Abnormal labour

Question 1

After what time would you suspect delay in stage 1 in a nulliparous women?

Answer 1

Less than 2cm dilation in 4 hours

Question 2

After what time would you suspect delay in stage 1 in a parous women?

Answer 2

Less than 2cm in 4 hours

Question 3

What are the three Ps that can cause a failure to progress in labour?

Answer 3

Powers
Passages
Passenger

Question 4

When should you start recording a partogram?

Answer 4

As soon as the women enters the labour ward

Question 5

In stage 1 of labour how often should you do a doppler auscultation of the fetal heart?

Answer 5

Every 15 minutes

During and after a contraction

Question 6

In stage 2 of labour how often should you do a doppler auscultation of the fetal heart?

Answer 6

Every 5 - 10 minutes

Question 7

Where does the shoulder get stuck in shoulder dystocia?

Answer 7

Behind the pubic symphisis

Question 8

What is the first position you should put the women in if there is shoulder dystocia?

Answer 8

McRoberts. Hyperflexion and abduction of the hips (Knees to forhead)

Question 9

What is a cord prolapse?

Answer 9

When the umbilical cord descends ahead of the fetal presenting part

Question 10

What is the management of a cord prolapse?

Answer 10

Oxygen to women
Place mother in knee chest position and apply pressure against the fetal head to lift it away from the prolapsed cord.
(Avoid handling the cord outside the vagina as this induces vasospasm)
Proceed to emergency caeserean section.
If possible give terbutaline
SC to reduce contractions.

Question 11

What does terbutaline do?

Answer 11

Stops contractions

Question 12

At what scalp pH would you need immediate delivery of the baby?

Answer 12

Below 7.20

Question 13

What is a normal scalp pH for a fetus?

Answer 13

7.25

Question 14

What is a borderline scalp pH for a fetus?

Answer 14

7.20 - 7.25

Question 15

Which instrument used in assisted delivery is more associated with cephalohaematoma and retinal haemorhage?

Answer 15

Ventouse

Question 16

What is meant by primary dysfunctional labour?

Answer 16

Poor progress in the active 1st phase of labour. Most commonly due to inefficient uterine contractions.

Question 17

What is meant by secondary arrest in labour?

Answer 17

Progress in the active phase of labour is initially good but then slows (typically after 7cm of dilatation)

Question 18

What are likely causes of secondary arrest of labour?

Answer 18

Fetal malpresentation, malposition, Cephalopelvic disproportion

Question 19

What are likely causes of delayed labour if initial progress has been good and there are efficient contractions but the fetal head is not becoming engaged?

Answer 19

Cephalopelvic disproportion

Question 20

When is it acceptable to give oxytocin in suspected CPD?

Answer 20

If it is a primagravida with mild to moderate CPD and the CTG is reactive.

Question 21

What is a common way of getting secondary uterine inertia?

Answer 21

Epidural analgesia

Question 22

How would you treat secondary uterine inertia?

Answer 22

Oxytocin infusion

Question 23

What type of pelvis has a narrow middle and prevents internal rotation of the fetal head?

Answer 23

Android

Question 24

What should you do if the baby gets stuck in a transverse position at the ischial spines?

Answer 24

Rotational (Kiellends) forceps

Question 25

When is induction of labour for post dates usually recommended?

Answer 25

10 - 12 days after due date

Question 26

What infection is a women at risk of if there is prolonged prelabour rupture of the membranes?

Answer 26

Chorioamniotis

Question 27

What is the bishops score?

Answer 27

A scoring system used to assess whether or not it is safe to induce labour

Question 28

What are all the parts of the bishop score?

Answer 28

Cervical dilation
Cervical effacement
Cervical consistency
Cervical Position
Fetal station

Question 29

What does a bishops score of less than 5 suggest?

Answer 29

Labour is unlikely to start without induction

Question 30

What does a bishop score of more than 9 suggest?

Answer 30

Labour will probably start spontaneosly