intrapartum care

Question 1

initially what qs would you ask the pregnant woman when she comes into hospital

Answer 1

Review the antenatal notes (including all antenatal screening results) and discuss these with the woman.

Ask her about the length, strength and frequency of her contractions.

Ask her about any pain she is experiencing and discuss her options for pain relief.

Record her pulse, blood pressure and temperature, and carry out urinalysis.

Record if she has had any vaginal loss.

Question 2

what examination would u do in a pregnant woman

Answer 2

Ask the woman about the baby’s movements in the last 24 hours.

Palpate the woman’s abdomen to determine the fundal height, the baby’s lie, presentation, position, engagement of the presenting part, and frequency and duration of contractions.

Auscultate the fetal heart rate for a minimum of 1 minute immediately after a contraction. Palpate the woman’s pulse to differentiate between the heartbeats of the woman and the baby.

Question 3

what observations of the pregnant woman might trigger you to transfer her to obstetrics

Answer 3

pulse over 120 beats/minute on 2 occasions 30 minutes apart

a single reading of either raised diastolic blood pressure of 110 mmHg or more or raised systolic blood pressure of 160 mmHg or more

either raised diastolic blood pressure of 90 mmHg or more or raised systolic blood pressure of 140 mmHg or more on 2 consecutive readings taken 30 minutes apart

a reading of 2+ of protein on urinalysis and a single reading of either raised diastolic blood pressure (90 mmHg or more) or raised systolic blood pressure (140 mmHg or more)

temperature of 38°C or above on a single reading, or 37.5°C or above on 2 consecutive readings 1 hour apart

any vaginal blood loss other than a show

rupture of membranes more than 24 hours before the onset of established labour (see recommendation 1.15.25)

the presence of significant meconium (see recommendation 1.5.2)

pain reported by the woman that differs from the pain normally associated with contractions

Question 4

what observations of the unborn baby might trigger you to transfer mother to obstetrics

Answer 4

any abnormal presentation, including cord presentation

transverse or oblique lie

high (4/5–5/5 palpable) or free‑floating head in a nulliparous woman

suspected fetal growth restriction or macrosomia

suspected anhydramnios or polyhydramnios

fetal heart rate below 110 or above 160 beats/minute

a deceleration in fetal heart rate heard on intermittent auscultation

reduced fetal movements in the last 24 hours reported by the woman.

Question 5

fetal monitoring with a woman in susp or established labour

Answer 5

Use either a Pinard stethoscope or doppler ultrasound.

Carry out auscultation immediately after a contraction for at least 1 minute and record it as a single rate.

Record accelerations and decelerations if heard.

Palpate the maternal pulse to differentiate between the maternal and fetal heartbeats.

Question 6

options for pain relief/analgesia in labour

Answer 6

• water immersion
• TENS machine
• having a birth partner

Ensure that Entonox (a 50:50 mixture of oxygen and nitrous oxide)

• nauseous
• light‑headed.

IV/IM opiods
- pethidine
- diamorphine
RISKS
(drowsiness, nausea and vomiting) and her baby (short‑term respiratory depression and drowsiness which may last several days)

Question 7

what observations should be done for women with regional analgesia/ epidural

maternal complications

CI

Answer 7

During establishment of regional analgesia or after further boluses (10 ml or more of low‑dose solutions), measure blood pressure every 5 minutes for 15 minutes.

If the woman is not pain‑free 30 minutes after each administration of local anaesthetic/opioid solution, recall the anaesthetist.

Assess the level of the sensory block hourly.

Risks

• epidural abscess
• hypotension
• temporary loss of bladder control/urinary retention
• delayed second stage due to inability to push effectively
• nausea
• headache
• nerve damage
• procedure failure
• inability to move freely
• increased chances of instrumentation delivery

CI

• abnormal bleeding
• skin infection at or near site
• hypovolaemia
• neurological disorders
• CVS disease
• anatomical abnormalities of the vertebral
• pt refusal
• lack of adequately trained staff

Question 8

when to perform CTG in regional analgesia

Answer 8

least 30 minutes during establishment of regional analgesia and after administration of each further bolus of 10 ml or more.

