Intrapartum Care

Question 1

Factors reducing c/s

Answer 1

Continuous support from women
Partogram use
Involvement of consultant obstetrician in decision making

Question 2

Cat 1 c/s

Answer 2

immediate threat to life of mother/fetus (uterine rupture, cord prolapse, fetal hypoxia/bradycardia)

Deliver within 30 minutes

Question 3

Cat 2 c/s

Answer 3

Maternal or fetal compromise not immediately life threatening

Deliver within 75 minutes

Question 4

Cat 3 c/s

Answer 4

No maternal or fetal compromise but needs early birth

Question 5

Cat 4 c/s

Answer 5

Timed to suit the woman or healthcare provider

Question 6

NICE definition of active management of labour

Answer 6

Established labour
Early routine amniotomy
2 hourly vaginal examination
Oxytocin if labour becomes slow

Question 7

Maintenance of BP after spinal anaesthesia during c/s

Answer 7

Phenylephrine injection and IV crystalloid co-loading

Question 8

Aim to keep BP at ____ of normal during c/s

Answer 8

Between 80-90% of baseline

Question 9

Reducing risk of aspiration during GA

Answer 9

Pre-oxygenation
Cricoid pressure
Rapid sequence induction

Question 10

Reducing infection after c/s

Answer 10

Chlorhexidine skin prep
(Iodine if not available)

Use aqueous iodine vaginal prep when PPROM (chlorhexidine if not available) to reduce endometritis

Using a separate knife makes no difference

Question 11

Blunt extension of uterine incision benefits

Answer 11

Less bleeding, PPH and need for transfusion

Question 12

Risk of fetal laceration during c/s

Answer 12

2%

Question 13

Uterotonics during c/s

Answer 13

Oxytocin 5 units slow IV infusion

Question 14

Method of placental removal during c/s

Answer 14

Controlled cord traction to reduce endometritis

Question 15

Cons of uterine exteriorisation

Answer 15

Increased pain
Does not reduce bleeding or infection

Question 16

Recommended closure of midline skin incision

Answer 16

Mass closure with slow absorbable suture to reduce incisional hernia and dehiscence

Question 17

When to close the subcut layer during c/s

Answer 17

When more than 2cm fat is present

Question 18

Recommended closure of the skin

Answer 18

Sutures over staples to reduce dehiscence

Question 19

Risk of endometritis, UTI or wound infection after c/s

Answer 19

8%

Question 20

Post GA care

Answer 20

1 to 1 care until haemodynamically stable, talking and has airway control

30 minute obs for 2 hours then routine

Question 21

Post spinal/epidural anaesthesia care

Answer 21

1 to 1 care until haemodynamically normalised then routine obs

Question 22

Post spinal/epidural anaesthesia care for women with factors for respiratory depression

Answer 22

Hourly O2 monitoring, RR and sedation for 12 hours then routine observation

Question 23

Risk of urinary tract injury during c/s

Answer 23

1 per 1000

Question 24

Overall Rate of assisted vaginal delivery

Answer 24

10-15%

Question 25

Rate of assisted vaginal delivery in primips

Answer 25

33%

Question 26

Factors reducing assisted vaginal birth

Answer 26

One to one support
Upright or lateral position (no epi)
Lateral lying down position (with epi)
Delay pushing 1-2 hours

Question 27

Classification for assisted vaginal birth

Answer 27

Outlet - vertex visible or head on perineum

Low - +2 station but not on perineum

Mid - 0 to +1 station, 1/5th or less palpable per abdomen

Question 28

Contraindications to assisted vaginal delivery

Answer 28

Suspected fetal bleeding disorder/risk of fractures
Blood borne viruses (relative)
Face presentation (ventouse)

Question 29

Gestation for vacuum extraction

Answer 29

Contraindicated <32 weeks
Caution from 32+0 to 36+0

Question 30

Indications for assisted vaginal delivery

Answer 30

Suspected fetal compromise
FTP in a primip for 3 hours with epidural
FTP in a primip for 2 hours without epidural
FTP in a multip for 2 hours with epidural
FTP in a multip for 1 hour without epidural
Maternal exhaustion
Medical indication to avoid valsava manouvres