Repro Flashcards
Indications for Induction
Diabetes
Post dates – Term + 7 days
Maternal health problem that necessitates planning of delivery e.g. on treatment for DVT
Fetal reasons e.g. growth concerns, oligohydramnios
Social / maternal request / pelvic pain / “big” babies
Bishop’s score
Indicates cervical progressive change and whether
induction is likely to be successful
Dilatation Length of Cervix - Effacement Position Consistency Station
Induction
instigate labour artificially (vaginal birth)
If cervix not dilated and effaced (low Bishop’s score), then vaginal prostaglandin pessaries / Cook Balloon can be used to ripen (open) the cervix - stimulate contraction
Once cervix has dilated and effaced, an amniotomy can be performed — ‘Bishop score’ => 7 amniotomy
Amniotomy
Amniotomy is the artificial rupture of the fetal membranes (“waters”) using amniohook
IV oxytocin can be used to achieve adequate contractions – aim for 4-5 contractions in 10 minutes
Active 1st stage of labour
Suboptimal progress is defined as cervical dilatation
abdominal and vaginal exam: Cervical effacement (stretches and gets thinner) Cervical dilatation (opens) Descent of the fetal head
less than 0.5cm per hour for primigravid women
less than 1cm per hour for parous women (having produced offspring)
Inadequate Pregnancy progress
Cephalopelvic disproportion (CPD)
- fetal head too large to negotiate the maternal pelvis
- caput and moulding develop
Malposition
- fetal head in an incorrect position for labour
- ‘relative’ CPD occurs
- Occipito-posterior & Occipito-transverse
Malpresentation
- Longitudinal lie Vertex/Breech
- Transverse lie shoulder
- Oblique
Inadequate uterine activity
Birth canal obstruction (e.g. ovarian cyst or fibroid)
Fetal Distress
Woman conditions where labour would not be safe
Previous labour complications eg. uterine rupture
Fetal well being in labour is determined by
Intermittent auscultation of the fetal heart
Cardiotocography
Fetal blood sampling – when abnormal CTG
–pH and base excess
Fetal ECG
Uterine Hyper-stimulation can result in
fetal distress due to insufficient placental blood flow.
Postnatal Problems
Postpartum Haemorrhage
Primary = blood loss of >500ml within 24 hrs of delivery
Tone, Trauma, Tissue, Thrombin (4 T’s)
Secondary = > 500ml from 24hrs - 6weeks post partum
Retained tissue, Endometritis (infection), Tears / trauma
NB: Lochia = normal discharge from the uterus after childbirth (3-4 weeks postnatal - “like a period/less”)
Thromboembolic disease in pregnancy / postnatally
High quality risk assessment
Pregnancy and the immediate post partum period is a hypercoagulable state
Pregnant women 6-10 times more likely to develop thromboembolism (DVT or PE - tachycardia**)
Suspicious = women with unilateral leg swelling and/or pain and women complaining of SOB or chest pain
Immobilisation following spinal anaesthetic / caesarean section will further increase risk, D-dimer unreliable
Investigate (ECG, Leg Dopplers, CXR +/- VQ scan/CTPA
(NB:radiation exposure during pregnancy/Breastfeed)
Treat with low molecular weight heparin
WARFARIN IS TERATOGENIC, CAN use in Breastfeed
Sepsis = leading cause of maternal death in UK
May present atypically
In any woman you suspect sepsis – prompt IV antibiotic administration
Perform full septic screen – blood cultures, LVS, MSSU, wound swabs
Antipyretic measures, IV fluids + referral to hospital if you concerned for pregnant / postnatal woman
Postnatal Depression
Can continue on from baby blues or start sometime later
Has classical ‘depressive’ symptoms
Affects functioning, bonding and often requires treatment
Increased risk in women with personal or family history of affective disorde
Puerperal psychosis
Rare but serious psychotic illness of the postnatal period
Women can be a danger to themselves and their babies
Requires inpatient psychiatric care
Much more common in women with personal or family history of affective disorder, bipolar disorder or psychosis
ThePearl Index
# contraceptive failures per 100 women-years exposure looks at the total months or cycles of exposure from the initiation of the product to the end of the study
Life Table Analysis
Provides the contraceptive failure rate over a specified time-frame and can provide a cumulative failure rate for any specific length of exposure
