Obstetrics and Maternity Slides

Question 1

What are the 4 stages of labour?

Answer 1

1. Includes prodromal and active labour. Contractions causing cervical dilation
2. Active pushing with crowning and delivery of baby
3. From delivery of baby to delivery of placenta
4. Recovery

Question 2

What are the 7 cardinal movements of labour (in order)?

Answer 2

1. Engagement
   
   • Head engages with pelvic inlet. Head is turned to side
2. Descent
   
   • Head begins to pass through bony parts of pelvis
3. Flexion
   
   • Neck flexion as baby follows curve of sacrum
4. Internal Rotation
   
   • Rotation to face down / face up to fit narrow passage
5. Extension
   
   • Neck extends to fit curvature at coccyx
6. Restitution
   
   • Rotation of head to lateral to facilitate passing of shoulder
7. Expulsion
   
   • BABY!

Question 3

What is the CATCH mnemonic for collection maternal information?

Answer 3

C: Colour of fluid

A: Additional risk factors

T: Term Gestation?

C: Cord Clamping Plan / C-sections?

H: How Many Babies?

Question 4

What is the advantage of delayed cord clamping?

Answer 4

Increases baby’s blood volume by up to 30%

Question 5

During crowning, should active pushing be encouraged during or between contractions?

Answer 5

Between!

Goal is to avoid explosive delivery

Question 6

What are situations that necessitate early cord clamping?

Answer 6

• Need for neonatal resuscitation
  
  • clamp cord after ~25 seconds
• Interuption of placental blood supply
  
  • placental abruption, cord avulsion, bleeding placenta or vasa previa

Question 7

What is AMTSL, and what are three recommendations to support it?

Answer 7

Active Management of Third Stage of Labour

1. Delayed cord clamping
2. Uterotonics
   
   • Not available to us, but early latching may help
3. Controlled cord traction

Question 8

What does GTPAL stand for?

Answer 8

• Gravida
  
  • Total number of pregnancies, current one included
• Term Deliveries
  
  • Multiples (twins triplets) count as one
• Preterm Deliveries
  
  • Multiples (twins triplets) count as one
  • Stillbirth after 24weeks counts as P
• Abortions
  
  • Medical or spontaneous
• Living children
  
  • Multiples count for their full number

Question 9

What is the normal weight and shape of a pacenta, and where does the cord normally insert?

Answer 9

• 450g
• round, 22cm across, 2cm thick
• in the middle

Question 10

What is a normal amount of blood loss after delivery

Answer 10

400-500mL