Intrapartum and postpartum Flashcards
Hormones involved in lactation
Prolactin
Oestrogen, progesterone, insulin, thyroid hormones, glucocorticoids - involved in priming the breast
What hormone is involved in milk release
Oxytocin
Can a baby with galactosaemia be breast fed?
No
Breast milk must be excluded from the diet
Can a baby with phenylketonuria be breast fed?
No
Breast milk must be excluded from the diet
Can a baby with alactasia be breastfed?
No
Breast milk must be excluded from the diet
What is the risk of tetracycline during breastfeeding?
Stains teeth
What is the risk of maternal metronidazole during breastfeeding
Alters taste of breast milk
Not contraindicated
Can women with mastitis breastfeed or express?
Yes.
Continued feeding or regular breast pumping should be recommended along with analgesia and antibiotics
What hormone maintains successful lactation
Prolactin
What hormone inhibits lactation
Dopamine
Constituents of human milk compared to cows milk
Less protein More fat More carbohydrate Low sodium Higher levels of IgA and lactoferrin
Can breast milk be given to babies with galactosaemia
No.
Precipitates hypoglycaemia
What is moulding
Change in anatomical relations of bones of detail skull during labour and delivery
Where is the fetal vertex
Between anterior and posterior fontanelles
Where is the fetal occiput
Posterior to the posterior fontanelle
Where is the fetal bregma
The area of the anterior fontanelle
Where is the fetal brow
Anterior to anterior fontanelle to root of nose
What is inadequate progress in labour for a nulliparous woman
Lack of continuing progress for 3 hours with regional anaesthesia.
or 2 hours without regional anaesthesia
What is inadequate progress in labour for a Multiparous woman
Lack of continuing progress for 2 hours with regional anaesthesia.
or 1 hour without regional anaesthesia
Conditions where forceps would be preferred to ventouse
Poor maternal effort
Operator or maternal preference, when either instrument would be suitable
Large amount of caput
Gestation of less than 34 weeks (at 34–36 weeks of gestation, ventouse is relatively contraindicated)
Marked active bleeding from a fetal blood-sampling site
After-coming head of the breech
Face presentation
Indications for FBS include:
pathological CTG in labour (cervix dilated >3 cm)
suspected acidosis in labour (cervix dilated >3 cm).
What is a normal FBS result
PH ≥7.25
Normal FBS result.
Repeat after 1 hour if CTG remains the same
What is the cut off for an abnormal FBS result
PH ≤7.20 - consider delivery
Contraindications to FBS
Contraindications include:
maternal infection (e.g. HIV, hepatitis viruses and herpes simplex virus)
Fetal bleeding disorders (e.g. haemophilia)
Prematurity (birth at less than 34 weeks of gestation)
Acute fetal compromise (e.g. prolonged fetal bradycardia of >3 minutes).
Limitations imposed by the use of continuous EFM
reduced mobility
possibility that woman will not be the centre of care in labour
increased intervention
variation in interpretation of CTG trace
chorioamnionitis could make interpretation unreliable
litigation
Normal CTG features
Baseline rate 100-160
Variability >5
Decelerations - none or early
Non-reassuring CTG features
Baseline rate 161-180
Variability 50% of contractions
Abnormal CTG features
Baseline rate 180
Variability 90 minutes
Late decelerations >30mins with >50% of contractions
Bradycardia/prolonged deceleration >3min
management of non-reassuring CTG
commence conservative measures – left lateral position, oral / intravenous fluids, stop oxytocin, consider tocolysis.
management of abnormal CTG
Offer to take fetal blood sample (FBS; for lactate or pH) after implementing conservative measures, or expedite birth if an FBS cannot be obtained and no accelerations are seen as a result of scalp stimulation.
What are late decelerations suggestive of
Fetal hypoxia
What are late decelerations controlled by
Reflex central nervous system response to hypoxia and acidaemia.
Consequences of maternal fever on the fetus
Fetal tachycardia.
Loss of variability
Increased oxygen demand
Late decelerations
How does fetal baseline variability change with gestation
Baseline variability is low in early pregnancy and increases with gestation
Non-hypoxia related causes of decreased variability
Anencephaly Central nervous system defects Drugs - opiates, magnesium sulphate, atropine Sepsis Defective cardiac conduction Quiet fetal sleep
Can cord compression cause decelerations?
Yes - variable decelerations
Most common type of deceleration in labour
80% variable decelerations
5% late decelerations
Isolated early decelerations - rare
change in blood volume in pregnancy
rapid increase in extracellular fluid - esp circulating plasma
Increase in total body water by 2L
What is the maternal mortality ratio?
The number of maternal deaths in population divided by the number of live births.
(The risk of maternal death relative to the number of live births)
What is the maternal mortality rate?
Number of maternal deaths in a population divided by the number of women of reproductive age.
(Reflects risk of maternal deaths per pregnancy and level of fertility in the population)
Define stillbirth
Baby born > 24 weeks with no signs of life
Define perinatal death
Stillbirth > 24 weeks gestation or death within 7 days of birth
Define live birth
Any baby born with signs of life regardless of gestation
Define maternal death
Death of a woman while pregnant within 42 days of termination of pregnancy from any cause related to all aggravated by the pregnancy or its management.
Not accidental or incidental death
Define perinatal mortality rate
Number of stillbirths and early neonatal deaths per 1000 live births and stillbirths
Where is the foramen ovale located
Atrial septum