Question 9

if rapid analgesia is required which one do u use

Answer 9

combined spinal-epidural analgesia

bupivacaine

fentanyl

Question 10

epidural v spinal anaesthetic

Answer 10

epidural is inseted into th epotential space that lies between the dura matter and the periosteum lining the inside of the vertebral canal

spinal anaesthesia is induced by injecting small amounts of local anaesthetic is induced by injecting small amounts of local anaesthetic into the CSF after having pierced the dura matter

Question 11

when to advise continous CTG

Answer 11

maternal pulse over 120 beats/minute on 2 occasions 30 minutes apart

temperature of 38°C or above on a single reading, or 37.5°C or above on 2 consecutive occasions 1 hour apart

suspected chorioamnionitis or sepsis

pain reported by the woman that differs from the pain normally associated with contractions

the presence of significant meconium (as defined in recommendation 1.5.2)

fresh vaginal bleeding that develops in labour

severe hypertension: a single reading of either systolic blood pressure of 160 mmHg or more or diastolic blood pressure of 110 mmHg or more, measured between contractions

hypertension: either systolic blood pressure of 140 mmHg or more or diastolic blood pressure of 90 mmHg or more on 2 consecutive readings taken 30 minutes apart, measured between contractions

a reading of 2+ of protein on urinalysis and a single reading of either raised systolic blood pressure (140 mmHg or more) or raised diastolic blood pressure (90 mmHg or more)

confirmed delay in the first or second stage of labour (see recommendations 1.12.14, 1.13.3 and 1.13.4)

contractions that last longer than 60 seconds (hypertonus), or more than 5 contractions in 10 minutes (tachysystole)

oxytocin use.

Question 12

when reviewing a CTG trace what should u document

Answer 12

baseline rate

baseline variability

presence or absence of decelerations (and concerning characteristics of variable decelerations* if present)

presence of accelerations.

Question 13

normal HR for fetus

Answer 13

110-160

Question 14

abnormal baseline in CTG

Answer 14

Below 100

OR

Above 180

Question 15

Abnormal baseline variability in CTG

Answer 15

Less than 5 for more than 50 minutes

OR

More than 25 for more than 25 minutes

OR

Sinusoidal

Question 16

abnormal decelerations seen in CTG

Answer 16

Variable decelerations with any concerning characteristics* in over 50% of contractions for 30 minutes (or less if any maternal or fetal clinical risk factors [see above])

OR

Late decelerations for 30 minutes (or less if any maternal or fetal clinical risk factors)

OR

Acute bradycardia, or a single prolonged deceleration lasting 3 minutes or more

Question 17

baseline in non reassuring CTG

Answer 17

100 to 109†

OR

161 to 180

Question 18

non reassuring baseline variability CTG

Answer 18

Less than 5 for 30 to 50 minutes

OR

More than 25 for 15 to 25 minutes

Question 19

non-reassuring decelerations in CTG

Answer 19

variable decelerations with no concerning characteristics for 90 minutes or more

variable decelerations with any concerning characteristics in up to 50% of contractions for 30 minutes or more

variable decelerations with any concerning characteristics in over 50% of contractions for less than 30 minutes

late decelerations in over 50% of contractions for less than 30 minutes, with no maternal or fetal clinical risk factors such as vaginal bleeding or significant meconium

Question 20

when is CTG suspicious

Answer 20

1 non-reassuring feature

AND

2 reassuring features

Question 21

Mx for suspicious CTG

Answer 21

Correct any underlying causes, such as hypotension or uterine hyperstimulation

Perform a full set of maternal observations

Start 1 or more conservative measures*

Inform an obstetrician or a senior midwife

Question 22

pathological feature criteria in CTG

Answer 22

1 abnormal feature

OR

2 non-reassuring features

Question 23

Mx of pathological CTG

Answer 23

Obtain a review by an obstetrician and a senior midwife

Exclude acute events (for example, cord prolapse, suspected placental abruption or suspected uterine rupture)

Correct any underlying causes, such as hypotension or uterine hyperstimulation

Start 1 or more conservative measures*

Talk to the woman and her birth companion(s) about what is happening and take her preferences into account

If the cardiotocograph trace is still pathological after implementing conservative measures:

obtain a further review by an obstetrician and a senior midwife

offer digital fetal scalp stimulation and document the outcome

If the cardiotocograph trace is still pathological after fetal scalp stimulation:

consider fetal blood sampling

consider expediting the birth

take the woman’s preferences into account

Question 24

need fo urgent intervention criteria

Answer 24

Acute bradycardia, or a single prolonged deceleration for 3 minutes or more

Question 25

Mx for need for urgent intervention

Answer 25

Urgently seek obstetric help If there has been an acute event (for example, cord prolapse, suspected placental abruption or suspected uterine rupture), expedite the birth Correct any underlying causes, such as hypotension or uterine hyperstimulation Start 1 or more conservative measures* Make preparations for an urgent birth Talk to the woman and her birth companion(s) about what is happening and take her preferences into account Expedite the birth if the acute bradycardia persists for 9 minutes If the fetal heart rate recovers at any time up to 9 minutes, reassess any decision to expedite the birth, in discussion with the woman

