is the process of induction?

Answer 4

• prostaglandin pessaries/Cook’s Balloon to open cervix (if low Bishop’s score)
• amniotomy- artificial rupture of fetal membranes (once score is 7 or more)
• IV oxytocin to cause contractions

Question 5

What can affect Power in labour?

Answer 5

• inadequate uterine cavity
• inadequate contraction- fetal head will not descend, put pressure on cervix and cause dilation
• IV oxytocin can inc. strength and duration of contraction*

*must exclude obstructed labour- could result inruptured uterus

Question 6

What can affect Passages in labour?

Answer 6

• Cephalopelvic Disproportion (CPD) (rare)
• fetal head is in correct position for labour but is to big to negotiate maternal pelvis and be born
• caput and molding develop

Question 7

What can affect Passenger in labour?

Answer 7

• malpresentation
• e.g. longitudinal lie breech presentation, transverse lie shoulder presentation
• malposition
• fetal head in incorrect position causing relative CPD

Question 8

What can cause fetal distress and how is the fetus monitored during labour?

Answer 8

• Uterine Hyperstimulation (too many contractions) can cause insufficient placental blood flow
• intermittent auscultation of fetal heart
• cardiotocography (CTG)
• fetal blood sampling
• when abnormal CTG
• measure pH (for hypoxia) + base excess
• fetal ECG

Question 9

What are some contraindications for labour?

Answer 9

• birth canal obsrtuction (masses, major placenta praevia)
• malpresentations
• some maternal medical conditions
• certain previous labour complications (previous uterine rupture)
• fetal conditions

Question 10

What are 2 methods of assisted/instumental delivery?

Answer 10

• forceps
• vacuum extraction

* account for around 15% of births

Question 11

When are Caesarian sections required and what are some risks?

Answer 11

• obstructed labour or fetal distress before cervix is fully dilated
• infection, bleeding, visceral injury, VTE
• dec. risk of perineal injury compared with viginal birth

* average rate around 25% in UK

Question 12

What are some 3rd stage complications?

Answer 12

• retained placenta
• postpartum haemorrhage
• Tone
• Trauma
• Tissue
• Thrombin
• tears
• graze, 1st/2nd/3rd/4th degree

Question 13

What happens during the postpartum period (puerperium)?

Answer 13

• see midwife for first 9/10 days, then health visitor
• observe for abnormal bleeding, infection
• debrief birth
• 6 week postnatal check at GP
• comon problems; infant feeding, bonding, social issues
• consider contraception

Question 14

What are some postnatal problems?

Answer 14

• postpartum haemorrhage
• primary- > 500ml loss within 24 hrs
• secondary - > 500mls loss from 24 hrs to 6 weeks
• VTE
• high quality risk assessment + appropriate thromboprophylaxis
• *unilateral leg swelling +/pain, SOB, chest pain, unexplained tachycardia*
• ECG, leg dopplers, CXR/VQ scan/CTPA (D-dimer unreliable in pregnancy)
• low molecular weight heparin
• sepsis
• prompt IV antibiotics (if any suspicion)
• blood cultures, LVS, MSSU, wound swabs
• antipyrectic measures, IV fluids
• psychiatric disorders of the puerperium
• Baby Blues- usually 1-3 days PN
• postnatal depression
• puerperal psychosis
• pre-eclampsia