Abnormal Labour

Question 1

What stage of labour may an Epidural inhibit?

Answer 1

Stage 2

Question 2

What are complications of an epidural?

Answer 2

Hypotension
Dural puncture
Headache
Back pain
Atonic bladder

Question 3

What 3 things are assessed during labour?

Answer 3

Cervical dilatation
Descent of presenting part
Signs of obstruction

Question 4

What is Nulliparous?

Answer 4

<2cm dilation in 4 hours

Question 5

What is Parous?

Answer 5

<2cm dilation in 4 hours or slowing of progress

Question 6

What are the 3 P’s of failures to progress?

Answer 6

Powers - Inadequate contractions, frequency and/or strength
Passages - Short stature/Trauma/Shape
Passenger - Big baby, Malposition - relative cephalo-pelvic disproportion

Question 7

How big is the Pelvic inlet?

Answer 7

Transverse = 13.5cm
AP = 11cm

Question 8

How big is the Mid-cavity?

Answer 8

Transverse = 12cm
AP = 12cm

Question 9

How big is the Pelvic inlet?

Answer 9

Transverse = 11cm
AP = 13.5

Question 10

What is noted down on a Partogram?

Answer 10

Fetal heart
Amniotic fluid
Cervical dilatation
Descent
Contractions
Obstruction - moulding 
Maternal observations

Question 11

When would you do a doppler auscultation of the fetal heart in stage 1?

Answer 11

Every 15 minutes

Question 12

When would you do a doppler auscultation of the fetal heart in stage 2?

Answer 12

Every 5-10 mins

Question 13

What else should be checked to assess the fetus?

Answer 13

Cardiotocograph (CTG) (+/- STAN)

Colour of amniotic fluid

Question 14

What should be measured in a CTG assessment?

Answer 14

Baseline fetal heart rate
Baseline variability
Presence or absence of deceleration
Presence of accelerations

Question 15

How should a CTG be classified?

Answer 15

Normal
Non-reassuring
Abnormal

Question 16

What management can be down to a fetus in distress?

Answer 16

Change in maternal position
IV fluids
Stop syntocinon
Scalp stimulation
Consider tocolysis - Terbutaline 250 micrograms
Maternal assessment - pulse/BP/Abdomen/VE
Fetal blood sampling
Operative delivery

Question 17

What are the ranges for scalp pH?

Answer 17

Normal = >7.25
Borderline = 7.20-7.25
Abnormal = <7.20

Question 18

What do you do when the scalp pH is borderline and abnormal?

Answer 18

Borderline = repeat test in 30 mins
Abnormal = deliver the baby

Question 19

What are standard indications for operative vaginal delivery?

Answer 19

Delay (failure to progress to stage 2)

Fetal distress

Question 20

What are the special indications for operative vaginal delivery?

Answer 20

Maternal cardiac disease
Severe PET/Eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse Stage 2

Question 21

What is Ventouse associated with?

Answer 21

Increased failure
Increased cephalohaematoma
Increased retinal haemorrhage
Increased maternal worry
Decreased anaesthesia
Decreased vaginal trauma
Decreased perineal pain

Question 22

What are the main indications for carrying out a caesarean section?

Answer 22

Previous caeserean
Fetal distress
Failure to progress to labour
Breech presentation
Maternal request

Question 23

What are complications with a caesarean?

Answer 23

4X maternal mortality
Sepsis
Haemorrhage
VTE
Trauma
TTN
Subfertility
Regret
Complications in future pregnancy