Normal Pregnancy & Labour

Question 1

Naegele’s Rule

Answer 1

Date of confinement= LMP-3months + 7 days

Question 2

GTPAL

Answer 2

1. Pregnancies
2. Term births
3. Preterm
4. Abortions
5. Live births

Question 3

Four important history questions?

Answer 3

1. Bleeding
2. Leaking
3. Contractions
4. Fetal movements

Question 4

Trisomy 21 screening findings

Answer 4

1. Increased nuchal translucency
2. Increased B-HCG
3. Decreased PAPP-A

Question 5

If a low PAPP-A on 1st trimester screen, do?

Answer 5

Uterine artery doppler @ 22 weeks

Question 6

Fundal height at:
12 weeks? 
16 weeks?
20 weeks?
Beyond 21 weeks?

Answer 6

12 weeks= symphysis
16 weeks=halfway to umbilicus
20 weeks=at umbilicus
Beyond 21 weeks=# of weeks +/- 2cm

Question 7

Treatment if mom is GBS positive?

Answer 7

IV abx during labour

1. Pen G (5 million U then 2.5 million q 4 h)
2. 2nd line= ancef/clindamycin

Question 8

Normal length of stages of labour?

Answer 8

1. Latent: 14 h multi, 20h primi
2. Active: 1.2 cm/h primi, 1.5 cm/h multi
3. Second stage: 1 h multi, 2 h primi ( add 1 h for epidural)
4. Third stage: 30 min.

Question 9

3 P’s of labour progress?

Answer 9

1. Power: contractions and pushing
2. Passenger: size and position of baby
3. Pelvis

Can correct power but not passenger or pelvis

Question 10

What are the cardinal movements of the fetal vertex?

Answer 10

1. Engagement: Head should lower to level of ischial spines
2. Descent
3. Flexion
4. Internal rotation to occiput anterior position
5. Extension
6. External Rotation

Question 11

What are the three signs of placental separation?

Answer 11

1. Gush of blood
2. Lengthening of cord
3. Rise of fundus (support so it does not invert)

Question 12

What are the types of malpresentation?

Answer 12

1. Breech (complete, frank, footing)
2. Face
3. Brow
4. Shoulder
5. Compound

Question 13

What are the parts of a fetal NST?

Answer 13

1. Baseline (110-160)
2. Variability: 5-25 bpm
3. Accelerations 15x15
4. Decelerations
5. Overal impression (atypical, abnormal, normal)

Question 14

Variable Decelerations

Answer 14

Cord compression, hypoxia

Question 15

Early Decelerations

Answer 15

Normal, due to head compression

Question 16

Late Decelerations

Answer 16

Placental insufficiency/ fetal hypoxia

Question 17

Increased variability ddx

Answer 17

Mild hypoxia, fetal gasping

Question 18

Decreased variability ddx

Answer 18

Fetal hypoxia, fetal sleep

Question 19

Fetal Bradycardia ddx

Answer 19

Need to deliver STAT

Ddx: rapid descent, late hypoxia, cord prolapse, hypercontractibility

Question 20

Scalp pH

Answer 20

Do if atypical FHS
<7.20: deliver
7.2-7.24: Repeat in 30 min
<7.25: repeat if FHR remains abnormal

Question 21

What should be done if you are unsure of babies oxygenation status?

Answer 21

1. Reposition into LL decubitus
2. Give o2
3. Give IV fluids
4. Stop oxytocin

Question 22

10 B’s of post-partum rounds

Answer 22

1. Blues
2. Breasts
3. Belly
4. Bleeding (1 pad/h normal)
5. Blood type (Rh)
6. Bladder
7. Bowels (avoid constipation)
8. Bum (tears, hemarrhoids)
9. Baby (social)
10. Before- deal with pre-existing conditions

Question 23

4 T’s of primary post-partum hemorrhage

Answer 23

1. Tone
2. Tissue
3. Trauma
4. Thrombin

Question 24

Puerpural fever

Answer 24

Fever in 6 weeks after birth
DDx: 
1. Wind- resp infections, atelectasis, PE
2. Woobies- mastitis
3. Water- UTI/ pyelonephritis
4. Womb- endometritis, retained products of conception
5. Wound
6. Walking- DVT,

Question 25

Diagnostic Criteria post-partum depression

Answer 25

1. Depressed mood 2. Sleep disturbance 3. Lake of interest in usually pleasurable thing 4. Diminished self-esteem or guilt 5. Fatigue or loss of energy 6. Change in appetite 7. Psychomotor agitation 8. Suicidal ideation

Question 26

First trimester investigations

Answer 26

Blood: serology for HIV, syphilis, HepBSAG, varicella, rubella, CBC, type and screen Urine: glucose, protein Date: 9-12 week dating ultrasound Screen: U/S for nuchal translucency, PAPP-A, B-HCG Diagnostics: maternal free cell DNA, amniocentesis, chorionic villi sampling

Question 27

Second trimester investigations

Answer 27

``` Check: ultrasound for parts Syphilis Repeat type and screen Check fetal heart rate, symphysis fundus height Screen, quadruple ```

Question 28

Components of a biophysical profile

Answer 28

1. FHR- >2 accells in 20 min 2. Breathing- >1 episode lasting >30s 3. Movements- >3 body or limb movements 4. Tone- >1 episode of flex/extension limb or open/close hand 5. Amniotic fluid- >1 cord and >1 limb free fluid pocket 2x2 cm If 6- repeat in 24 h If <6- delivery may be indicated

Question 29

Abnormal NST

Answer 29

1. Baseline: <100bpm or >160 for >30 min or erratic 2. Variability: <5 for 80 min, sinusoidal, 25 bpm>10 min 3. Decelerations: variable > 60s, late decels 4. Accelerations: <2 with >15 bpm, 15 s in 80 min This means urgent action is required