Abnormal Labour

Question 1

What does presentation mean?

Answer 1

Part of foetus overlying maternal pelvic inlet

Question 2

Vertix?

Answer 2

Area of foetal skull outlined by the anterior and posterior fontanelles and parietal eminences

Question 3

Breech Presnetation is generally safest delivered by?

Answer 3

C section

Question 4

Transverse or shoudler/arm presnetation delivery?

Answer 4

NOT vaginal
High risk of sever sepsis as uterus will keep contracting and then it will rupture and = death
If vaginal is attempted

Question 5

Position of the foetal head is defined as?

Answer 5

Relationship of denominator to fixed points of maternal pelvis

Question 6

Denominator of head defined as?

Answer 6

Most definable prominence at periphery of presenting part

Question 7

Occipitoanterior position is though to be strange or normal?

Answer 7

Normal- back of babys head is at front

Question 8

How can you tell if back of baby head is at fornt?

Answer 8

Anterior fontanelle looks bigger and is at back

Question 9

2 exmaples of malposition?

Answer 9

Occipitoposterior (back of babys head at back)

Occipitotransverse (back of babys head in transverse plane)

Question 10

Failure of labour to progress in stage 1?

Answer 10

Defined as <2cm dilation in 4 hours or slowing progress

Question 11

Normal duration of 2nd stage primiparous?

a) epidural
b) No epidural

Answer 11

2 hours: no

3 hours: epi

Question 12

Normal duration for 2nd stage of labour if multiparous?

a) Epidural
b) No epidural

Answer 12

1 hour: no epidural

2 hours: epidural

Question 13

Failure of labour to progress is due to 3 Ps?

Answer 13

Powers
Passages
Passenger

Question 14

Power:

Answer 14

Inadequate contractions in frequency and/or strength

Question 15

Passages?

Answer 15

Short stature, trauma, shape of pelvi

Question 16

Passenger?

Answer 16

Big baby, malosition

Question 17

What does a partogram do?

Answer 17

Allows recognition of labour that is not progressing

Question 18

Moulding menaing?

Answer 18

Bones overlapping so head fits through pelvis, signif moulding can be sign of cephalon-pelvic disproportion up to 2+ is normal

Question 19

Caput is?

Answer 19

Diffuse swelling of scalp caused by presssure of scalp against dilated cervix in labour assoc with moulding

Question 20

Descent of foetal head is recorded by?

Answer 20

Assessing at level of presenting part in cm above or below the ischial spine and marked as +1, +2, +3 below spines and -1, -2, -3 if above spine

Question 21

What is liquor?

Answer 21

Amniotic fluid and if ruptured colour is recorded, meconium stained liquor can be sign of foetal distress

Question 22

Assessment of foetal wellbeing involves?

Answer 22

Low risk women: dopler monitoring at intervals
High risk women: CEFM with CTG screens for foetal hypoxia

CEFM= Continuous electronic foetal monitoring

Question 23

What is CTG

Answer 23

Cardiotocography

Question 24

Pneumonic for interpreting CTG?

Answer 24

DR C BRAVADO

Question 25

DR stands for in CTG interpretation?

Answer 25

Define risk

Question 26

C stands for in DR C BRAVADO?

Answer 26

Contractions -Peaks at bottom of trace, small nox= 1 min, CTG only demonstrates contraction frequency, not strength, expect 3-5 contractions in 10 mins in established labour

Question 27

How many contractions per 10 mins in established labour o CTG?

Answer 27

3-5 in 10 minutes

Question 28

BRA in BRAVADO of CTG interpretation?

Answer 28

Baseline rate foetal baseline HR should be 110-160 BPM, look at average rate over 10 mins ignoring accelerations or decelerations, tachycardia

Question 29

What is tachycardia in foetu?

Answer 29

>160 bpm, bradycardia is <110 bpm

Question 30

V in BRAVADO?

Answer 30

Varaibility Good= 5-25 bom <5bpm= reduced variability, which can be reduced by foetal sleep state but not for longer than 40 mins

Question 31

A in BRAVADO?

Answer 31

Accelerations | Increase in FHR by at least 15 bpm for 15s or more and assoc with foetal movement

Question 32

D in BRAVADO?

Answer 32

Decelerations

Question 33

O IN BRAVADO?

Answer 33

Overall impression/diagnosis

Question 34

2 important things to be aware of on CTG?

Answer 34

Terminal bradycardia | Decelerations

Question 35

What does operative vaginal delivery involve use of?

Answer 35

Forceps | Vacuum extraction/ventouse

Question 36

Indications for opertaive vaginal delivery?

Answer 36

Failure to progress in 2nd stage Foetal distress Maternal exhaustion

Question 37

Requirements for forceps delivery?

Answer 37

``` Fully dilated OA position Ruptured membranes Cephalic presentation Engaged presenting part Pain relief Sphincter ``` FORCEPS acronym

Question 38

Main indications for C section?

Answer 38

``` Prev C section Foetal distress Failure to progress in labour Breech presentation Maternal request ```

Question 39

Indications for induction of labour?

Answer 39

``` Prolonged pregnancy (XS of 42 weeks) Pre-eclampsia Placental insufficiency and IUGR APH Rh isoimmunization Diabetes Chronic renal disease ```

Question 40

What allows you to determine likely outcome of induction of labour

Answer 40

BIshops score

Question 41

What are methods of induction of labour decided by?

Answer 41

Whether membranes are still intact and score on cervical assessment

Question 42

Examples of induction techniques?

Answer 42

-Stripping of membranes -Artificial ROM -Medical induction following artificial ROM with syntocinon Medical induction by cervical ripening with prostaglandins Mechanical cervical ripening using balloon catheter

Question 43

Types of pain management in labour?

Answer 43

``` Narcotic analgesia Inhalation analgesia Epidural analgesia Pudendal nerve block Spinal anaesthesia General anaesthesia ```

Question 44

Examples of narcotic anaglesia?

Answer 44

Pethidine and morphine | -Helpful if unsuitable for regional analgesia

Question 45

What can narcotic analgesia cause?

Answer 45

Foetal resp depression

Question 46

Examples of inhalational analgesia?

Answer 46

Etonox (AKA gas and air) | Often in early labour but sometimes inadequate

Question 47

Epidural analgesia gives how much pain relief?

Answer 47

Usually complete pain relief

Question 48

When can epidural be commenced?

Answer 48

Established Labour usually

Question 49

SE of epidural?

Answer 49

``` Can cause abnormal foetal HR Risk of Hypotension in mum Accidental dural puncture risk Postdural headache Atonic bladder High block can cause resp depression in mother ```

Question 50

What is pudendal nerve block often used for?

Answer 50

Operative vaginal delivery

Question 51

Spinal anaesthesia used for?

Answer 51

Operative delivery

Question 52

General anaesthesia used for?

Answer 52

Emergency