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Reproductive System > Abnormal Labour and Postpartum Care > Flashcards

Abnormal Labour and Postpartum Care Flashcards

1
Q

What proportion of pregnancies are induced currently?

A

1 in 5

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2
Q

What are the downsides of induction of labour?

A

Induced labours tend to be less efficient and more painful

Increased fetal monitoring required due to risk of uterine hyperstimulation

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3
Q

What are the indications for induction of labour?

A
  • Diabetes (usually before due date)
  • Post-dates- term + 7 days
  • Maternal health problems requiring planning of delivery
  • Fetal reasons such as growth concerns
  • Social/maternal request/pelvic pain/big babies
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4
Q

How is induction of labour given?

A

Medications and/or devices used to ripen cervix

Membranes ruptured artificially (amniotomy)

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5
Q

How is the cervix assessed clinically?

A

Using Bishop’s score, higher score means cervix is more progressed and IoL is more likely to be successful

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6
Q

How is induction of labour given when there is a low Bishop’s score?

A

Vaginal prostaglandin or Cook’s pessaries given to get Bishop’s score >7

Amniotomy given with amniohook

IV oxytocin given to induce contractions (aiming for 4-5 contractions every 10 mins)

Woman can go into labour herself at any stage

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7
Q

What are some common reasons for inadequate progression of labour?

A
  • Cephalopelvic disproportion (CPD)
  • Malposition
  • Malpresentation
  • Inadequate uterine activity
  • Other reasons for obstruction (e.g. ovarian cyst or fibroid)
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8
Q

How is progress of labour determined?

A

Combination of vaginal and abdominal examinations to determine:

  • Cervical effacement
  • Cervical dilatation
  • Descent of the fetal head through the maternal pelvis
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9
Q

How is inadequate progress of labour defined in the active first stage of labour?

A
  • Less than 0.5cm per hour for primigravid women
  • Less than 1.0cm per hour for multiparous women
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10
Q

How can contractions be increased?

A

IV oxytocin to increase strength and length of contractions

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11
Q

What complication is causes by stimulation of an obstructed labour?

A

Rupture of the uterus

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12
Q

What is cephalopelvic disproportion and what complications can it cause?

A

When the fetal head is in the right position for labour but it is too big to negotiate the maternal pelvis.

Caput and moulding of the head can develop.

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13
Q

What are the common malpresentations?

A

Breach or transverse lie

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14
Q

In what cases can a breach presentation be delivered vaginally?

A

Second twin

Multiparous woman

All other incidences requiring caesarean

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15
Q

What complication can occur if the waters break with the baby in a transverse lie?

A

Cord prolapse

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16
Q

What occurs in cord prolapse?

A

The cord is delivered before the baby and when it hits the cold, external air it vaspospasms. Emergency delivery of the baby is required

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17
Q

What is malposition?

A

Common and involves the fetal head being in an incorrect position for labour, meaning that relative CPD occurs. Occipito-transvers and occipito-posterior positions are deemed malpositioned.

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18
Q

How is fetal well-being determined during labour?

A
  • Intermittent auscultation of the fetal heart
  • Cardiotocography
  • Fetal blood sampling
  • Fetal ECG
19
Q

How is a CTG interpreted?

A

Variability in fetal heartbeat is a healthy sign

Long period with no variability is worrying

20
Q

What is done if CTG is abnormal?

A

Fetal blood sampling

Provides a direct measurement from the baby and looks at excess pH and base, with excess pH indicating possible hypoxia.

Blood sample obtained by visualising the babies head with a speculum and scratching the baby’s scalp.

21
Q

In what situations should labour be advised against?

A
  • Obstruction to birth canal (major placenta praevia, masses)
  • Malpresentations
  • Medical conditions where labour would not be safe for woman
  • Specific previous labour complications
  • Previous uterine rupture
  • Fetal conditions
22
Q

How many births involve assisted/instrumental delivery?

A

15%

23
Q

What instruments can be used in an assisted delivery?

A

Forceps

Vaccum extraction

Instruments can also be used to turn baby occipito-anteriorly for a vaginal birth

Instruments cannot be used if cervix is not fully dilated

24
Q

What proportion of UK births are done by caesarean?

A

~25%

25
Q

What are the main causes for a caesarean?

A

Obstructed labour

Fetal distress before cervix is fully dilated

26
Q

What risks are associated with a caesarean?

A

Infection

Bleeding

Visceral injury

Venous thromboembolism

27
Q

What are the possible complications in the third stage of labour?

A
  • Retained placenta
  • Post-partum haemorrhage
  • Tears
28
Q

How is a retianed placenta managed?

A

IV oxytocin to deliver placenta

Surgical removal in theatre

29
Q

What are the causes of primary post-partum haemorrhage?

A

From most to least common:

  • Tone- atonic uterus
  • Trauma- lacerations, haematoma, inversion, rupture
  • Tissue- retained tissue, invasive placenta
  • Thrombin- coagulopathies
30
Q

How are tears classified?

A

Graze

1st degree tear

2nd degree tear

3rd degree tear (internal/external anal sphincter complex torn)

4th degree tear (rectal mucosa torn).

31
Q

What are the common postnatal problems?

A
  • Post-partum haemorrhage
  • Venous thromboembolism
  • Sepsis
  • Psychiatric disorders
  • Pre-eclampsia
32
Q

How is post partum haemorrhage classified?

A

Primary PPH- blood loss of >500mls within 24 hours of delivery

Secondary PPH- blood loss >500ml from 24 hours to six weeks

33
Q

What are the causes of secondary post partum haemorrhage?

A

Retained tissue

Endometritis

Tears

Trauma

34
Q

When is bleeding after labour normal?

A

If no more than usual period and for no more than 4 weeks

35
Q

How much more at risk of thromboembolism are pregnant and post-partum women and why?

A

6-10 times more at risk

Pregnancy and the post-partum period are a hypercoagulable state

36
Q

What are the symptoms of thromboembolic disease?

A

Unilateral leg swelling

Pain

Shortness of breath

Chest pain

37
Q

What investigations are useful in diagnosing VTE in pregnancy?

A
  • ECG
  • Leg Dopplers
  • CXR +/- VQ scan or CTPA (NB: radiation exposure during pregnancy /breast feeding)
38
Q

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

A

Sepsis

39
Q

What steps should be taken when maternal sepsis is suspected?

A

Start prompt IV antibiotic treatment before doing full septic screen (blood cultures, MSSU, wound swabs, genital swabs) and giving antipyrexic measures

40
Q

What is baby blues?

A

“Baby blues” affects most women due to hormonal changes around the time of birth- usually 1-3 days postnatally. This does not affect function and requires no specific treatment

41
Q

What are the symptoms of postnatal depression?

A

Postnatal depression can carry on from baby blues or it can start later on.

It has classical depressive symptoms, affecting function, bonding and usually requires treatment

42
Q

What are the risk factors for postnatal depression?

A

Women with personal or family history of affective disorder

43
Q

What is puerperal psychosis?

A

Rare but serious psychotic illness of the postnatal period, during which women can be a danger to themselves and their babies. The condition requires inpatient psychiatric care and is much more common in women with a personal or family history of affective disorder, bipolar disorder or psychosis.

Reproductive System (30 decks)

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