Abnormal Labour

Question 1

Abnormal labours?

Answer 1

Too early- preterm
Too late - induction of labour
Too painful - requires anaesthesia
Too long - failure to progress
Fetal distress - hypoxia/ sepsis
Requires interventions- operative birth

Question 2

Analgesia available?

Answer 2

Support/ massage/ relaxation techniques 
Inhalation techniques - Entonox 
TENS- transcutaneous electrical nerve stimulator 
Water immersion 
IM opiate - morphine 
IV remifentanil PCA
Epidural

Question 3

What indicated suspected delay in a nulliparous?

Answer 3

<2cm dilation in 4 hours

Question 4

What indicates a suspected delay in a parous?

Answer 4

<2cm in 4 hours or slowing in progress

Question 5

Problem with powers that could cause failure to progress?

Answer 5

Inadequate contractions - frequency and or strength

Question 6

Problems with passage that could cause failure to progress?

Answer 6

Short stature
Trauma
Shape

Question 7

Problems with passenger that could cause failure to progress?

Answer 7

Big baby

Malposition

Question 8

What is assessed in a partogram ?

Answer 8

Fetal heart
Amniotic fluid
Cervical dilatation 
Descent 
Contractions 
Obstruction 
Maternal observations

Question 9

Methods of intra-Partum fetal assessment ?

Answer 9

Doppler auscultation of fetal Heart
CTG
Colour of amniotic fluid

Question 10

Aetiology of fetal distress?

Answer 10

Abruption 
Vasa praevia
Cord prolapse 
Uterine rupture
Feto-maternal haemorrhage 
Uterine hyper stimulation 
Regional anaesthesia 
Hypoxia

Question 11

What are the classifications of CTG?

Answer 11

Normal
Suspicious
Pathological

Question 12

Neumonic for CTG interpretation?

Answer 12

DR C BRAVADO

Question 13

What does DR C BRAVADO stand for?

Answer 13

Determine
Risk
Contractions 
Baseline
Rate
A
Variability
Accelerations
Decelerations
Overall impression

Question 14

Management of fetal distress?

Answer 14

Change maternal position 
IV fluids
Stop syntocinon
Scalp stimulation 
Tocolysis - terbutaline 
Maternal assessment 
Fetal blood sampling?

Question 15

What fetal blood sampling result is considered normal?

Answer 15

pH >7.25

Question 16

What fetal blood sampling result is considered abnormal and what action needs to be taken?

Answer 16

pH <7.20

Deliver baby

Question 17

Standard indications for operative vaginal delivery ?

Answer 17

Delay

Fetal distress

Question 18

Special indications for operative vaginal delivery?

Answer 18

Maternal cardiac disease
Severe PET/ eclampsia
Intra Partum haemorrhage
Umbilical cord prolapse - stage 2

Question 19

Main indications for Caesarean section?

Answer 19

Previous c section 
Fetal distress
Failure to progress
Breech
Maternal request

Question 20

Is there greater risk with c section?

Answer 20

Yes x4 greater risk of mortality