Abnormal labour & postpartum care Flashcards
What are the common reasons for failure of labour?
1) Inadequate Uterine activity
2) Cephalopelvic disproportion (CPD)
3) Malpresentation (vertex, breech or shoulder)
4) Malposition (longitudinal, transverse, oblique)
5) Fetal distress
What can cause fetal distress?
Too many contractions (uterine hyper stimulation) caused by labour induction which result in decreased placental blood flow
What are the normal changes to the mother in the perpeurium?
Perpeurium = post partum period
1) Contraction of uterus
2) Hypercoaguability peaks during post-partum period
3) Vascularity and oedema of vagina resolves
4) Discharge from uterus
What are the potentially serious medical problems that can occur in the postpartum period?
1) Post partum haemorrhage (PPH)
2) Venous thromboembolism
3) Sepsis
4) Post natal depression and postnatal psychosis
5) Pre-eclampsia
What is the difference between primary and secondary PPH?
Primary = Blood loss > 500ml within 24hrs delivery
Secondary = Blood loss > 500ml from 24hrs to 6 weeks
How much more likely are pregnant woman to develop a DVT or PE?
6-10 times
What are the signs to look out for in pregnant woman who may be suffering with a DVT or PE?
1 - Unilateral leg swelling
2 - Chest pain
3 - SOB
What are some reasons for why labour may need to be induced?
1 - Diabetic mother
2 - Term + 7 days
3 - Mother on DVT treatment
4 - Growth concerns
5 - Oligohydramnios (not enough amniotic fluid)
What does induction involve?
1 - Use medications to ‘ripen’ cervix (pessaries or gel)
2 - Artifical rupture of membranes (amniotomy)
What scoring system is used to assess the cervix when making a decision whether to induce labour or not?
Bishop’s score
What is Bishop’s score used for?
It is an indicator of whether or not induction of labour is going to be successfull
What are the components of Bishop’s score?
1 - Cervical dilatation
2 - Cervical effacement (length)
3 - Position of cervix
4 - Consistency of cervix (firm, soft etc.)
5 - Station of fetus (-3, -2, +2 etc.)
What Bishop’s score is considered favourable for amniotomy?
7
Once the cervix has been ‘ripened’ and amniotomy performed, which drug is used to help achieve adequate contractions?
IV Oxytocin
How many contractions in 10 minutes is considered adequate?
4-5
What are the 3 components that control how a labour will proceed?
Powers (contractions)
Passages (size of birth canal compared to fetus head)
Passenger (fetal position and presentation)
What is defined as ‘suboptimal’ progress during the active 1st stage of labour in terms of cervical dilatation?
< 0.5cm/hour for primargravid woman
< 1cm/hour for parous woman
What is the most common orientation of the fetal head during delivery?
Occiput-anterior
What are the most common mal-positions of the fetus during labour?
Occiput-posterior
Occiput-transverse
How is fetal wellbeing assessed during labour?
1 - Cardiotocograph
2 - Fetal ECG
3 - Fetal blood sample
4 - Auscultation of fetal heart
What can a fetal blood sample indicate?
pH - therefore understand if the baby is hypoxic
Why are sections performed?
To manage an obstructed labour or fetal distress before the cervix is fully dilated
What are the increased risks associated with C-sections?
1 - Infection
2 - Bleeding
3 - VTE
What is the averga rate of C-sections in the UK?
25%
What are some commonly encountered complications during 3rd stage of labour?
1 - Retained placenta
2 - PPH
3 - Tears
What are the 4T’s of PPH?
Tissue
Thrombin
Trauma
Tone
What could the only sign of a PE in a pregnant woman?
Unexplained Tachycardia
How should Thromboembolic disease be investigated in pregnant mothers?
1 - ECG
2 - Leg doppler
3 - CXR +- VQ
How is thromboembolic disease treated in pregnant woman?
Low-molecular weight heparin
What drug must not be used to treat thromboembolic disease in pregnancy and why?
Warfarin - it is teratogenic
When can warfarin be used by mothers?
When breastfeeding
How should maternal sepsis be treated?
Prompt IV antibiotics
When do most eclamptic seizures occur in relation to pregnacy?
Postnatal period