Question 26

concerning characterisitcs of variable decelerations

Answer 26

lasting more than 60 seconds reduced baseline variability within the deceleration failure to return to baseline biphasic (W) shape no shouldering

Question 27

conservative measures for heart fetal

Answer 27

encourage the woman to mobilise or adopt an alternative position (and to avoid being supine) offer intravenous fluids if the woman is hypotensive reduce contraction frequency by: reducing or stopping oxytocin if it is being used and/or offering a tocolytic drug (a suggested regimen is subcutaneous terbutaline 0.25 mg).

Question 28

when to offer fetal blood sampling

Answer 28

if CTG is stilkl pathological regardless of fetal scalp stimulation

Question 29

what is fetal blood sampling

Answer 29

measure the level of acid in the baby's blood, which may help to show how well the baby is coping with labour. when taking a sample a small scratch may be formed on the baby's scalp - small risk of infection

Question 30

classification of pH of fetal blood

Answer 30

normal: 7.25 or above borderline: 7.21 to 7.24 abnormal: 7.20 or below

Question 31

classification of lactate of fetal blood

Answer 31

normal: 4.1 mmol/l or below borderline: 4.2 to 4.8 mmol/l abnormal: 4.9 mmol/l or above. [2017]

Question 32

if fetal blood sample is borderline - no accelerations in response to fetal scalp stimulation

Answer 32

second fetal blood sample no more than 30 minutes later if this is still indicated by the cardiotocograph trace

Question 33

if fetal blood sample is normal - no accelerations in response to fetal scalp stimulation

Answer 33

second fetal blood sample no more than 1 hour later if this is still indicated by the cardiotocograph trace

Question 34

what advise should be given to women presenting with prelabour rupture of the membranes

Answer 34

the risk of serious neonatal infection is 1%, rather than 0.5% for women with intact membranes 60% of women with prelabour rupture of the membranes will go into labour within 24 hours induction of labour[4] is appropriate approximately 24 hours after rupture of the membranes

Question 35

what observations are recorded during the first stage of labour

Answer 35

half‑hourly documentation of frequency of contractions hourly pulse 4‑hourly temperature and blood pressure frequency of passing urine offer a vaginal examination 4‑hourly or if there is concern about progress or in response to the woman's wishes (after abdominal palpation and assessment of vaginal loss).

Question 36

delay in first stage what to take into account

Answer 36

parity cervical dilatation and rate of change uterine contractions station and position of presenting part the woman's emotional state referral to the appropriate healthcare professional.

Question 37

what aspects should be assessed when diagnosing delay

Answer 37

cervical dilatation of less than 2 cm in 4 hours for first labours cervical dilatation of less than 2 cm in 4 hours or a slowing in the progress of labour for second or subsequent labours descent and rotation of the baby's head changes in the strength, duration and frequency of uterine contractions.

Question 38

if delay is established what might be done

Answer 38

amniotomy - rupturing of membranes artificially repeat vaginal examination 2 hours later whether her membranes are ruptured or intact

Question 39

what would amniotomy do

Answer 39

shorten her labour by about an hour and may increase the strength and pain of her contractions

Question 40

role of oxytocine in first stage labour

Answer 40

ncrease the frequency and strength of her contractions and that its use will mean that her baby should be monitored continuously. vaginal examination 4 hours after stating oxytocin

Question 41

define passive second stage of labour

Answer 41

the finding of full dilatation of the cervix before or in the absence of involuntary expulsive contractions.

Question 42

define onset of the active second stage of labour

Answer 42

the baby is visible expulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation of the cervix active maternal effort following confirmation of full dilatation of the cervix in the absence of expulsive contractions.

