Labour and delivery

Question 1

First stage of labour

Answer 1

From the onset (true contractions) until cervix is 10cm dilated

Question 2

Second stage of labour

Answer 2

From 10cm dilated to delivery of the baby

Question 3

Third stage of labour

Answer 3

From delivery of the baby to delivery of the placenta

Question 4

Signs of labour 4

Answer 4

Show - mucuos plug
rupture of membranes
regular painful contractions
Dilation of cervix

Question 5

Prophylaxis of preterm labour 2

Answer 5

Vaginal progesterone - decreasing activity of myometrium

Cervical cerclage - Stitch into the cervix to help keep it closed - stitch removed when woman goes into labour

Question 6

What is PROM

Answer 6

Premature rupture of membranes - sac ruptures under 37 weeks, inducing labour

Question 7

How is P PROM diagnosed

Answer 7

Speculum exam - pooling of amniotic fluid in the vagina

IGFBP 1 and PAMG 1 present in fluid - high concentration in amniotic fluid

Question 8

How is P PROM mx

Answer 8

Prophylactic AB to prevent development of chorioamnioitis - amoxicillin or erythromycin 10 days

Tocolysis - nifedipine

Steroids and magnesium sulphate

Question 9

What is Tocolysis

Answer 9

medications to stop uterine contractions in preterm labour to buy time for fetal development

Nifedipine 1st line - prevents contractions

Question 10

When are steroids given

Answer 10

Given when pregnancy are less than 35 weeks - to reduce the risk of ARDs

Question 11

Why is magnesium sulphate given

Answer 11

Protect the fetal brain in preterm labour - redcues risk of cerebral palsy

*Monitor for overdose

Question 12

Sx of magnesium overdose

Answer 12

Reduced resp rate, reduced BP, absent reflexes

Question 13

When is induction of labour needed

Answer 13

IOL is offered between 41-42 weeks or: P PROM, fetal groth restriction, pre-eclampsia, obstetric cholestasis, diabetes, fetal death

Question 14

Scale used to determine induction of labour

Answer 14

BISHOPS

8 or more predicts successful induction as labour is about to begin

less than 8 means induction might not be successful

Question 15

Options for induction of labour 4

Answer 15

Membrane sweep - finger into cervix to stimulate

Vaginal prostaglandins - pessary that stimulates cervix and uterus

Cervical ripening balloon - balloon in cervix to dilate

Artificial rupture of membrane - oxytocin - given after prostaglandins to stimulate

Question 16

What is uterine hyperstimulation and the mx

Answer 16

Complication when given vaginal prostaglandins - prolonged contractions causing fetal distress

Mx - Removing trigger
tocolysis with terbutaline

Question 17

3ps of labour

Answer 17

power - uterine contractions
Passanger - size, presentation, position
Passage - size and shape

Question 18

Pain relief offered in labour 5

Answer 18

Paracetamol and codeine
Entonox
IM pethidine or diamorphine
Epidural
Patient controlled - remifentanil

Question 19

Risks Umbilical cord prolapse

Answer 19

Cord descending below presenting part of foetus and below vagina - can compress cord cx hypoxia

RF - abnormal lie

Question 20

Dx of cord prolapse 2

Answer 20

Fetal distress on CTG

Speculumn/vaginal exam

Question 21

Mx of cord prolapse

Answer 21

Presenting part of baby pushed up to prevent compression - knee chest or L lateral

Emergency c section

Question 22

What is shoulder dystocia and what cx

Answer 22

Anterior shoulder of the baby becomes stuck behind the pubic bone after the head has been delivered

Macrosomnia due to gestational diabetes

Question 23

Mx of shoulder dystocia

Answer 23

HELP
episiotomy - not always done
Mcroberts (legs up) - Hyperflex hips
Pressure to anterior shoulder
Delivery post arm

Question 24

Complications of shoulder dystocia

Answer 24

Fetal hypoxia
Brachial plexus (erbs)
perineal tearms
PPH

Question 25

Risks with epidural delivery

Answer 25

*iNCREASED RISK OF INSTRUMENTAL DELIVERY*

Question 26

Instrumental delivery options

Answer 26

Ventouse - suction on baby's head Forceps - large tongs on baby's head

Question 27

Complication of instrumental delivery

Answer 27

Ventouse - Cephalohaemotoma Forceps - Facial nn palsy, bruises and fat necrosis

Question 28

RF for perineal tears

Answer 28

1st brith, macrosomnia, shoulder dystocia, instrumental delivery

Question 29

Classification of perineal tears

Answer 29

1st degree - superficial skin 2nd - perineal muscles 3rd - anal sphincter involvement 4th - through anal sphincter to rectal mucosa

Question 30

Mx of tears

Answer 30

1st degree conservative > 1st - sutures 3rd-4th - theatre mx

Question 31

Complications of perineal tears 3

Answer 31

Incontinence (urinary and bowel) Fistula sexual dysfunction

Question 32

Steps of management of 3rd stage

Answer 32

Physiological - maternal effort Active - IM oxytocin to help contract the uterus

Question 33

When is active mx offered in the 3rd stage

Answer 33

Haemorrhage Delay of more than 1 hour

Question 34

Criteria for PPH

Answer 34

500ml blood loss after vaginal 1l loss after caesaren minor <1000, major >1000

Question 35

Cx of PPH 4

Answer 35

Tone - atony Trauma - tear Tissue - retained placenta Thrombin - bleeding disorder

Question 36

Prevention of PPH 4

Answer 36

Treating anaemia during AN period Empty bladder - reduces contractions Active mx of 3rd stage IV tranexamic acid

Question 37

Mx of PPH

Answer 37

Mechanical - rubbing uterus - stimulate contractions Catheterisation - distensions prevents contracts Medical Oxytocin (40units), ergometrine, carboprost, misoprostol - stimulate contraction Tranexamic acid - reduce bleeding Surgical IU balloon - press against bleeding Suture - compress uterus Uterine artery ligation Hysterectomy

Question 38

Chorioamnionitis/ maternal sepsis

Answer 38

Infection in amniotic membranes and fluid - leading cx of maternal sepsis Fever, tachy, low sats, low BP, altered consciousness, reduced urine, raised markers, CTG x, other UTI sx Mx - sepsis 6

Question 39

uterine rupture RF

Answer 39

Previous section** uterine surgery, BMI, high parity, increased age, induction

Question 40

Px of uterine rupture

Answer 40

Abnormal CTG Abdo pain, vaginal bleeding, ceasing of contractions**, hypotension, tachycardia, collapse

Question 41

Mx of uterine rupture

Answer 41

Emergency c section Hysterectomy