3008 Obstetrics

Question 1

What are the 5 P’s of birthing?

Answer 1

Passage (pelvis), Passenger (baby’s head), Power (uterine contractions and maternal pushing), Positioning (mother’s comfort), Psychology (positive, safe environment).

Question 2

What are the three stages of labour?

Answer 2

Onset of regular painful contractions (cervix effaces and dilates), Full dilation (10 cm) to birth of baby, Delivery of the placenta.

Question 3

What movements does a baby make during birth (cardinal movements)?

Answer 3

Descent, flexion, internal rotation, extension, external rotation, expulsion.

Question 4

What are the three immediate priorities for a newborn?

Answer 4

Dry and stimulate, APGAR scoring at 1 and 5 minutes, clamp and cut the cord.

Question 5

What are signs of placental abruption?

Answer 5

Constant abdominal pain, hard uterus, fetal distress.

Question 6

What are common causes of Primary Postpartum Hemorrhage (PPH)? (4 T’s)

Answer 6

Tone (uterine atony), Trauma (tears), Tissue (retained placenta), Thrombin (coagulation disorders).

Question 7

What is PROM and why is it a risk?

Answer 7

Prelabour Rupture of Membranes; after 18 hours, risk of infection for baby and mother increases.

Question 8

What is shoulder dystocia and how is it managed?

Answer 8

Baby’s shoulder stuck behind pubic bone; managed by McRoberts maneuver, suprapubic pressure, running start position.

Question 9

How should a cord prolapse be managed?

Answer 9

Position mum on all fours (head down, bum up), manually elevate presenting part off the cord if needed, urgent transport.

Question 10

What defines pre-eclampsia?

Answer 10

High blood pressure, proteinuria, headache, epigastric pain, pitting oedema, poor fetal growth.

Question 11

What treatment is used for eclampsia?

Answer 11

IV magnesium, seizure management protocols (e.g., midazolam if needed).

Question 12

What is a uterine rupture and its symptoms?

Answer 12

Tear in uterus; sudden sharp pain then no pain, fetal distress, hypovolemic shock signs.

Question 13

What is vasa previa?

Answer 13

Exposed fetal blood vessels without protection from the cord membrane, risk of vessel rupture during birth.

Question 14

What immediate actions are needed in newborn resuscitation?

Answer 14

BVM at 21% oxygen, SPO2 monitoring (right hand), If HR <60, commence compressions (3:1) and consider adrenaline.

Question 15

What is amniotic fluid embolism (AFE)?

Answer 15

Foetal cells enter maternal circulation causing anaphylactic reaction — presents with dyspnoea, hypotension, cardiac arrest.

Question 16

What are special considerations for premature babies?

Answer 16

Use NEOHELP bag, avoid drying, focus on thermoregulation, and be cautious with stimulation.

Question 17

What are important factors in culturally safe birthing for Indigenous Australians?

Answer 17

Respecting cultural practices, minimal male presence if not appropriate, holistic care (social, emotional, physical).

Question 18

What are common antenatal complications to watch for?

Answer 18

Pre-eclampsia, gestational diabetes, PROM, placenta previa, placental abruption, uterine rupture.

Question 19

What blood composition change occurs during pregnancy?

Answer 19

Increased plasma volume leading to dilutional anaemia.

Question 20

What is the importance of left lateral positioning after 20 weeks gestation?

Answer 20

To avoid supine hypotensive syndrome by preventing compression of the inferior vena cava.

Question 21

What hormone sustains early pregnancy and is associated with nausea and vomiting?

Answer 21

HCG (Human Chorionic Gonadotropin).

Question 22

What does progesterone do during pregnancy?

Answer 22

Relaxes smooth muscles, lowers blood pressure, slows GI movement (causing constipation and reflux).

Question 23

What respiratory changes occur during pregnancy?

Answer 23

Increased respiratory rate (tachypnea), decreased tidal volume due to raised diaphragm.

Question 24

What cardiovascular change happens to maternal blood during pregnancy?