Question 43

observations done during the second stage

Answer 43

partogram half‑hourly documentation of the frequency of contractions hourly blood pressure continued 4‑hourly temperature frequency of passing urine offer a vaginal examination hourly in the active second stage, or in response to the woman's wishes (after abdominal palpation and assessment of vaginal loss). Perform intermittent auscultation of the fetal heart rate immediately after a contraction for at least 1 minute, at least every 5 minutes. Palpate the woman's pulse every 15 minutes to differentiate between the two heartbeats

Question 44

duration of second stage of labour in a nulliparous woman

Answer 44

birth would be expected to take place within 3 hours of the start of the active second stage in most women diagnose delay in the active second stage when it has lasted 2 hour undertake an operative vaginal birth if birth is not imminent

Question 45

duration of second stage of labour in a nulliparous woman

Answer 45

birth would be expected to take place within 2 hours of the start of the active second stage in most women diagnose delay in the active second stage when it has lasted 1 hour undertake an operative vaginal birth if birth is not imminent

Question 46

when to suspect delay in progress in a nulliparous woman second stage

Answer 46

in terms of rotation and/or descent of the presenting part) is inadequate after 1 hour of active second stage. Offer vaginal examination and then offer amniotomy if the membranes are intact

Question 47

when to suspect delay in progress in a nulliparous woman second stage

Answer 47

(in terms of rotation and/or descent of the presenting part) is inadequate after 30 minutes of active second stage. Offer vaginal examination and then offer amniotomy if the membranes are intact

Question 48

when to consider oxytocin in the second stage

Answer 48

Consideration should be given to the use of oxytocin, with the offer of regional analgesia, for nulliparous women if contractions are inadequate at the onset of the second stage.

Question 49

intervention to recuse perineal trauma

Answer 49

Either the 'hands on' (guarding the perineum and flexing the baby's head) or the 'hands poised' (with hands off the perineum and baby's head but in readiness) technique can be used to facilitate spontaneous birth.

Question 50

what advise to give to women who have had third or fourth degree trauma

Answer 50

current urgency or incontinence symptoms the degree of previous trauma risk of recurrence the success of the repair undertaken the psychological effect of the previous trauma management of her labour

Question 51

if episiotomy has to be performed which method might be recommended

Answer 51

mediolateral episiotomy originating at the vaginal fourchette and usually directed to the right side. The angle to the vertical axis should be between 45 and 60 degrees at the time of the episiotomy

Question 52

when to offer instrumental birth

Answer 52

baby's wellbeing or there is a prolonged second stage]]advise the woman to ahve tested effective anaesthesia if anaesthesia declines offer a pudendal block

Question 53

assessments that needs to be done when expediting birth

Answer 53

the degree of urgency clinical findings on abdominal and vaginal examination choice of mode of birth (and whether to use forceps or ventouse if an instrumental birth is indicated) anticipated degree of difficulty, including the likelihood of success if instrumental birth is attempted location any time that may be needed for transfer to obstetric‑led care the need for additional analgesia or anaesthesia the woman's preferences

Question 54

define third stage of labour

Answer 54

time from the birth of the baby to the expulsion of the placenta and membranes.

Question 55

what does active Mx of the third stage of labour involves

Answer 55

routine use of uterotonic drugs deferred clamping and cutting of the cord controlled cord traction after signs of separation of the placenta. shortens the third stage compared with physiological management is associated with nausea and vomiting in about 100 in 1,000 women is associated with an approximate risk of 13 in 1,000 of a haemorrhage of more than 1 litre is associated with an approximate risk of 14 in 1,000 of a blood transfusion.

Question 56

what does physiological Mx of the third stage involves

Answer 56

Gold standard is active -no routine use of uterotonic drugs - IM Injection with oxytocin, usually as birth is taking place - Cord is clamped and cut, 1-5mins after birth - Placenta is pulled out by the midwife once it has separated from the wall of the uterus, usually happens within 30 mins REDUCED risk of PPH, need for blood transfusion and postnatal anaemia is associated with nausea and vomiting in about 50 in 1,000 women physiological - delivery of the placenta by maternal effort. - no clamping of the cord until pulsation has stopped is associated with an approximate risk of 29 in 1,000 of a haemorrhage of more than 1 litre is associated with an approximate risk of 40 in 1,000 of a blood transfusion

Question 57

when can prolonged third stage be diagnosed

Answer 57

if it is not completed within 30 minutes of the birth with active management or within 60 minutes of the birth with physiological management.

Question 58

what is recorded in the third stage labour

Answer 58

her general physical condition, as shown by her colour, respiration and her own report of how she feels vaginal blood loss.

