Abnormal Labour And Postpartum Care

Question 1

What are the common reasons for abnormal labour and how are they remedied?

Answer 1

Failure to start labour - remedied via induction (also used if maternal health problems necessitate planning, or foetal reasons eg growth concerns)

Induction = ripen cervix eg medications, balloon and then artificial rupture of membranes, then IV oxytocin to achieve adequate contractions

Problems can occur in: Powers eg contractions, passages eg pelvis, passenger eg baby

Examples: inadequate progress due to

• cephalopelvic disproportion (head and pelvis mismatch)
• malposition eg head in incorrect position, occipitoposterior, occipitotransverse
• malpresentation eg breech or shoulder
• inadequate uterine activity (can remedy through synthetic IV oxytocin)
• obstruction eg fibroids
• foetal distress

Labour can be: assisted/instrumental, Caesarian section

Question 2

What stress does labour have on the foetus and what are the limitations of foetal assessment during labour?

Answer 2

Stress can be caused by insufficent placental blood flow

Assessed by: intermittent auscultation, cardiotocography, foetal blood sampling (direct measure of pH and base excess, gives measure of likely hypoxaemia), foetal EEG

Question 3

What are the normal changes that occur to the mother in the postpartum period?

Answer 3

Normally see midwife first 9-10 days, then health visitor

Monitored for: abnormal bleeding, evidence of infection, debrief of birth

6 week postnatal check up at GP

Common problem: infant feeding, bonding, social issues

Question 4

What are the potentially serious medical problems that arise during the postpartum period?

Answer 4

3rd stage complications

• retained placenta
• post partum haemorrhage:
• primary (tone, trauma, tissue, thrombin) >500ml/24hr
• secondary (retained tissue, endometritis, tears/trauma) >500ml/24hr-6wkm

Postnatal

• venous thromboembolism: pregnant women are hypercoaguable, risk assessment and appropriate thromboprophylaxis required. Suspicious when unilateral leg swelling +/or pain, or SOB or chest pain. Sometimes only unexplained tachycardia. Investigate: ecg, Doppler, CXR +/- VQ scan. TM: low molecular weight heparin
• sepsis: prompt IV antibiotic, full septic screen, antipyretic measures, IV fluids and referal to hospital if concerns
• psychiatric disorders: baby blues, postnatal depression, puerperal psychosis (inpatient psychiatric care)
• pre eclampsia can develop post nasally and may worsen