6. Principles of intrapartum care

Question 1

Labour definition

Answer 1

Onset of regular painful contractions leading to cervimetric change

Question 2

Define cervimetric changes

Answer 2

Dilatation, effacement, and softening

Question 3

Signs of labour

Answer 3

• Abdominal pains: regular,
• Passage of ‘show’ – mucus plug
• Passage of water PV but usually in full dilatation 10 cm

Question 4

Stages of labour

Answer 4

• First stage: onset of painful contractions until full dilatation of cervix
• Second stage: dilatation till the delivery of the foetus
• Third stage: delivery of baby until the delivery of placenta

Question 5

First stage of Labour steps

Answer 5

• Latent first stage is 0-4cm
• Active first stage is >4cm
• Normal progress is 0.5cm/h primiparous, 1cm/h multiparous when in ACTIVE labour (3-4cm)

Question 6

Indications for operative vaginal delivery

Answer 6

Foetal compromise, Maternal failure to progress in 2nd stage

Question 7

Operative vaginal delivery prerequisites:

Answer 7

Head presentation and position determined, mother full dilatation, membranes ruptured, bladder empty, analgesia

Question 8

Operative vaginal delivery complications

Answer 8

Foetal (haematoma, jaundice, facial nerve damage, bruising, skull fracture, shoulder dystocia)
Maternal (perianal trauma , VTE, PTSD, post-partum haemorrhage, incontinence, infection)

Question 9

Elective C section

Answer 9

• Breech
• Placenta praevia
• HSV
• HIV
• Multiples

Question 10

C section complications

Answer 10

Foetal (foetal lacerations, respiratory morbidity)

Maternal (increased risk of CS in the future, PPH, VTE, Damage to bowel, bladder, ureters)

Question 11

C section complications

Answer 11

Foetal (foetal lacerations, respiratory morbidity)

Maternal (increased risk of CS in the future, PPH, VTE, Damage to bowel, bladder, ureters)

Question 12

Foetal heart rate monitoring

Answer 12

Low risk: IA intermittent auscultation

High risk: CTG cardiotocograph

Question 13

Risk factors for foetal distress

Answer 13

IUGR, oligohydroaminos, Pre-eclampsia, GDM, Multiple pregnancy, Prolonged rupture of membranes, infection

Question 14

Indications for labour induction

Answer 14

Foetal (growth restriction, foetal macrosomia)

Maternal (pre-eclampsia, ruptured membranes, maternal disease)

Question 15

Methods for IOL

Answer 15

• Cervical sweep
• Dilapan
• Prostaglandin pessaries
• ARM

Question 16

Cervical sweep

Answer 16

Stretch and sweep

Question 17

Dilapan

Answer 17

Rods inserted into cervix which absorb water and expans

Question 18

Prostaglandin pessaries

Answer 18

Stimulate uterine contractions

Question 19

ARM

Answer 19

Artifical rupture of membranes (breaking the waters)

Question 20

Bishop score

Answer 20

Assessment whether IOL is required

Question 21

Causes for collapse in labour

Answer 21

Amniotic fluid embolism, PE, epilepsy, Intrauterine inversion (hypotension), Eclamptic fit (eclampsia)