Question 59

what is injected in active management

Answer 59

administer 10 IU of oxytocin by intramuscular injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut. Use oxytocin as it is associated with fewer side effects than oxytocin plus ergometrine

Question 60

when to clamp cord

Answer 60

Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heart rate below 60 beats/minute that is not getting faster. Clamp the cord before 5 minutes in order to perform controlled cord traction as part of active management. If the woman requests that the cord is clamped and cut later than 5 minutes, support her in her choice

Question 61

when to perform controlled cord traction

Answer 61

active management only after administration of oxytocin and signs of separation of the placenta.

Question 62

when do u move from physiological to active Mx

Answer 62

haemorrhage the placenta is not delivered within 1 hour of the birth of the baby. shorten the third stage

Question 63

if placenta is retained

Answer 63

IV access examine vagina needs to be removed

Question 64

antenatal RFs for postpartum haemorrhage

Answer 64

previous retained placenta or postpartum haemorrhage maternal haemoglobin level below 85 g/litre at onset of labour BMI greater than 35 kg/m2 grand multiparity (parity 4 or more) antepartum haemorrhage overdistention of the uterus (for example, multiple pregnancy, polyhydramnios or macrosomia) existing uterine abnormalities low‑lying placenta maternal age of 35 years or older.

Question 65

risk factors in labour for postpartum haemorrhage

Answer 65

induction prolonged first, second or third stage of labour oxytocin use precipitate labour operative birth or caesarean section

Question 66

Mx of postpartum haemorrhage

Answer 66

all for help give immediate clinical treatment: emptying of the bladder and uterine massage and uterotonic drugs and intravenous fluids and controlled cord traction if the placenta has not yet been delivered continuously assess blood loss and the woman's condition, and identify the source of the bleeding give supplementary oxygen arrange for transfer of the woman to obstetric‑led care

Question 67

first line treatment for postpartum haemorrhage

Answer 67

oxytocin (10 IU intravenous) or ergometrine (0.5 mg intramuscular) or combined oxytocin and ergometrine (5 IU/0.5 mg intramuscular).

Question 68

second line treatment for postpartum haemorrhage

Answer 68

repeat bolus of: oxytocin (intravenous) ergometrine (intramuscular, or cautiously intravenously) combined oxytocin and ergometrine (intramuscular) misoprostol oxytocin infusion carboprost (intramuscular).

Question 69

other treatment for postpartum haemorrhage

Answer 69

tranexamic acid (intravenous) rarely, in the presence of otherwise normal clotting factors, rFactor VIIa, in consultation with a haematologist

Question 70

initial assessment of the newborn baby

Answer 70

Record the Apgar score routinely at 1 and 5 minutes for all births. Record the time from birth to the onset of regular respirations.

Question 71

mother baby bonding

Answer 71

skin to skin contact breastfeeding within first hour if possible

Question 72

observations of baby born due to PROM

Answer 72

(more than 24 hours before the onset of established labour) at term for the first 12 hours of life (at 1 hour, 2 hours, 6 hours and 12 hours) in all settings. Include assessment of: temperature heart rate respiratory rate presence of respiratory grunting significant subcostal recession presence of nasal flare presence of central cyanosis, confirmed by pulse oximetry if available skin perfusion assessed by capillary refill floppiness, general wellbeing and feeding.

Question 73

observation of the woman after birth

Answer 73

record her temp, pulse, BP Uterine contraction and lochia. Examine the placenta and membranes: assess their condition, structure, cord vessels and completeness. successful voiding of the labour

Question 74

define first degree

Answer 74

injury to skin only

Question 75

define second degree

Answer 75

injury to the perineal muscles but not the anal sphincter

Question 76

define third degree

Answer 76

injury to the perineum involving the anal sphincter complex: 3a – less than 50% of external anal sphincter thickness torn 3b – more than 50% of external anal sphincter thickness torn 3c – internal anal sphincter torn.

Question 77

define fourth degree

Answer 77

injury to the perineum involving the anal sphincter complex (external and internal anal sphincter) and anal epithelium

Question 78

what is induction of labour

Answer 78

starting labour artificially.

