Labour Complications Flashcards
what is the puerperium
period of recovery after birth when tissues return to pre-pregnancy state
describe the changes to maternal discharge in the post-partum period
days 3-4 fresh red blood
days 4-14 brown watery discharge
days 10-20 yellow discharge
after how long will the uterus have returned to its normal size of within the pelvis
2 weeks
what volume of blood loss is considered normal during labour
<500 ml
what is the difference between primary and secondary PPH
primary - within first 24 hours
secondary - after 24 hours but before 6 weeks
a minor PPH is blood loss of how much
500-1000ml
a major PPH is blood loss of how much
> 1000ml or signs of collapse
what are the 4 main causes of PPH
tone - uterine atony
trauma - vaginal tear/cervical laceration
tissue - retained placenta or membranes
thrombin - coagulation disorder
what is the most common cause of PPH
uterine atony - failure of the uterus to contract following delivery
list some antenatal risk factors for PPH
placental problems such as praevia or accreta
past obstetric history of retained placenta, c-section
multiple pregnancy
polyhdramnios
list some obstetric risk factors for PPH
operative vaginal delivery use of syntocinon or syntometrine retained placenta c-section labour >12 hours perineal tear during delivery
what is the initial management of PPH
ABCDE
oxygen
IV access for G&S + crossmatch + FBC + coag screen
IV transexamic acid to stop the bleeding
how is uterine atony and retained placental products managed non-surgically
uterine massage with bimanual compression
5 units of IV syntocinon
if no response administer ergometrine or carboprost
what is carboprost
synthetic prostaglandin
how is a thrombin problem managed non-surgically
expel any clots manually
when is insertion of a catheter indicated in managing PPH
if uterine atony, to minimise the bladder pressure on the uterus
what are the surgical methods of managing PPH
balloon insertion to put pressure on the bleeding vessels arterial embolisation uterine artery ligation iliac artery ligation hysterectomy last resort
when are perineal tears most common
in nulliparous women
describe a first degree tear
involves vaginal skin and mucosa
describe a second degree tear
involves the perineal muscles
describe a 3a tear
involves <50% of external anal sphincter
describe a 3b tear
involves >50% of external anal sphincter
describe a 3c tear
involvement of internal anal sphincter
describe a fourth degree tear
rectal mucosa torn
how are perineal tears managed
local anaesthetic injected to branches of pudendal nerve and area is stitched at the time
what is cord prolapse
descent of the umbilical cord through the cervix below the presenting part following rupture of membranes
what are the main complications of cord prolapse
foetal asphyxia
how does cord prolapse present
may be visible on examination
CTG changes - foetal bradycardia and variable decelerations
how is cord prolapse managed
knee to chest position to relieve pressure
displace presenting part by inserting hand into vagina and pushing back up on contractions
give tocolytics
what tocolytics are given and what is their effect
terbutaline - aim to reduce contractions
what is the only definitive management of cord prolapse
delivery - either LSCS or assisted vaginal delivery if fully dilated
what is shoulder dystocia
bony impaction of foetal anterior shoulder on maternal symphysis
outline the risk factors for shoulder dystocia
obesity
macrosomia
prolonged labour
instrumental delivery
what are the complications of shoulder dystocia
asphyxia hypoxic brain injury brachial plexus injury PPH 3rd and 4th degree tears
what is the mnemonic for management of shoulder dystocia
HELP H - help E - evaluate for episiotomy L - legs into McRoberts manoeuvre P - pressure suprapubically
what is McRoberts manoeuvre
hyper flexed lithotomy position
what is a useful position for a mother to get into if presenting with shoulder dystocia
roll onto all 4s
