Abnormal Labour and Obstetric Emergencies

Question 1

how many women achieve a normal SVD?

Answer 1

60%

Question 2

how many women need a forceps delivery?

Answer 2

15%

Question 3

define malpresentation?

Answer 3

non-vertex

Question 4

posterior fontanelle is shaped like…

Answer 4

a triangle

Question 5

anterior fontanelle is shaped like…

Answer 5

a diamond

Question 6

malposition is defined as…

Answer 6

OP or OT

Question 7

pre-term delivery is defined as

Answer 7

37

Question 8

post-term delivery is defined as >_ weeks

Answer 8

42

Question 9

risk of stillbirth increases at >_ weeks

Answer 9

38

Question 10

Tx cord prolapse

Answer 10

category 1 CS (within 30 mins)

Question 11

describe a footling breech?

Answer 11

one or both feet point down

Question 12

describe a frank breech?

Answer 12

legs point up with feet at baby’s head so bottom comes first

Question 13

describe a complete breech

Answer 13

legs folded with feet at level of baby’s bottom

Question 14

when would a malpresentation prompt a definite CS delivery?

Answer 14

active labour

membranes ruptured

Question 15

what malpresentation of the face can still undergo a vaginal delivery? why?

Answer 15

mentoanterior

can still flex chin to chest

Question 16

anesthesia used in CS? what anaesthetic is used in emergencies

Answer 16

spinal -15/20 mins

general - for emergencies

Question 17

risks for obstructed labour

Answer 17

sepsis
uterine rupture
AKI (obstruction)
PPH
fistula
fetal asphyxia
neonatal sepsis

Question 18

define obstructed labour

Answer 18

even though the uterus is contracting normally, the baby does not exit the pelvis during childbirth due to being physically blocked.

Question 19

how do you assess progress in labour?

Answer 19

cervical dilatation via VE

descent of presenting part

Question 20

signs of obstruction?

Answer 20

moulding
caput (swollen fontanelles)
anuria
haematuria
vulval oedema

Question 21

failure to progress is defined as

Answer 21

failure of the cervix to dilate by 2cm in 4hrs

Question 22

how many contractions do you want in labour per 10 mins?

Answer 22

3-5 in 10 mins

Question 23

what problems with the baby can cause failure to progress?

Answer 23

big baby

malposition

Question 24

components of intra-partum fetal assessment?

Answer 24

doppler auscultation of fetal heart every 15 mins
colour of AF
CTG

Question 25

why is fetal HR checked for 1 whole min after a contraction?

Answer 25

late decelerations to check for hypoxia

Question 26

risk factors for fetal hypoxia?

Answer 26

``` SGA pre/post term APH hypertensive problems diabetes meconium epidural sepsis IOL ```

Question 27

a temp over _ degrees makes you worry about sepsis

Answer 27

38

Question 28

acute causes of fetal distress

Answer 28

``` uterine hyperstimulation eg syntocinon PA vasa praevia cord prolapse uterine prolapse feto-maternal haemorrhage regional anaesthesia ```

Question 29

chronic causes of fetal distress

Answer 29

placental insufficiency | fetal anaemia

Question 30

normal FH rate?

Answer 30

110-150bpm

Question 31

normal variability

Answer 31

5-25bpm

Question 32

how should you deliver a baby in fetal distress?

Answer 32

whatever way is quickest

Question 33

early decelerations are normal T or F

Answer 33

T

Question 34

why does epidural anaesthesia carry a risk of fetal distress?

Answer 34

vasodilatation underperfuses babys placenta

Question 35

define the DR C BRAVADO method of reading a CTG

Answer 35

``` Determine Risk Contractions Baseline RAte Variability Accelerations Decerations Overall impression ```

Question 36

Tx of fetal distress

Answer 36

``` change maternal position IV fluids stop syntocinon scalp stimulation vitals abdo exam/VE FBS operative delivery ```

Question 37

what is tocolysis? give an example of a tocolytic drug

Answer 37

medication that relaxes the uterus | terbutaline

Question 38

when would you do fetal blood sampling?

Answer 38

if cervix >4cm dilated | not sure about CTG

Question 39

Ix fetal distress

Answer 39

1. CTG, VE, vitals, abdo exam | 2. FBS

Question 40

scalp pH under ___ on FBS is concerning

Answer 40

7.2

Question 41

standard indications for assisted vaginal delivery?

Answer 41

delay | fetal distress

Question 42

special indications for assisted vaginal delivery?

Answer 42

maternal cardiac disease severe PET IPH cord prolapse stage 2

Question 43

duration of stage 2 for prims without epidural? with epidural?

Answer 43

2h | 3h

Question 44

duration of stage 2 for multiparous women without epidural? with epidural?

Answer 44

1h | 2h

Question 45

what is a ventouse delivery?

Answer 45

vaginal delivery using suction

Question 46

ventouse delivery is less safe than forceps or CS T or F

Answer 46

F

Question 47

contraindications to FBS?

Answer 47

anaemic babies low platelets high bleeding risk

Question 48

main indications for CS?

Answer 48

``` previous CS fetal distress failure to progress in labour breech presentation maternal request ```

Question 49

main complications of CS?

Answer 49

``` sepsis haemorrhage VTE trauma hysterectomy if bleeding badly ```

Question 50

what is shoulder dystocia

Answer 50

ant shoulder stuck under symphysis pubis which causes hypoxia

Question 51

how long do you have to deliver a baby who is hypoxic from shoulder dystocia?

Answer 51

7

Question 52

cause of uterine inversion?

Answer 52

iatrogenic from pulling on cord too hard

Question 53

main causes of maternal collapse?

Answer 53

4Hs and 4T's PLUS: amniotic fluid embolism pre-eclampsia

Question 54

how can you resolve supine hypotension in a pregnant woman?

Answer 54

turn woman into left lateral position

Question 55

pathophysiology of aortocaval compression

Answer 55

lying supine can compress IV and aorta causing reduced venous return

Question 56

how long after performing CPR on a collapsed pregnant woman should you attempt delivery?

Answer 56

4 mins