Labour

Question 1

Within how long should an emergency C-sec take place from threat to mother or baby’s life?

Answer 1

30mins

Question 2

What are the 2 most common reasons to perform emergency C-sec?

Answer 2

Failure to progress

Suspected/confirmed foetal compromise

Question 3

What are H2 receptor antagonists used for in C-sec?

Answer 3

Prevent Mendelson’s syndrome

Question 4

What is Mendelson’s syndrome?

Answer 4

Aspiration of gastric contents into the lung

Question 5

Which anaesthetic options can be used in C-sec?

Answer 5

Epidural
Spinal
GA

Question 6

What layers are incised during C-sec?

Answer 6

Skin
Camper's fascia
Scarpa's fascia
Rectus sheath
Rectus muscle
Abdominal peritoneum
Visceral peritoneum
Uterus

Question 7

C-sec carries in increases risk of uterovaginal prolapse, neonatal infection and perineal trauma true/false

Answer 7

False

It is lower risk for all of these as well as incontinence and later still birth

Question 8

Give indications for induction of labour?

Answer 8

Prolonged gestation
Premature membrane rupture
Maternal health problems (pre-eclampsia, DM)
Foetal growth restriction

Question 9

What is the management of preterm rupture of membranes >37 weeks gestation?

Answer 9

Expectant waiting for 24 hours and then induction

Question 10

What is the management of rupture of membranes <34 weeks gestation?

Answer 10

Delay labour induction unless there are other negative factors

Question 11

What are the absolute contraindications to induction of labour?

Answer 11

Major PP
VP
Cord prolapse
Transverse lie
Active genital herpes
Prev C-sec

Question 12

What are relative contraindications to C-sec?

Answer 12

Breech presentation
Triplets (or more !!)
2+ previous low transverse C-sec

Question 13

What are the three main methods of labour induction?

Answer 13

Vaginal prostaglandins
Amniotomy
Membrane sweep

Question 14

How do vaginal prostaglandins induce labour?

Answer 14

Ripen the cervix

Stimulate contraction of sm of uterus

Question 15

What is an amniotomy?

Answer 15

Artificial rupture of membranes with amniohook

Causes prostaglandin release

Question 16

What is a membrane sweep?

Answer 16

Insert gloved finger to “sweep” around foetal membranes to separate them from the decidua

Question 17

What does the Bishop score assess?

Answer 17

Cervical ripeness

Question 18

What Bishop score indicates induction of labour is possible?

Answer 18

> =7

Question 19

How is foetus monitored if oxytocin given during labour?

Answer 19

CTG

Question 20

What is an operative vaginal delivery?

Answer 20

Use of instrument to aid delivery of the uterus

Question 21

What are the two main instruments used in operative delivery?

Answer 21

Ventouse

Forceps

Question 22

What is a ventouse?

Answer 22

Instrument used which attaches at the foetal head with vaccuum

Question 23

What are the two most common types of ventouse?

Answer 23

Kiwi

Silastic cup

Question 24

In which foetal position may a silastic cup be used?

Answer 24

OA

Question 25

How is a forceps delivery carried out?

Answer 25

Blades applied to either side of the head and gentle traction applied in time with contractions

Question 26

Which forceps type is used a C-sec?

Answer 26

Wrigley's

Question 27

Which type of forceps is used for rotational delivery?

Answer 27

Klielland;s

Question 28

Which maternal factors would be an indication for operative delivery?

Answer 28

``` Inadequate progress (2hrs nulliparous, 1hr multiparous) Maternal exhaustion Congenital heart disease HTN Intracranial pathologies ```

Question 29

Which foetal factors would be indications for operative delivery?

Answer 29

Foetal compromise | APH

Question 30

Give examples of absolute contraindications to any operative delivery

Answer 30

Unengaged foetal head Incompletely dilated cervix (in single preg) Breech presentation

Question 31

Give absolute contraindications for ventouse delivery?

Answer 31

Perterm | High likelihood of coag disorder

Question 32

Which foetal complications may arise from operative delivery?

Answer 32

``` Scalp laceration Bruising Facial nerve damage Skull fracture Retinal haemorrahge ```

Question 33

Which maternal complications may arise as a result of operative delivery?

Answer 33

``` Vaginal tear VTE Incontinence PPH Shoulder dystocia Infection ```

Question 34

Define premature rupture of membranes

Answer 34

Rupture of membranes 1 hour prior to onset of labour >=37 weeks gestation

Question 35

Define pre-term premature rupture of membranes

Answer 35

Rupture <37 weeks gestation

Question 36

What do the foetal membranes consist of?

Answer 36

Chorion | Amnion

Question 37

How do the foetal membranes become weaker for labour?

Answer 37

Through apoptosis and enzyme-mediated collagen breakdown

Question 38

What are the three main causes of early membrane rupture?

Answer 38

Physiological early activation Infection Genetic predisposition

Question 39

What are the major risk factors for early membrane rupture?

Answer 39

``` Smoking Prev event Vaginal bleeding Invasice procedures Multiple preg Polyhydramnios Cervical insuff ```

Question 40

Even if fluid can be seen leaking from vagina, speculum exam is required true/false

Answer 40

False Get woman to lay on back for 30mins - should see pooling of fluid Ask to cough and amniotic fluid should come out

Question 41

What investigation should be performed in all early membrane rupture?

Answer 41

High vaginal swab