Return to Medicines ListShow Learning Points most relevant to Phase 1:

Labour

Clinical Discipline(s)/Organ System(s)
Obstetrics & Gynaecology, Reproduction & Development, Paediatrics
Progress Test Topic(s)
Women's health
Description
A 16 year old G2P0 Māori woman presents at 38 weeks pregnant in early labour. While being transferred to the Labour and Birthing Suite she tells you her 'waters broke'. Her labour progresses quickly and she starts pushing. The midwife becomes concerned and calls the obstetrician when she notices fetal heart rate decelerations
Applied Science for Medicine 
   - Anatomy and function of the perineum and pelvic floor
   - Different pelvic types and fetal positions and the consequences of these
   - Physiology of uterine contractility and fetal heart rate patterns
   - Mechanisms and stages of labour and birth
   - Fetal oxygenation and normal/abnormal acid base balance
   - Transition at birth from fetal to postnatal breathing
   - Causes of cerebral palsy and neonatal seizures
   - Science of neonatal body cooling
Clinical and Communication Skills 
   - History from a patient and her midwife during labour
   - Recognise symptoms and signs of latent and active phases of labour
   - Examination of a woman in labour
   - Use and interpret the partogram
   - Management of normal labour and delivery
   - Fetal monitoring for normal and high risk labour
   - Options for pain relief in labour and indications for epidural
   - Indications for: continuous fetal monitoring, induction and augmentation of labour, fetal blood testing, emergency delivery
   - Interpret relevant investigations: cardiotocograph (CTG), fetal scalp samples including lactate, cord blood gases
   - Differential diagnosis and management of abnormal fetal heart rate pattern including that associated with meconium
   - Differential diagnosis and management of delayed labour progress: non-pharmacological, artificial rupture of membranes, syntocinon, episiotomy, ventouse, forceps and caesarean
   - Management of third stage
   - Types of perineal trauma (tears and episiotomy)
   - Emergency management of postpartum haemorrhage
   - Prognosis and complications of operative delivery for mother and baby, short- and long-term; implications for future pregnancies
   - Post-natal contraception
   - Resuscitation of the newborn; complications of fetal acidaemia; lactation issues due to separation from mother
   - Neonatal care of term baby
   - Completing paperwork after a stillbirth or neonatal death;importance of post-mortem examination after stillbirth or neonatal death; when to refer to the coroner
Personal and Professional Skills 
   - Team and leadership skills
   - Respecting a women's views and choices in labour and birth (birth plan)
   - Appreciate the loss of 'normality' and feelings of failure associated with an operative birth
   - Withdrawing neonatal care owing to futility of treatment
   - Caring for a woman after a neonatal death; grief counselling
   - Discussion of management and outcome with members of staff/students after the event
Hauora Māori 
   - Managing the whenua (placenta)
   - Consideration of inequities in access to maternity services including Caesarean sections for Māori
   - Having a baby in Neonatal Intensive Care Unit; access for extended Whānau
   - Inequities in perinatal mortality between Maori and non Maori and reasons for this
   - Consideration of access to cultural/spiritual support for patient/whānau (including accommodating return of any body parts to whānau if requested).
   - Māori beliefs relevant to postmortem examination
Population Health 
   - Burden on families who have to travel to tertiary centre to receive treatment
   - Antenatal care and optimizing maternal health
   - Incidence of medical intervention in labour and birth
   - Health and economic implications of increasing operative deliveries
   - Developmental delay and cerebral palsy: impact on the health and education system
Conditions to be considered relating to this scenario
Common
normal labour, induced labour, poor progress in labour, fetal malposition (occipito-posterior), abnormal fetal presentation (breech, cord), abnormal fetal heart rate pattern in labour, normal birth, episiotomy, operative birth (ventouse, forceps), caesarean birth, physiological and active third stage, perineal trauma, retained placenta or tissue/clots, postpartum haemorrhage, uterine atony, venous thromboembolism, wound/episiotomy/urine infections, maternal sepsis, normal birth transition, meconium exposure, stillbirth, neonatal death
Less common but 'important not to miss'
face/brow presentation, cord prolapse, uterine rupture, uterine inversion, chorioamnionitis, shoulder dystocia, hypoxic ischaemic encephalopathy, meconium aspiration syndrome, pulmonary hypertension of the newborn
Uncommon
uterine malformation, pelvic abnormalities (obstructed labour), congenital fetal abnormality, cerebral palsy
Resources

teenparentsschools.org.nz

www.sands.org.nz

www.hqsc.govt.nz/our-programmes/mrc/pmmrc