Answer 24

Plasma volume increases, causing dilutional anaemia.

Question 25

What condition is caused by implantation of a fertilised egg outside the uterus?

Answer 25

Ectopic pregnancy.

Question 26

What are symptoms of ectopic pregnancy?

Answer 26

Intense flank pain, blood loss, signs of shock.

Question 27

What is gestational diabetes and why does it occur?

Answer 27

Reduced maternal insulin sensitivity to allow more glucose for the baby; usually self-resolving after birth.

Question 28

What are complications of gestational diabetes?

Answer 28

Macrosomia (large baby), polyhydramnios (excess fluid), risk of type 2 diabetes later in life.

Question 29

What defines a miscarriage?

Answer 29

Pregnancy loss before 20 weeks gestation.

Question 30

What is the management for uterine inversion?

Answer 30

Immediate manual replacement with a gloved hand; urgent hospital transfer.

Question 31

In newborn resuscitation, when do you start chest compressions?

Answer 31

If heart rate is below 60 bpm despite effective ventilations.

Question 32

What is the compression to ventilation ratio in newborn resuscitation?

Answer 32

3 compressions to 1 ventilation.

Question 33

What is the MR SOPA acronym in newborn ventilation troubleshooting?

Answer 33

Mask adjustment, Reposition airway, Suction, Open mouth, Pressure increase, Airway adjuncts.

Question 34

What is the ideal positioning for shoulder dystocia management?

Answer 34

McRoberts maneuver (knees to chest), suprapubic pressure, and running start.

Question 35

What is a nuchal cord and how is it managed?

Answer 35

Umbilical cord around baby’s neck; unwrap after head is born, or clamp and cut if tight and obstructive.

Question 36

What is a normal blood loss post-delivery, and what defines postpartum hemorrhage?

Answer 36

Normal: ~375 mL. PPH: >500 mL within 24 hours.

Question 37

What actions can paramedics take for suspected postpartum hemorrhage?

Answer 37

Fundal massage, oxytocin administration, bilateral IV access, TXA, external aortic compression if necessary.

Question 38

Why is left lateral positioning important in late pregnancy trauma?

Answer 38

To prevent vena cava compression and maintain venous return.

Question 39

What causes amniotic fluid embolism?

Answer 39

Fetal cells or amniotic fluid entering maternal circulation, causing anaphylactic-type reaction.

Question 40

What are signs of amniotic fluid embolism?

Answer 40

Sudden dyspnea, hypotension, altered mental state, cardiac arrest.

Question 41

What is the best pelvic type for natural birth?

Answer 41

Gynecoid pelvis.

Question 42

Why should women avoid lying on their back during labour?

Answer 42

It narrows the pelvic outlet, making birth harder.

Question 43

What is a ‘shy baby’ and why is it preferred during labour?

Answer 43

A baby with chin tucked to chest; this position presents the smallest diameter for birth.

Question 44

What is the risk of using opioids during labour?

Answer 44

Risk of neonatal respiratory depression.

Question 45

What is 'forewaters' in relation to labour?

Answer 45

Fluid sitting between the baby’s head and the cervix, slowly trickling when membranes rupture.

Question 46

What is the significance of 'hind waters' breaking?

Answer 46

Indicates deeper rupture of membranes, often associated with stronger labour progression.

Question 47

Why should ECG dots be avoided on premature babies?

Answer 47

Their skin is fragile and can be easily damaged.

Question 48

How should the umbilical cord be clamped and cut?

Answer 48

Clamp at 10 cm, 15 cm, and 20 cm, and cut between the second and third clamp.

Question 49

How can you identify a retained placenta after birth?

Answer 49

Continuous bleeding, failure of uterus to contract, or palpation of body parts in the uterus.

Question 50

What is 'Bimanual Compression' and when is it used?

Answer 50

Emergency technique inserting a hand into the vagina and applying pressure externally to stop uterine bleeding.

Question 51

What is the main risk during breech birth if the baby's head is stuck?

Answer 51

The baby may initiate breathing too early, leading to inhalation of amniotic fluid.