Question 79

when will IOL is indicated

Answer 79

prolonged gestation -> between 41-41w premature rupture of membranes, infection, bleeding maternal health problems - HTN, pre-eclampsia, diabetes, obstetric cholestasis fetal growth restiriction or fetal macrosomia intrauterine fetal death previous c section

Question 80

when to offer IOL in PROM

Answer 80

less than 37 weeks gestation or offer expectant management for a maximum of 24 hours

Question 81

when to offer IOL in P-PROM

Answer 81

<34 weeks’ gestation – delay IOL unless obstetric factors indicate otherwise e.g. fetal distress. >34 weeks’ gestation – the timing of IOL depends on risks vs benefits of delaying pregnancy further e.g. increased risk of infection.

Question 82

Absolute contraindications of IOL

Answer 82

Cephalopelvic disproportion Major placenta praevia Vasa praevia Cord prolapse Transverse lie Active primary genital herpes Previous classical Caesarean section

Question 83

Relative contraindication of IOL

Answer 83

1. Breech presentation 2. Triplet or higher order pregnancy 3. Two or more previous low transverse caesarean sections

Question 84

main methods of induction

Answer 84

vaginal PGs amniotomy membrane sweep

Question 85

method of vaginal PGs

Answer 85

prepare the cervix for labour by ripening it, and also have a role in the contraction of the smooth muscle of the uterus. They come as either a tablet, gel or a controlled-release pessary: Tablet/gel regimen: 1 cycle = 1st dose, plus a 2nd dose if labour has not started 6 hours later. Pessary regimen: 1 cycle = 1 dose over 24 hours. There is a recommended maximum of one cycle in 24 hours

Question 86

define amniotomy

Answer 86

membranes are ruptured artificially using an instrument called an amnihook. releases prostaglandins in an attempt to expedite labour. It is only performed when the cervix has been deemed as ‘ripe’ (see Bishop Score below). Often, an infusion of artificial oxytocin (Syntocinon) will be given alongside an amniotomy, acting to increase the strength and frequency of contractions. The aim is to start low and titrate upwards until there are 4 contractions every 10 minutes.

Question 87

when is membrane sweep offered

Answer 87

40 and 41 weeks’ gestation to nulliparous women, and 41 weeks to multiparous women. procedure is performed by inserting a gloved finger through cervix and rotating it against the fetal membranes, aiming to separate the chorionic membrane from the decidua. The separation helps to release natural prostaglandins in an attempt to kick-start labour.

Question 88

what is the bishop score

Answer 88

‘cervical ripeness‘ based on measurements taken during vaginal examination. It is checked prior to induction, and during induction to assess progress (6 hours post-table/gel, 24 hours post-pessary): Score of ≥ 7 – suggests the cervix is ripe or ‘favourable’ – this means that there is a high chance of a response to interventions made to induce labour (i.e. induction of labour is possible). Score of <4 – suggests that labour is unlikely to progress naturally and prostaglandin tablet/gel/pessary will be required

Question 89

what must be done prior to IOL

Answer 89

CTG After initiation of IOL, when contractions begin assess fetal heart rate using continuous CTG until a normal rate is confirmed. Subsequently assess using intermittent auscultation.

Question 90

complications of IOL

Answer 90

Failure of induction (15%) – offer a further cycle of prostaglandins, or a caesarean section. Uterine hyperstimulation (1-5%) – contractions last too long or are too frequent, leading to fetal distress. Can be managed with tocolytic agents (anti-contraction) such as terbutaline. Cord prolapse – can occur at time of amniotomy, particularly if the presentation of the fetal head is high. Infection – risk is reduced by using pessary vs tablet/gel, as fewer vaginal examinations are required to check progress. Pain – IOL is often more painful than spontaneous labour. Often epidural analgesia is required. Increased rate of further intervention vs spontaneous labour – 22% require emergency caesarean sections, and 15% require instrumental deliveries. Uterine rupture (rare)

Question 91

what is the optimal head position for delivery

Answer 91

occiput anterior

Question 92

what is looked for in a vaginal examination

Answer 92

consistency, effacement and dilatation of the cervix - whether the membranes are intact - colour of the amniotic fluid - nature and presentation of the presenting part and its relationship to the ischial spine - size of pelvic outlet

Question 93

RFs for GBS mx

Answer 93

Suspected or confirmed infection in another baby in the case of a multiple pregnancy Parenteral antibiotic treatment given to the woman for confirmed or suspected invasive bacterial infection (such as septicaemia) at any time during labour, or in the 24-hour periods before and after the birth [This does not refer to intrapartum antibiotic prophylaxis] Respiratory distress starting more than 4 hours after birth Seizures Need for mechanical ventilation in a term baby Signs of shock