Abnormal labour & postpartum care

Question 1

What are the common reasons for failure of labour?

Answer 1

1) Inadequate Uterine activity
2) Cephalopelvic disproportion (CPD)
3) Malpresentation (vertex, breech or shoulder)
4) Malposition (longitudinal, transverse, oblique)
5) Fetal distress

Question 2

What can cause fetal distress?

Answer 2

Too many contractions (uterine hyper stimulation) caused by labour induction which result in decreased placental blood flow

Question 3

What are the normal changes to the mother in the perpeurium?

Answer 3

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

Question 4

What are the potentially serious medical problems that can occur in the postpartum period?

Answer 4

1) Post partum haemorrhage (PPH)
2) Venous thromboembolism
3) Sepsis
4) Post natal depression and postnatal psychosis
5) Pre-eclampsia

Question 5

What is the difference between primary and secondary PPH?

Answer 5

Primary = Blood loss > 500ml within 24hrs delivery

Secondary = Blood loss > 500ml from 24hrs to 6 weeks

Question 6

How much more likely are pregnant woman to develop a DVT or PE?

Answer 6

6-10 times

Question 7

What are the signs to look out for in pregnant woman who may be suffering with a DVT or PE?

Answer 7

1 - Unilateral leg swelling

2 - Chest pain

3 - SOB

Question 8

What are some reasons for why labour may need to be induced?

Answer 8

1 - Diabetic mother

2 - Term + 7 days

3 - Mother on DVT treatment

4 - Growth concerns

5 - Oligohydramnios (not enough amniotic fluid)

Question 9

What does induction involve?

Answer 9

1 - Use medications to ‘ripen’ cervix (pessaries or gel)

2 - Artifical rupture of membranes (amniotomy)

Question 10

What scoring system is used to assess the cervix when making a decision whether to induce labour or not?

Answer 10

Bishop’s score

Question 11

What is Bishop’s score used for?

Answer 11

It is an indicator of whether or not induction of labour is going to be successfull

Question 12

What are the components of Bishop’s score?

Answer 12

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.)

Question 13

What Bishop’s score is considered favourable for amniotomy?

Answer 13

7

Question 14

Once the cervix has been ‘ripened’ and amniotomy performed, which drug is used to help achieve adequate contractions?

Answer 14

IV Oxytocin

Question 15

How many contractions in 10 minutes is considered adequate?

Answer 15

4-5

Question 16

What are the 3 components that control how a labour will proceed?

Answer 16

Powers (contractions)

Passages (size of birth canal compared to fetus head)

Passenger (fetal position and presentation)

Question 17

What is defined as ‘suboptimal’ progress during the active 1st stage of labour in terms of cervical dilatation?

Answer 17

< 0.5cm/hour for primargravid woman

< 1cm/hour for parous woman

Question 18

What is the most common orientation of the fetal head during delivery?

Answer 18

Occiput-anterior

Question 19

What are the most common mal-positions of the fetus during labour?

Answer 19

Occiput-posterior

Occiput-transverse

Question 20

How is fetal wellbeing assessed during labour?

Answer 20

1 - Cardiotocograph

2 - Fetal ECG

3 - Fetal blood sample

4 - Auscultation of fetal heart

Question 21

What can a fetal blood sample indicate?

Answer 21

pH - therefore understand if the baby is hypoxic

Question 22

Why are sections performed?

Answer 22

To manage an obstructed labour or fetal distress before the cervix is fully dilated

Question 23

What are the increased risks associated with C-sections?

Answer 23

1 - Infection

2 - Bleeding

3 - VTE

Question 24

What is the averga rate of C-sections in the UK?

Answer 24

25%

Question 25

What are some commonly encountered complications during 3rd stage of labour?

Answer 25

1 - Retained placenta

2 - PPH

3 - Tears

Question 26

What are the 4T’s of PPH?

Answer 26

Tissue

Thrombin

Trauma

Tone

Question 27

What could the only sign of a PE in a pregnant woman?

Answer 27

Unexplained Tachycardia

Question 28

How should Thromboembolic disease be investigated in pregnant mothers?

Answer 28

1 - ECG

2 - Leg doppler

3 - CXR +- VQ

Question 29

How is thromboembolic disease treated in pregnant woman?

Answer 29

Low-molecular weight heparin

Question 30

What drug must not be used to treat thromboembolic disease in pregnancy and why?

Answer 30

Warfarin - it is teratogenic

Question 31

When can warfarin be used by mothers?

Answer 31

When breastfeeding

Question 32

How should maternal sepsis be treated?

Answer 32

Prompt IV antibiotics

Question 33

When do most eclamptic seizures occur in relation to pregnacy?

Answer 33

Postnatal period