Repro Online Tutorials

Question 1

indications for instrumental delivery of baby?

Answer 1

failure to progress in 2nd stage of labour

Question 2

5Ps of things which can cause problems in 2nd stage of labour?

Answer 2

power
passenger (foetal distress etc)
passage (pelvic outlet)
physical exhaustion 
planned (i.e earlier instrumental delivery planned due to maternal cardiac condition, pre-eclampsia etc)

Question 3

time limit for 2nd stage of labour?

Answer 3

3 hrs in primigravid

2hrs in parous women

Question 4

why might instrumental delivery not be appropriate if the problem is with the passage?

Answer 4

bc if there is an obstruction an instrumental delivery wont help, it will just force the baby further into the obstruction
should be thinking more about a C section if there is an obstruction

Question 5

what pre-requisites are required to be present for an instrumental delivery to be done?

Answer 5

fully dilated 10cm and membranes ruptured
cephalic presentation
well engaged head (0/5 palpable)
no signs of obstruction (moulding and caput)
defined foetal position (OA, OT, OP)
analgesia
maternal consent
empty bladder
neonatal resuscitation facilities present
ability to perform C section if it fails

Question 6

contra-indications for instrumental delivery?

Answer 6

no consent
no analgesia
undefined foetal position
unskilled operator 
foetal bleeding risk (ITP, low platelets etc)
foetal gestation <34 weeks
maternal infection (hep C etc)

Question 7

types of instruments for instrumental delivery?

Answer 7

ventouse
non-rotational forceps
rotationsl forceps/keillands forceps

Question 8

which type of forceps are used if baby is positioned occipito-anterior (correctly)?

Answer 8

non-rotational

Question 9

when are rotational forceps used?

Answer 9

when baby is positioned occipito-transverse or occipito-posterior

Question 10

what position must baby be in for ventouse?

Answer 10

any position

Question 11

foetal complications of instrumental delivery?

Answer 11

haematoma
damage to face and head
cephalohaematoma?
rarely spinal injury

Question 12

maternal complications of instrumental delivery?

Answer 12

bleeding
pain
usually requires episiotomy
tears
damage to vagina
failure

Question 13

what is an antepartum haemorrhage?

Answer 13

PV bleeding after 24 weeks and before 2nd stage of labour

Question 14

signs of a large antepartum haemorrhage?

Answer 14

shock features

blood reaches mother toes

Question 15

placental causes of antepartum haemorrhage?

Answer 15

placental abruption
placenta praevia
placenta accreta (very adherant placenta)

Question 16

local causes of antepartum haemorrhage?

Answer 16

cervical - ectropion, polyp, cancer

vaginal - trauma, polyp, infection (chlamydia)

Question 17

foetal causes of antepartum haemorrhage?

Answer 17

vasa praevia

Question 18

traumatic causes of antepartum haemorrhage??

Answer 18

uterine rupture

Question 19

common management of antepartum haemorrhage?

Answer 19

ABCDE (mother comes first)
blood tests (FBC, U&Es, LFT, coag, cross match, kleighauer (rhesus), shock pack)
catheterise
foetal assessment (CTG, US, fetal heart)

Question 20

definitive management of antepartum haemorrhage?

Answer 20

conservative - steroids, treat anaemia, thromboprophylaxis, anti D Ig
delivery - vaginal or C section

Question 21

when are CTGs done routinely?

Answer 21

only after 28 weeks

Question 22

what is placental abruption and how is it diagnosed?

Answer 22

detachment of placenta

clinical diagnosis

Question 23

risk factors for placental abruption?

Answer 23

smoking
pre-eclampsia
previous C section?

Question 24

management of placental abruption?

Answer 24

ABCDE
resuscitate mother
get help
deliver baby asap - usually C section or vaginal if already in labour and seems safe

Question 25

placenta praevia vs low lying placenta?

Answer 25

praevia = placenta covers os (or within 2cm?) | low lying = placenta in the lower segment of uterus but not covering os

Question 26

what is placenta acreata?

Answer 26

adherant placenta | aka increata or percreta depending on severity

Question 27

placenta accreta diagnosis?

Answer 27

MRI

Question 28

accreta management?

Answer 28

delivery of baby | usually by 34 weeks

Question 29

important points to remember with antepartum haemorrhage?

Answer 29

dont do digital vaginal/rectal exam (as dont know position of placenta) accreta = MRI diagnosis praevia = clinical diagnosis

Question 30

when can vaginal delivery be attempted with low lying placenta?

Answer 30

if >2cm away from os | otherwise do C section

Question 31

praevia vs accreta presentation?

Answer 31

``` praevia = painless bleeding accreta = painful, woody hard uterus ```

Question 32

what is uterine rupture?

Answer 32

complete pathological full thickness opening of the uterus | usually during labour but can be antepartum

Question 33

risk factors for uterine rupture?

Answer 33

previous C section multiparous induction of labour

Question 34

clinical features of uterine rupture?

Answer 34

pain collapse foetal distress

Question 35

management of uterine rupture?

Answer 35

resuscitate mother | surgical repair

Question 36

minor vs major vs massive APH?

Answer 36

``` minor = <50ml major = 50-1000ml (no shock) massive = 1000ml +/- shock ```