Labour

Question 1

What can happen before labour begins which makes you think a female is in a labour?

Answer 1

Braxton Hicks

Question 1

How many stages of labour are there?
what are they called?

Answer 1

3 stages
stage 1 - latent and active
stage 2 - baby delivery
stage 3 - placental delivery

Question 2

What are Braxton hicks?

Answer 2

vague cramps in 3/3
Mild, Irregular, uncomfortable and painless tightening of uterine wall

Question 3

What happens before labour begins?

Answer 3

Bloody show, mucus plug
Just before - spontaneous rupture of membranes (ROM),

Question 4

What is happening to the cervix in stage 1?

Answer 4

it is shortening and widening

Question 5

How long does stage 1 latent phase last for?
length for Primi vs multi
Dilation?
diameter and contractions?

Answer 5

20 hours Primi (1)
14 hours multi
Dilation <30%
0-4cm diameter
contractions 1-3 mins

Question 6

How long does stage 1 active phase last for?
length for Primi vs multi
Dilation?
diameter and contractions?

Answer 6

6 hours primi
5 hours multi
dilation 30-100%
5-10cm diameter
contractions 60s every 1-2 mins

Question 7

What is the dilation rate for primi/multi?

Answer 7

1.2cm primi
1.5cm multi

Question 8

What is stage 2 of labour?
Length for Primi/multi?

Answer 8

Baby comes out
2 hours Primi
1 hour multi

Question 9

What are the 3 Ps in stage 2 labour that affects labour time?

Answer 9

Power (tone)
Passage (pelvic inlet dimensions S2-S4)
Passenger (cephalopelvic proportion)

Question 10

What are the movements of the foetus out of the mum?

Answer 10

Engage
Decent
Flexion
Internal rotation
extension
External rotation
Restitution
Expulsion

Question 11

What is stage 3 of labour?
Time?

Answer 11

deliver the placenta + monitor Postpartum haemorrhage
30 mins

Question 12

What do we check in the placenta?

Answer 12

check placental remnants
2 umbilical arteries and 1 umbilical vein

Question 13

What is a portogram used for?

Answer 13

Labour progression
Parameters to measure maternal + fetal health during labour
can guide the need to add/change methods
eg. cat 1 c section if distressed

Question 14

What is the bishop score used for?

Answer 14

to assess cervical ripeness
How likely a woman is to go into labour

Question 15

What is the acronym for the bishop score?

Answer 15

CDEFP

Question 16

What does CDEFP mean?

Answer 16

Consistency
Dilation
Effacement
Fetal station
Position

Question 17

What are the different scores for the bishop criteria?

Answer 17

<5
5-7
>8

Question 18

what do these mean?
<5
5-7
>8

Answer 18

<5 - Unripe therefore unlikely to spontaneously induce - need to induce labour

5-7 - intermediate

> 8 - Ripe, likely to spontaneously induce

Question 19

What are some indications to induce?

Answer 19

Prolonged labour
Preterm premature rupture of membranes (PPROM)
Maternal issues = Gestational DM, Pre eclampsia, obs, Cholestasis

Question 20

What bishop scores determine the different ways of inducing labour?

Answer 20

6 or less
more than 6

Question 21

How is labour induced in a bishop score 6 or less?

Answer 21

Membrane sweep
Vaginal Prostaglandin (gel or pessary)
PO Misoprostol

Question 22

What do prostaglandins do?

What is a common prostaglandin gel that’s used and what type of prostaglandin is it?

What type of pros is misoprostol?

Answer 22

Promote cervical ripening

Dinoprostone gel (Prostaglandin E2)

Prostaglandin E1

Question 23

How is labour induced in a bishop score of above 6?

Answer 23

Amniotomy (ARM)
IV Oxytocin

Question 24

What is an example of an oxytocin that is used and what does it do?

Answer 24

Syntocinon Stimulates contractions

Question 25

What is induction Contraindicated in?

Answer 25

Vasa previa and cord prolapse

Question 26

What is a complication of inducing labour and what can this cause?

Answer 26

Uterine hyperstimulation >6 contractions in 10 mins Risk of foetal ischemia and uterine rupture

Question 27

What is conservative pain relief for labour?

Answer 27

Perianal + fundal massage TENS (transcutaneous electrical nerve stimulation)

Question 28

what are some medications given in labour for pain relief?

Answer 28

Entonox Pethidine Morphine

Question 29

What are the side effects of entonox?

Answer 29

N+V

Question 30

What are the foetal and maternal side effects of pethidine/morphine?

Answer 30

foetal = Resp depression, diminished breast feeding/seeking behaviour maternal = Euphoria/dysphoria, N+V, longer labour

Question 31

How effective is the epidural?

