delivery

Question 1

name some of the main indications for a caesarean

Answer 1

previous caesarean
foetal distress
failure to progress
maternal request
breech presentation

Question 2

what is the most optimal presentation for vaginal delivery

Answer 2

cephalic

Question 3

name some maternal risk factors for malpresentation

Answer 3

uterine abnormalities, placenta previa, poly/oligohydramnios, previous abnormal presentation

Question 4

name some foetal risk factors for malpresentation

Answer 4

prematurity, multiple pregnancy, foetal abnormalities

Question 5

what is transverse lie

Answer 5

foetus is lying sideways across the uterus

Question 6

what is oblique lie

Answer 6

foetus lies diagonally within the uterus

Question 7

what is frank breech

Answer 7

bum down, legs near head

Question 8

what is complete breach

Answer 8

baby in normal position, but bum down instead of head

Question 9

what is PROM

Answer 9

amniotic sac ruptures at least one hour before contractions start

Question 10

what is classed as a premature baby

Answer 10

before 37 weeks

Question 11

what is pPROM

Answer 11

pre-term premature rupture of membranes

Question 12

name some risk factors associated with PROM

Answer 12

polyhydramnios, cervical insufficiency, infection, trauma, bleeding

Question 13

what does PROM stand for

Answer 13

prolonged (pre-labour) rupture of membranes

Question 14

what is cervical insufficiency

Answer 14

cervix starts to dilate in the absence of uterine contractions

Question 15

clinical signs of PROM

Answer 15

liquor pooling in the posterior fornix on speculum
oligohydramnios on ultrasound

Question 16

management of pPROM

Answer 16

antibiotic prophylaxis, steroids, admission for minimum 48 hours, close monitoring for infection

Question 17

what is a serious complication of PROM

Answer 17

cord prolapse

Question 18

name some acute causes of foetal hypoxia

Answer 18

uterine hyperstimulation, abruption, cord prolapse, uterine rupture, haemorrhage, vasa previa

Question 19

name 2 chronic causes of foetal hypoxia

Answer 19

placental insufficiency, foetal anaemia

Question 20

how do we monitor baby and identify foetal hypoxia

Answer 20

CTG
loss of accelerations, repetitive decelerations, rising baseline heartrate and loss of variability

Question 21

management of foetal hypoxia

Answer 21

change maternal position, stop contractions, IV fluids, scalp stimulation

Question 22

definitive management for foetal distress

Answer 22

operative delivery

Question 23

drug commonly given for tocolysis

Answer 23

terbutaline - stops contractions

Question 24

how do we define post dates pregnancy

Answer 24

extending beyond 42 weeks

Question 25

name the 3 main categories of management of post-dates pregnancy

Answer 25

expectant with increased monitoring c-section induction

Question 26

what is the role of cervical sweep in inducing labour

Answer 26

naturally stimulates the production of prostaglandins

Question 27

what are the 2 main types of cervical priming

Answer 27

mechanical with cooks balloon vaginal prostaglandin

Question 28

what is a risk associated with vaginal prostaglandin to induce labour

Answer 28

uterine hyperstimulation

Question 29

what is failure to progress

Answer 29

delayed progress or slow labour

Question 30

how do we define failure to progress in the first stage of pregnancy

Answer 30

NP: <2cm in 4 hours MP: <4cm in 4 hours

Question 31

how do we define failure to progress in the second stage of pregnancy

Answer 31

NP > 2 hours MP > 1 hours

Question 32

how does failure to progress definitions change if patient has been given an epidural

Answer 32

add an hour as epidurals might slow labour

Question 33

what is obstructed labour

Answer 33

labour not progressing despite good contractions - must be a mechanical blockage

Question 34

how can we categorise the 3 main causes of failure to progress

Answer 34

3P's power: contraction strength and frequency passage: short mum, pelvic shape, history of pelvic trauma passenger: big baby, malposition

Question 35

name 2 foetal signs of obstruction during labour

Answer 35

moulding and caput

Question 36

what is moulding

Answer 36

bones of the foetal skull start to overlap during labour

Question 37

what is caput

Answer 37

swelling on top of baby's head

Question 38

name 3 clinical signs of of obstructed labour (maternal signs)

Answer 38

anuria, haematuria vulval oedema

Question 39

what can be used to assess the progression of labour

Answer 39

partogram

Question 40

definitive management of failure to progress

Answer 40

operative delivery

Question 41

how can we increase power during failure to progress

Answer 41

artificial rupture of membranes, IV oxytocin

Question 42

what is the ferguson's reflex

Answer 42

the more the head pushes down on the cervix during labour, the more oxytoxin released

Question 43

what initiates and sustains contractions

Answer 43

the release of oxytocin - promotes the release of prostaglandins

Question 44

what are the 2 changes that happen to the cervix during labour

Answer 44

softening ripening: thins and dilates

Question 45

what is the active first stage of labour

Answer 45

4cm onwards to full dilatation

Question 46

what is active management of the 3rd stage of labour

Answer 46

oxytocin and controlled cord traction

Question 47

what pelvic shape is most suitable for childbirth

Answer 47

gynaecoid

Question 48

what are the 7 cardinal movements of labour

Answer 48

engagement descent flexion internal rotation crowning and extension restitution and external rotation expulsion

Question 49

what is used to determine whether it is safe to induce labour - and what is a positive indication

Answer 49

bishops score > 4

Question 50

what is a contraindication for giving ergometrine during the third stage of labour

Answer 50

hypertension