Abnormal labour and postpartum care

Question 1

What are the factors used to diagnose labour?

Answer 1

CErvical effacement
Cervical dilatation
Descent of foetal head through maternal pelvis

Question 2

What are the risks associated with inducing labour?

Answer 2

Less efficient and more painful
Need foetal monitoring
Hyperstimulation pf uetrus

Question 3

What are th indications for induction?

Answer 3

Diabetes
7 days after due date
Maternal health problems necessitating planning of delivery
Foetal- growth concerns, oligohydramnios

Question 4

What is the process of inducing labour?

Answer 4

If no cervical dilatation, use prostaglandin pessaries or Cook balloon
Once cervix dilated and effaced, perform amniotomy
Once amniotomy, consider IV oxytocin, esp in primigravida

Question 5

What is used to assess the cervix in labour?

Answer 5

Bishop’s score

Question 6

What would be described as inadequate progress in labour?

Answer 6

Less than 0.5cm dilation an hour in primigravida women

Less than 1cm an hour in parous women

Question 7

What are the causes of inadequate progress in labour?

Answer 7

Cephalopelvic disproportion
Malposition --> relative CPD
Malpresentation
Inadequate uterine activity
Obstruction

Question 8

What is the treatment of inadequate uterine activity in labour?

Answer 8

IV oxytocin

Question 9

What is the main cause of foetal distress?

Answer 9

Uterine hyperstimulation

Question 10

What Is done to monitor foetal distress?

Answer 10

Intermittent auscultation of heart
CTG
Foetal blood sampling if CTG abnormal
Foetal ECG

Question 11

When would you opt not to labour?

Answer 11

Obstruction
Malpresentation
Medical condition causing labour to be unsafe
Specific previous labour complications
Foetal conditions

Question 12

What are the options once one has opted not to labour?

Answer 12

Assisted/instrumental delivery

C section

Question 13

What are the 3rd stage complications of labour?

Answer 13

Retained placenta
Post partum haemorrhage
Tears

Question 14

What health professionals are seen in the post partum stage?

Answer 14

Midwife for first 9-10 days then health visitor

Gp at 6 weeks

Question 15

What is moniotred for post partum?

Answer 15

Bleeding

Infection

Question 16

What are the common post partum problems?

Answer 16

HAemorrhage
Venous thromboembolism
Sepsis
Psych disorders
Pre-ecclampsia

Question 17

What is primary PPH?

Answer 17

Blood loss >500ml within 24 hours of delivery

Question 18

What are the causes of primary PPH?

Answer 18

Tone
Trauma
Tissue
Thrombin

Question 19

What is secondary PPH?

Answer 19

Blood loss > 500ml from 24 hours to 6 weeks post partum

Question 20

What are the causes of secondary PPH?

Answer 20

Retained tissue
Endometriosis
Tears/trauma

Question 21

What are the risks of VTE?

Answer 21

Pregnant/post partum
Epidural
C sectoon

Question 22

What investigations are done for VTE?

Answer 22

ECG
Leg dopplers
CXR +/- VQ or CTPA

Question 23

What is the treatment/prophylaxis for VTE?

Answer 23

Low molecular weight heparin

Question 24

What is done for any pregnant/post partum women with a suspicion of sepsis?

Answer 24

Prompt IV antibiotics

Question 25

What are the different puerperium psych conditions?

Answer 25

Baby blues
Postnatal depression
Puerperal psychosis

Question 26

What is baby blues?

Answer 26

Mood decreases 1-3 days after birth due to hormonal changes

Question 27

What are the symptoms of postnatal depression?

Answer 27

Classical depressive symptoms

Affects function, bonding

Question 28

What increases risk of postnatal depression?

Answer 28

Personal or FH of affective disorder

Question 29

What is the treatment of puerperal psychosis?

Answer 29

Inpatient care

Question 30

What increases the risk of puerperal psychosis?

Answer 30

Personal or FH of affective disorder, bipolar or psychosis

Question 31

Why is pre-eclampsia still a risk post natally?

Answer 31

Can develop post nasally or worsen several days following delivery