Abnormal labour + postpartum care

Question 1

• To describe the common reasons for abnormal/failed labour and their remedies
• To describe the stress of labour on the foetus and the limitations of foetal assessment in labour
• To describe the normal changes to the mother in the puerperium
• To describe the potentially serious medical problems arising in the postpartum period

Answer 1

.

Question 2

Indications for early induction

Answer 2

DM or other maternal health issues e.g. DVT

Overdue 7 days

Foetal reasons, e.g. huge growth, oligohydramnios (low amniotic fluid)

Question 3

What is the bishop’s score (0-13) used for

Answer 3

Clinically assess the cervix
-the higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful

Question 4

Induction involves doing what

Answer 4

Stimulate labour by using medications and/or devices to dilate (ripen) cervix, followed by artificial rupture of membranes (amniotomy)

Question 5

If cervix isn’t dilated or effaced (thinned/stretched) then what can be used to open it

Answer 5

Prostaglandin pessaries or cook balloon

Then can do amniotomy

Question 6

A bishop score of what is favourable for an amniotomy

Answer 6

7 or more

Question 7

Following an amniotomy, what hormone is given IV to stimulate contractions

Answer 7

Oxyotocin

Question 8

Reasons for abnormal/failed labour

Answer 8

Cephalopelvic disproportion (CPD) - foetal head too big to go through pelvis (RARE)

Malposition - incorrect head position, ideally OA

Malpresentation - breech (longitudinal), shoulder (transverse)

Inadequate uterine activity

Obstruction, e.g. ovarian cyst, fibroids

Foetal distress

Question 9

In the active stage of stage I labour, what should the rate of cervical dilation be in

• primigravid women
• parous women

Answer 9

Less than 0.5cm per hour for primigravid women

Less than 1cm per hour for parous women

Question 10

Inadequate uterine activity can cause abnormal labour as the foetal head won’t descend and exert force on the cervix

What can remedy this

Answer 10

IV oxytocin to increase strength + duration of contractions

Question 11

Before giving IV oxytocin to stimulate labour, it’s important to exclude what

Answer 11

Obstruction of the birth canal (e.g.ovarian cyst, fibroids) as it could rupture the uterus

Question 12

Ways of assessing foetus during labour (4)

Answer 12

Intermittent auscultation of the foetal heart
Cardiotocography
Foetal blood sampling
Foetal ECG

Question 13

What can excessive IV oxytocin cause

Answer 13

Uterine hyper-stimulation which can cause foetal distress

Question 14

What would be concerning on a CTG

Answer 14

If foetal HR decelerates for a long period and is slow to recover back to normal

Question 15

When is foetal blood sampling indicated + where is it taken from + what does it measure

Answer 15

If CTG abnormal

Head

pH - suggests potential hyperaemia

Question 16

In what situations is natural labour not indicated

Answer 16

Obstructed birth canal - major placenta praevia, masses

Malpresentation - shoulder or breech presentation

Existing medical conditions where labour in unsafe

Previous labour complications

Foetal state

Question 17

Complications in stage III labour

Answer 17

Retained placenta

Post-partum haemorrhage - 4 Ts (tone, trauma, tissue, thrombin)

Tears

Question 18

Normal changes to the mother in the puerperium (postpartum period up to 6wks)

Answer 18

?

Question 19

Potentially serious medical problems arising in the postpartum period

Answer 19

Post partum haemorrhage

Venous thromboembolism - because pregnancy and postpartum are hypercoagulable states

Sepsis

Psychiatric disorders during postpartum, e.g. depression, psychosis (rare)

Pre-eclampsia

Question 20

In women with unilateral leg swelling and/or pain or women complaining of SOB or chest pain, what should you be suspicious of

Answer 20

Thromboembolism

Question 21

How are thromboembolisms treated in pregnant woman or postpartum

Answer 21

LMWH; not warfarin as teratogenic but can be used when breastfeeding