Question 52

What manoeuvre is used if the breech baby's head is stuck?

Answer 52

Mauriceau–Smellie–Veit (MSV) maneuver.

Question 53

What is the role of Wharton’s jelly in the umbilical cord?

Answer 53

Protects and cushions the umbilical vessels.

Question 54

Why is tactile stimulation (dry and stimulate) important immediately after birth?

Answer 54

It encourages spontaneous breathing.

Question 55

What is the goal SpO₂ reading for newborns at birth?

Answer 55

Pre-ductal SpO₂ >90% (measured on right hand).

Question 56

What is the risk of tocolytic medications given in premature labour?

Answer 56

Excessive antibiotic use can increase the risk of cerebral palsy.

Question 57

What defines 'occult' cord prolapse?

Answer 57

Cord prolapse that is not visible externally but is compressed internally.

Question 58

What cultural consideration is important when caring for Indigenous birthing women?

Answer 58

Male healthcare providers may not be welcome in the birthing environment.

Question 59

What is the 'two-eyed seeing' approach in cultural safety?

Answer 59

Balancing the patient’s cultural view with the healthcare provider’s clinical view.

Question 60

What is lotus birthing?

Answer 60

A practice where the umbilical cord is not cut but left attached until it naturally falls off.

Question 61

What are the four types of miscarriage?

Answer 61

Threatened, Inevitable, Incomplete, Complete.

Question 62

What is the risk when the cervix remains open after incomplete miscarriage?

Answer 62

Cervical shock due to vasovagal response — rapid decline.

Question 63

What medication type is used to delay premature labour?

Answer 63

Tocolytics.

Question 64

How does the foetal circulation bypass the lungs before birth?

Answer 64

Through the Foramen Ovale and Ductus Arteriosus.

Question 65

What changes happen to the Foramen Ovale after birth?

Answer 65

It closes and becomes the Fossa Ovalis.

Question 66

What are the different types of breech presentations?

Answer 66

Frank breech, Complete breech, Footling breech, Kneeling breech.

Question 67

In which breech presentation is natural vaginal birth still sometimes possible?

Answer 67

Frank breech.

Question 68

What is PPROM?

Answer 68

Preterm Premature Rupture of Membranes — rupture of membranes before 37 weeks gestation.

Question 69

Why is left lateral positioning critical after 20 weeks gestation?

Answer 69

To prevent supine hypotensive syndrome caused by vena cava compression.

Question 70

What is a biophysical profile in obstetric scanning?

Answer 70

Ultrasound assessment of fetal wellbeing (includes movements, breathing, amniotic fluid levels).

Question 71

What is lotus birthing?

Answer 71

Leaving the umbilical cord and placenta attached until it naturally falls off.

Question 72

What is the main danger of a tight nuchal cord?

Answer 72

It restricts blood flow and oxygen to the baby, risking cerebral hypoxia.

Question 73

In cultural birthing practices, what role do Aboriginal liaison officers play?

Answer 73

Help translate and advocate for culturally safe care.

Question 74

What is the primary physiological cause of pre-eclampsia?

Answer 74

Failure of cytotrophoblasts to remodel maternal spiral arteries, leading to vasoconstriction.

Question 75

What are common features of maternal collapse?

Answer 75

Dyspnea, hypotension, altered consciousness, potential cardiac arrest.

Question 76

Why is a delayed cord clamping beneficial?

Answer 76

It allows additional blood (and stem cells) transfer to the newborn, improving iron stores.

Question 77

What indicates non-vigorous newborns needing resus?

Answer 77

Poor tone, heart rate <100, poor breathing efforts.

Question 78

What temperature should water be for a water birth?

Answer 78

Between 37°C and 40°C.

Question 79

What is Wharton’s jelly and its function?

Answer 79

Gelatinous material in the umbilical cord that protects vessels from compression.

Question 80

Why must the placenta always be transferred to hospital after birth?

Answer 80

To allow pathological examination for retained products or abnormalities.