Intrapartum + Postpartum Care Flashcards
Steps of induction of labor and the medications used.
- ripening of uterus
- prostaglandins - topical misoprostal
- balloons (becoming preferred because less likely to cause fetal distress)
- amniotomy (if not spontaneous)
- augmentation (contractions) - IV oxytocin
5 things for ripening of uterus (same as Bishop’s score)
- effacement
- dilation (2-3 cm proceed to amniotomy)
- cervical position moves from posterior –> anterior
- softer
- fetal station near pelvis
which bishop’s score indicates that:
- induction is a success and spontaenous labor will occur
- labor unlikely to start without induction
- start amniotomy
- > 8
- <5
- > 7
indications for induction (8)
(in no particular order)
- DM
- prolonged pregnancy - 41 weeks max
- PROM
- maternal conditions: hypertension, on anticoagulants
- multiple pregnancies
- previous stillbirth, intrauterine death
- fetal conditions: growth restrictions, macrosomia, oligohydraminos
- mother’s request
contraindications for induction (7)
- placental previa/vasa previa
- anatomical abnormalities
- malpresentation
- cord prolapse
- fetal distress
(relative risk) - maternal asthma
- previous C section
when is pregnancy:
- how long is 1 pregnancy
- full term
- premature
- 40 wks
- 37 wks
- <37 wks
prolonged pregnancy poses risk for:
stillbirth
complications of induction of labor (6)
- uterine hypertonicity –> fetal distress
- fetal distress
- ruptured uterus - if prolonged or hypertonic
- adverse drug reaction (hypotension, hyponatremia)
- failed induction –> C section
- PPH
what are the 3 P’s that cause failure of labor to progress?
- power
- passages
- passenger
what is the suboptimal cervical dilatation in cm in the first stage of labor?
< 0.5 cm in primigravid
< 1 cm in parous
if > 4 cm and regular contractions –> labour should progress
what is the main natural inducer of cervical dilatation, and how is this related to adequate contractions?
contraction –> fetal head descends –> exert force on cervix –> dilatation
caput and moulding and how these happen
CPD (cephalopelvic disproportion, or when the fetal head is too big for the pelvis)
- caput - diffuse swelling of the scalp caused by pressure against cervix
- moulding - skull bones overlap
fetal presentation and fetal position
presentation:
- vertex/breech
- longitudinal/transverse
ideal - longitudinal lie, vertex presentation
position:
- right/left
- occipito-anterior/posterior
- occipito transverse
ideal - occipito anterior
how to identify the location of the occiput before delivery?
vaginal examination - feel fontanelles
- anterior = diamond shaped
- posterior = triangular shaped
causes of fetal distress (5)
- hypoxia
- infections
- placental previa/vasa previa
- cord prolapse
- placental abruption
why is oxytocin always given with fluid?
it causes hypotension and hyponatremia
methods of fetal monitoring and when to use which
- intermittent auscultation (with doppler ultrasound, every 15 mins in 1st stage of labor and every 5 mins in 2nd stage) - low risk
- CTG (cardiotocography) - high risk or if abnormal intermittent auscultation
- fetal blood sampling - only if abnormal CTG
- fetal ECG
what does CTG detect?
- fetal heart rate
- contraction rate
- can also detect CNS, ANS changes due to hypoxia
what does fetal blood sampling detect, and how was sample collected
scratch made to baby’s scalp with speculum and collected
- detects pH of blood:
- < 7.20: deliver immediately
- 7.21-7.24: repeat in 30 mins if CTG stable
- > 7.25: repeat in 1 hr if CTG stable
how to read CTG (DR C BRVADO)
DR - determine risk, what is the need for CTG
C - contractions (4-5/10 mins)
BR - baseline rate (100-160 systolic)
V - variability
A - acceleration
D - deceleration, might be feature of normal labor, but prolonged or late deceleration indicates fetal distress
O - overall
indications of C section
- fetal distress
- multiple pregnancy with malpresentation
- failed induction/progress of labor
- prolonged pregnancy
- malpresentation
- placenta previa/vasa previa
- severe pre-eclampsia
- previous C section
type of incision done in C section
99% lower uterine segment incision (LUSI) - horizontal
what does puerperinum mean
postnatal period, 6 weeks after delivery
when where and for what reason would postnatal woman have her check up?
9-10 days: see midwife at home - check wounds, bleeding, endometritis, breast, debrief of events around birth, mental health
6 weeks: GP - contraception, mental health
