Abnormal Labour and Postpartum Care Flashcards

1
Q

What proportion of pregnancies are induced currently?

A

1 in 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is induction of labour given?

A

Medications and/or devices used to ripen cervix

Membranes ruptured artificially (amniotomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can contractions be increased?

A

IV oxytocin to increase strength and length of contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What complication is causes by stimulation of an obstructed labour?

A

Rupture of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the common malpresentations?

A

Breach or transverse lie

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In what cases can a breach presentation be delivered vaginally?

A

Second twin

Multiparous woman

All other incidences requiring caesarean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

Cord prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.