Birth

Question 1

Widest landmark of faetal head?

Answer 1

“the bi-parietal landmark”

Question 2

“the more flexed the fetal head, the ____________”

Answer 2

"”the more flexed the fetal head, the smaller the diameter of the presenting part”

Question 3

What are the 3 P’s for labour?

Answer 3

Passage: pelvis Passenger: size and position of baby Power: strength of uterine contractions

Question 4

How do the waters usually break? What else can happen?

Answer 4

Spontaneous Rupture of Membranes (SROM) However they can break before labour commences (pre-labour Rupture of membranes) or even artificially (ARM).

Occassionally a baby is born with the membranes still intact: “encaul”

PPROM: preterm prelabour rupture of membranes***

Question 5

What are the 3 phases of Stage 1 of labour?

Answer 5

Phase 1: Latent Phase. Cervical effacement and ~3cm dilitation. *In nulliparous women this can last 10-12 hrs*

Phase 2: Accelatory. ~1cm/hour dilitation with increased uterine contractions and the head descends.

Phase 3: Transition. onset of expulsion of the head of the baby

Question 6

Describe Stage 2 of Labour

Answer 6

From full dilitation to the birth of the baby.

Can be latent (esp if epidural used)

Active is with mother actively pushing out

Question 7

Describe Stage 3 of Labour

Answer 7

From birth of baby until birth of the placenta.

Uterine muscles contract to stop blood loss once the palcenta has seperated, and it is usually expelled <60 minutes.

Question 8

Natural stage 3 of labour versus medically controlled?

Answer 8

Natural: Sometimes higher risk of blood loss

Medically controlled: With Oxytocin, clamping of the cord and using controlled cord traction Increased side effects of N+V+ HTN

Question 9

the baby is said to be engaged when …..

Answer 9

The point of widest diameter of the presenting part (usually the head unless the baby is in breech) is past the pelvic inlet

Question 10

What is IOL and how many women require it?

Answer 10

Induction of Labour is common and required by 15-20% of women

Question 11

What scoring system is used to assess the need for IOL?

Answer 11

The Bishop score:

assesses the readiness/’ripeness’ of the cervix and the dose of medication required.

Question 12

On the Bishop Scoring System, what does a low score vs a high score indicate for treatment?

Answer 12

Low Score: longer induction. Vaginal prostagladin gel or balloon catheter used.

High Score >5: Now a ARM (Artificial Rupture of Membranes) is usually done, so the IV oxytocin infusion (syntocin) can be used to start or increase contractions

Question 13

ideal labour contractions shoudl be what?

Answer 13

Strong, lasting ~60seconds, around 3/4x per ten minutes

Question 14

Reasons for poor uterine contractions

Answer 14

• Fatigue
• Dehydration
• exhaustion
• Pain and fear
• Idiopathic

Question 15

Support for patients with poor uterine contractions

Answer 15

• IV fluids
• Amniotomy (ARM with Amniohook)
• Oxytocin
• Pain relief
• Support

Question 16

Should Oxytocin be used to help multiparous women with utetrine contraction problems

Answer 16

**Caution**

unlikely to be due to inadequate uterine activity alone.

When using oxytocin ensure membranes are ruptured, give continuous monitoring and perform regular review.

Question 17

What will cause accelerations on CTG

Answer 17

Contractions will block fetal blood flow, causing an acceleration of the heart rate.

Fetal movement can also cause accelerations.

Question 18

What is the concern surrounding a decceleration on CTG?

Answer 18

Deceleration of the fetal HR during or after a contraction may indicate fetal stress.

A compromised fetus is more likely to get stressed and not cope, ultimately becoming acidotic and hypoxic

Question 19

What are the causes of the differing types of decelerations

Answer 19

Early decelerations: Normal in the first stageof labour, indicatees head contractions not hypoxia.

Late Decelerations: associated with decreased uterine blood flow during contractions, can indicate fetal hypoxia

Variable Decelerations: Due to cord compression, can lead to fetal hypoxia

Question 20

What are all the things we should be looking at within a CTG (anagram)

Answer 20

DR C BRAVADO

DR - Define Risk

C - Contractions

BR - Baseline rate

A - Accelerations

VA - VAriability

D - Decelerations

O - Overall impression

Question 21

Normal HR and variability that can be seen on CTG

Answer 21

Baseline- 110-160 bpm

Variability- 5-25 bpm

Accelerations- rise 15bpm for 15secs