labour

Question 1

hormonal uterine changes in normal labour

Answer 1

progesterone keeps uterus settled
oestrogen makes uterus contract
oxytocin initiates and maintains contractions

Question 2

cervical changes in normal labour

Answer 2

softening (increase in hyaluronic acid)
ripening (decrease in collagen fibre alignment and strength of cervical matrix and increase in decorin)

Question 3

signs of third stage of labour

Answer 3

uterus contracts, hardens and rises
umbilical cord lengthens

Question 4

latent phase of the 1st stage

Answer 4

mild uterine contraction
cervix shortens and softens
durable variation

Question 5

active phase of the 1st stage

Answer 5

4cm > full dilation
contractions become more rhythmic and stronger
1-2cms per hour

Question 6

second stage of labour

Answer 6

starts with complete dilation of cervix (10cm)

Question 7

prolonged 2nd stage in nulliparous women

Answer 7

3+ hours with regional analgesia
2+ hours without regional analgesia

Question 8

prolonged 2nd stage in multiparous women

Answer 8

2 hours with analgesia
1 hours without

Question 9

3rd stage of labour

Answer 9

delivery of baby to expulsion of the placenta and fetal membranes
normally 10 minutes

Question 10

when to prepare of surgical removal of placenta in 3rd stage

Answer 10

after an hour

Question 11

active management of third stage

Answer 11

use of oxytocic drugs and controlled cord traction
prophylactic administration of syntometerine

Question 12

pacemaker of contractions

Answer 12

tubal ostia

Question 13

7 cardinal movements of labour

Answer 13

engagement
decent
flexion
internal rotation
crowning and extension
restitution and external rotation
expulsion, anterior shoulder first

Question 14

what is an epidural

Answer 14

levobupivacaine +/- opiate
between L3-L4

Question 15

complications of epidural

Answer 15

hypotension
dural puncture
headache
high block
atonic bladder

Question 16

obstructed labour risks

Answer 16

sepsis
uterine rupture
obstructed AKI
post partum haemorrhage
fistula formation
fetal asphyxia
neonatal spesis

Question 17

signs of obstruction

Answer 17

moulding
caput
anuria
haematuria
vulval oedema

Question 18

suspected failure to progress (stage 1)

Answer 18

nulliparous < 2cm dilation in 4 hours
parous < 2cm dilation of in 4 hours or slowing in progress

Question 19

causes of failure to progress- 3Ps

Answer 19

powers: inadequate contractions, frequency, strength
passages: short stature, severe pelvic trauma, shape
passenger: big baby, malposition

Question 20

doppler auscultation of fetal heart

Answer 20

stage 1: during and after a contraction, every 15 minutes
stage 2: at least every 5 minutes during and after a contraction for 1 whole minutes

Question 21

normal heart rate on CTG

Answer 21

110-150bpm

Question 22

normal variability on CTG

Answer 22

5-25bpm

Question 23

hypoxia on CTG

Answer 23

loss of accelerations
repetitive deeper and wider decelerations
rising of fetal baseline heart rate
loss of variability

Question 24

management of abnormal CTG

Answer 24

change maternal position
IV fluids
stop syntocinon
scalp stimulation
consider tocolysis- terbutaline 250
maternal assessment
consider fetal blood sampling
operative delivery- category 1

Question 25

standard indications for operative delivery

Answer 25

delay: failure to progress stage 2
fetal monitoring concern

Question 26

special indications for operative delivery

Answer 26

maternal cardiac disease
severe PET/eclampsia
intra-partum haemorrhage
umbilical cord prolapse stage 2

Question 27

most common cause of PPH

Answer 27

tone- uterine atony
uterus fails to contract adequately following delivery due to lack of tone in the uterine muscles

Question 28

management of uterine atony causing PPH

Answer 28

bimanual compression to stimulate uterine contraction
empty bladder- foley catherter
pharmacological measures that increase uterine contraction: oxytocin (syntocinon), ergometrine, carboprost, misoprolol
consider surgical measures- intrauterine balloon tamponade, haemostatic suture around uterus, bilateal uterine or internal iliac artery ligation, hysterectomy

Question 29

management of trauma causing PPH

Answer 29

primary repair of laceration, if uterine rupture: laparotomy and repair or hysterectomy

Question 30

tissue- cause of PPH

Answer 30

the retention of placental tissue which prevents the uterus from contracting

Question 31

management of tissue cause of PPH

Answer 31

administer IV oxytocin, manual removal of placenta with regional or general anaesthetic and prophylactic antibiotics in theatre
start IV oxytocin infusion after removal