Labour & Delivery

Question 1

Define effective uterine contractions?

Answer 1

3-5 contractions in 10 mins lasting 45-55 seconds

Question 2

Classify operative vaginal delivery?

Answer 2

Outlet, Low and Mid cavity

Criteria for each:
Outlet [2+ or lower]:
1. Fetal scalp visible w/o separating the labia
2. Fetal head is at the perineum
3. Lead/lowest point of skull is at station 2+/more and NOT on the pelvic floor
4. Fetal skull has reached the pelvic floor
5. Sagittal suture in the AP diameter or right or left occipit anterior or posterior position
- rotation is NOT >45°

MID:
1. Fetal head is at most 1/5th palpable abdominally
2. Leading point of skull above +2 but NOT above ischial spines/station 0

Question 3

T/F. Operative vaginal delivery is not recommended of head is 2/5th palpable abdominally/above station?

Answer 3

True

Question 4

In which scenarios should lowrisk women in labour receive continuous ctg monitoring?

Answer 4

1. MSL
2. Abnormal FHR on intermittent auscultation
3. Oxytocin augmentation
4. Fresh/new onset bleeding in labor
5. Maternal pyrexia >38°C
6. Maternal request

Question 5

How is intermittent fetal auscultation performed in labour?

Answer 5

For 1 minute after a contraction, every 15 minutes, recorded as a single value (an average).

Question 6

Treatment for uterine hyperstimulation?

Answer 6

SUBCUTANEOUS terbutaline 0.25mg

Question 7

What are the indications for a c/s?

Answer 7

Maternal:
1. Prior c/s
2. CPD
3. Maternal compromise (severe pe/eclampsia
4. Placenta praevia

Fetal:
1. Fetal macrosomia >4.5kg
2. Malpresentation (breech, shoulder, cord…)
3. Fetal distress
4. Failure to progress

Question 8

What are the increased vs reduced risks associated with planned csection?

Answer 8

Planned csection is associated with reduced risk of:

• traumatic vaginal delivery
• perineal trauma
• perineal/vaginal pain
• PPH

Increased risks include:
- longer hospital stay
- Postop pain
- higher risk of infection/endometritis
- risk of VTE
- risk of hysterectomy due to PPH
- placenta praevia and morbidly adherent placenta with future pregnancies.
- Risk of stillbirth with future pregnancies

Question 9

What are the risks assoc with csection that u would counsel a pt about?

Answer 9

1. Haemorrhage - 5 in 1000 (uncommon)
2. Damage to surrounding structures:
   ▪︎Bladder: 1 in 1000 (rare)
   ▪︎Bowel: ?
   ▪︎Ureters: 3 in 10,000 (rare)
3. Infection: 6 in 100 (common)
4. Emergency Hysterectomy: 7-8 in 1,000 (uncommon)
5. VTE: 4-16 in 10,000 (rare)
6. Laparotomy: 5 in 1000 (uncommon)
7. ICU admission: 9 in 1000 (uncommon)
8. Persistent wound/abd pain in first few months: 9 in 100 (common)
9. Readmission: 5 per 100 (common)
10. Risk of repeat csection in future pregnancies: 1 in 4 (25%, very common)
11. Death: 1 in 12,000 (very rare)