RCSI LECTURES

Question 1

Complications of molar pregnancy

Answer 1

• severe hyperemesis
• thyrotoxicosis
• early onset preeclampsia
• hemorrhage
• persistant trophoblasict disease
• choriocarcinoma

Question 2

Labour diagnosis

Answer 2

Progressive effacement and dilatation of the cervix in the presence of uterine contractions

Question 3

First stage of labour

Answer 3

From establishment of labour until full dilatation

Question 4

Second stage of labour

Answer 4

Full dilatation to delivery of the fetus

Question 5

Third stage of labour

Answer 5

Delivery of the placenta

Question 6

What are the standard procedures in labour assessment?

Answer 6

• general examination
• assessment of uterine contractions and fetabl wellbeing
• FBC, blood type and Rh status
• Partogram
• Minimal vaginal examinations following initial assessment

Question 7

What are the fetal assessments in labour?

Answer 7

• Amniotic fluid (volume and colour)

- Maternal assessment - BP, HR and temp charting - uterine contractions

Question 8

Average rate of cervical dilatation in a primigravida?

Answer 8

1cm per hour

Question 9

When is the fetal head considered engaged?

Answer 9

When 2/5ths or less are palpable

Question 10

When does the second stage of labour begin?

Answer 10

-with full dilatation

Question 11

What are the two phase of the second stage of labour?

Answer 11

Passive phase: from full dilatation until the head reaches the pelvic floor
Active phase: when the fetal head reaches pelvic floor - usually associated with strong desire to push

Question 12

First degree tear?

Answer 12

Injury to the vaginal epithelium and vulval skin only

Question 13

Second degree tear?

Answer 13

Injury to the perineal muscles but not the anal sphinctor

Question 14

Third degree tear?

Answer 14

Injury to the perineum involving the anal sphinctor

Question 15

Fourth degree tear?

Answer 15

Injury involving the anal sphincter and rectal mucosa

Question 16

Signs of placental separation

Answer 16

• lengethening of the umbilical cord
• gush of blood
• Rising up of the fundus

Question 17

what is the latent phase of labour?

Answer 17

up to 3cm dilation

Question 18

how long may the latent phase of labour take?

Answer 18

up to 6 hours

Question 19

what is the active phase of labour?

Answer 19

3cm to 10cm dilation

Question 20

at what rate should dilation occur?

Answer 20

1cm per hour in primi, 1-2cm per hour in multi

Question 21

what are EFFICIENT uterine contractions?

Answer 21

Regular contractions, lasting 60-80 seconds with a frequency of up to 7 in 15 min

Question 22

Most common cause of failure to progress in primigravid women?

Answer 22

Inefficient uterine action

Question 23

Management of inefficient uterine action?

Answer 23

Oxytocin via IV infusion - start low and increase
Aim to acheive 7 contractions in 15 min
Must monitor fetal heart while using oxytocin

Question 24

A multigravid woman is likely to have inefficient uterine action T OR F

Answer 24

FALSE - unlikely - caution when using oxytocin, failure to progress could be from malpresentation

Question 25

Diagnosis of prolonged labour?

Answer 25

- certainty about onste of labour? - review history - assess contractions - review the CTG - perform abdominal and vaginal exams before making any decisions

Question 26

Management of prolonged labour?

Answer 26

IF maternal and fetal wellbeing are satisfactory - alllow labour to continue IF suspected fetal compromise, arrest in cervical dilation despite adequate contractions, or cephalic disproportion -> C-section

Question 27

What is malpresentation?

Answer 27

When any non-vertex part presents - arm/face/feet/brow etc

Question 28

Risk factors for oblique/transverse lie?

Answer 28

- preterm labour - placenta previa - abnormal uterus - polyhydramnios

Question 29

why does transverse lie occur in women with high parity?

Answer 29

laxity of the abdominal wall

Question 30

Management of a non-reassuring CTG ?

Answer 30

Fetal blood sampling OR delivery via C section/instrumental delivery

Question 31

normal pH on fetal blood sampling?

Answer 31

7.25 and up

Question 32

Borderline ph and procedure for borderline ph?

Answer 32

7.2-7.25 = repeat in 30 min or deliver if rapid fall since last sample

Question 33

What is an abnormal pH on fetal blood sampling?

Answer 33

<7.20 -> delivery (based on cervical dilation)

Question 34

Indicators of down syndrome on a first trimester screening?

Answer 34

- nuchal translucency | - decreased PAPP-A and elevated b-hcg

Question 35

What are the definitive tests for down syndrome in uteruo?

Answer 35

Chorionic villus sampling - performed at 11-14 weeks gestation Amniocentesis - greater than 15 weeks gestation

Question 36

what is the risk of chorionic villus sampling?

Answer 36

1% risk of miscarriage

Question 37

Risk of amniocentesis?

Answer 37

<0.1% chance of miscarriage

Question 38

trisomy 18 =

Answer 38

edwards syndrome

Question 39

ultrasound features of a fetus with edwards syndrome?

Answer 39

IUGR, strawberry shaped head, choroid plexus cysts, hydrocephalus, micrognathia, nuchal edema, heart defects, neural tube defects

Question 40

trsimoy 13 =

Answer 40

patau syndrome

Question 41

ultrasound features of a fetus with patau syndrome?

Answer 41

IUGR, holoprosencephaly, facial abnormalities, microcephaly, heart defects

Question 42

when should the neural tube close?

Answer 42

26-28 days

Question 43

when should a woman commence folic acid?

Answer 43

3 months prior to conception - 0.4mg OR 5mg if high risk

Question 44

what is the role of the first trimester scan?

Answer 44

- to confirm viability of the pregnancy - to confirm that its an intrauterine pregnancy - to confirm or exclude multiple gestation - if multiple gestation - confirm chorionicity - confirm dates by measuring crown rump length

Question 45

What is the role of the second trimester scan?

Answer 45

18-22 weeks - fetal anomoly scan - confirm pregnancy dating with biophysical measurements - placental location (especially in women with bleeding)