Exam 4- labour

Question 1

What is the main hormonal influence underlying the onset of labour?

Answer 1

Rising oestrogen to progesterone ratio

Question 2

Stages of labour:

a) first
b) second
c) third

Answer 2

a) contractions to full dilatation (latent up to 4 cm, active up to 10cm)
b) complete dilatation to delivery
c) delivery of placenta+ membranes

Question 3

Active management of the third stage? (2) Why?

Answer 3

Syntometrine and controlled traction.

Reduces primary post-partum haemorrhage

Question 4

How should premature prelabour rupture of membranes be managed? (3)

Answer 4

Admit and observe
Consider steroids + induction if 34 weeks or more
Erithromycin to prevent chorioamnioitis

Question 5

What is Bishops score? What are its constituents? (5)

Answer 5

Assesses the readiness of the cervix for induction.

Position, dilatation, length, foetal station, consistency

Question 6

If the Bishop score is less than 5 what should be given?

Answer 6

Vaginal prostaglandins to ripen the cervix

Question 7

What are the main indications for labour induction? (4)

Answer 7

Maternal diabetes, haemorrhage, pre-eclampsia

Post-dates

Question 8

When is the second stage considered prolonged a) primiparous b) multiparous women?

Answer 8

a) 2 hours
b) 1 hour
(+1 hour for analgesia, e.g. spinal/epidural)

Question 9

Signs of placental separation (3)

Answer 9

Cord lengthening
Blood trickle
Uterus hardens and rises

Question 10

How long does placental separation usually take?

Answer 10

Up to 30 minutes

Question 11

Where is an epidural inserted?

Answer 11

Between L3 and L4

Question 12

Main risk of an epidural and how is this countered?

Answer 12

Postural hypotension- give 500ml hartmann solution at the outside

Question 13

Why might an epidural cause second stage delay?

Answer 13

Interferes with desire to push

Question 14

What three criteria are used to assess the progress of labour?

Answer 14

Cervical dilatation
Descent of presenting part
Signs of obstruction

Question 15

Desired rate of contraction after 3cm?

Answer 15

1cm/hour

Question 16

Signs of obstruction in labour? (2)

Answer 16

Moulding

Caput formation

Question 17

When might tocolysis be considered and what agent is used?

Answer 17

Premature labour- to give time for steroids to be administered. Terbutaline

Question 18

What pattern on CTG indicates placental insufficiency?

Answer 18

Late and variable decelarations are indicative of foetal hypoxia

Question 19

Complications of ventouse delivery? (2)

Answer 19

Cephalohaematoma

Retinal haemorrhage

Question 20

Painless blood loss, with a high presenting part/abnormal lie

Answer 20

Placenta praevia

Question 21

Vaginal bleeding, with shock out of keeping with visible loss. Abdominal pain with a tense uterus

Answer 21

Placental abruption

Question 22

Describes the situation where foetal vessels lie in the membranes and over the cervical os

Answer 22

Vasa praevia

Question 23

Potentially catastorphic complication of abruption

Answer 23

DIC

Question 24

Four T’s of primary post-partum haemorrhage

Answer 24

Tone (atony)
Tissue (retained placenta)
Trauma
Thrombin (coagulopathy)

Question 25

Management of uterine atony (2)

Answer 25

Bimanual uterine compressiiion

Syntometrine

Question 26

Two commonest causes of secondary post-partum haemorrhage

Answer 26

Endometritis

often secondary to Retained products

Question 27

Commonest cause of puerperal pyrexia

Answer 27

Endometritis

Question 28

What is placenta accreta?

Answer 28

Placenta attached to myometrium and doesnt detach during third stage

Question 29

In what circumstances does bleeding from placenta praevia often occur?

Answer 29

Post-coital