Answer 31

85-90% effective

Question 32

Epidural Contraindications?

Answer 32

Low platelets (Risk of bleeding) On DOAC/Aspirin High ICP bleeding disorders allergy

Question 33

Side effects of an epidural?

Answer 33

Urine retention Hypotension (low BP) Hypoanalgese Headache (1/100 post epidural)

Question 34

When can an epidural be denied?

Answer 34

Foetal distress Antepartum haemorrhage

Question 35

What are 2 other things that can be given in labour?

Answer 35

IV Benzylpenicillin RhoGAM

Question 36

Why would benzylpenicillin + RhoGAM be given?

Answer 36

If there is Group B strep bacteria in urine (GBS) or UTI at any time in pregnancy If Rhesus negative

Question 37

What can be given instead of benzylpenicillin if they're allergic?

Answer 37

Clindamycin

Question 38

C section is what % of births?

Answer 38

25%

Question 39

What are the 3 types of incisions?

Answer 39

Classical (midline) Joel Cohen Incision Pfannenstiel

Question 40

classical (midline) incision is it done? Increased risk of?

Answer 40

not done Increased risk of uterine rupture with vaginal birth after caesarian CI to VBAC

Question 41

What is a Joel Cohen incision?

Answer 41

Incision through 7 layers

Question 42

What are the 7 layers that are incised through?

Answer 42

Skin Scarpa fascia camper fascia Rectus sheath Rectus abdominis Peritoneum Uterus

Question 43

what is a CI to vaginal birth?

Answer 43

2 or more C Section

Question 44

Complications of C section?

Answer 44

VBAC rupture (1/200) Postpartum haemorrhage Endometriosis TTON

Question 45

What are some indications for a c section?

Answer 45

Placenta previa Vasa previa Failure to progress Active genital herpes Cord prolapse Fetomaternal distress

Question 46

CAT: 1 2 3 4 What do these mean?

Answer 46

Cat 1 - emergency <30 mins Cat 2 - <75 mins Cat 3 - needed not immediate Cat 4 - elective

Question 47

What is a CTG? what does it stand for? What is it used for?

Answer 47

Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen. CTG is widely used in pregnancy as a method of assessing fetal well‐being, predominantly in pregnancies with increased risk of complications.

Question 48

What is the acronym for CTG findings interpretation?

Answer 48

DR C BRAVADO

Question 49

what does DR C BRAVADO stand for?

Answer 49

DR = Define risk C = contractions BRA = Baseline heart rate V = Variability A = accelerations D = decelerations O = overall

Question 50

What does Define Risk Contractions mean?

Answer 50

DR - High or low risk? C - No of contractions in 10 mins, duration and intensity 3-5 every 10 mins

Question 51

What does Baseline Heart rate Variability mean?

Answer 51

BRA - Check 10 mins, 110-160 bpm V - variation of foetal HR from 1 beat to the next - 5-25 bpm normal

Question 52

What does Accelerations Decelerations Overall mean?

Answer 52

Abrupt increase or decrease in fetal HR of 15 bpm longer than 15 secs Overall good or bad

Question 53

When can you only do a CTG?

Answer 53

28 WEEKS ONWARDS

Question 54

Low risk (good) CTGs have? Contractions? HR? Variability? A or D

Answer 54

regular contractions HR 110-160 Accelerations present Early decels

Question 55

High risk (bad) CTGs have? HR? Variability? A or D

Answer 55

Bradycardia/tachy Variability <5 No acceleration late (or variable) decels

Question 56

What does it mean when <40 variability?

Answer 56

sleeping foetus

Question 57

What would you consider if CTG is high risk/bad? what would be seen on that?

Answer 57

Fetal scalp sample low pH = indicates HYPOXIA

Question 58

What are the 2 types of instrumental delivery methods?

Answer 58

Ventouse (vacuum cup) - suction cup Forceps

Question 59

What are the 2 things the ventouse can cause?

Answer 59

cephalohematoma (blood under scalp) - bad Caput Succedaneum (swelling of scalp) - better

Question 60

When do you offer instrumental aid in birth?

Answer 60

Fetal distress Premature delivery HTN/Comorbidities

Question 61

What is cephalohematoma? when does it resolve?

Answer 61

Subperiosteal bleed confined to suture lines resolves in 3 months or less

Question 62

What can happen that is even worse than a cephalohematoma?

Answer 62

Subgaleal (extra cranial bleed of emissary veins, crosses suture lines, fetal distress and shock)

Question 63

What is caput succedaneum?

Answer 63

SC oedema resolves in days not confused

Question 64

What can forceps delivery cause?

Answer 64

can cause CN7 palsy