Abnormal Labour

Question 1

What is malpresentation in terms of abnormal labour?

Answer 1

Presentation of the fetus other than the vertex

Question 2

What is malposition in terms of abnormal labour?

Answer 2

When there is abnormal position of the vertex of the fetal head

Question 3

Why are all women induced at 42 weeks?

Answer 3

Risk of stillbirth post-term

Question 4

What are the three types of breech that may be seen at labour?

Answer 4

Complete breech
Footling breech
Frank breech

Question 5

Give some risks of a vaginal breech delivery

Answer 5

Fetal trauma

Head entrapment leading to fetal hypoxia

Question 6

What methods of analgesia can be used in abnormal labour?

Answer 6

Inhalational agents (entonox)
TENS
IM opiate analgesia
IV remifentanil
Epidural anaesthesia

Question 7

Give some complications of epidural anaesthesia

Answer 7

Hypotension
Dural puncture
Headache
High block (blocks the phrenic nerve)
Atonic bladder

Question 8

Give some potential causes of obstructed labour

Answer 8

Sepsis
Uterine rupture
Obstructed AKI
PPH
Fetal asphyxia

Question 9

What is the best way to assess progress in labour?

Answer 9

Vaginal examination

Question 10

When is a woman said to have failure to progress in labour?

Answer 10

<2cm dilation in 4 hours

Question 11

Give some reasons for failing to progress in labour according to the three P’s

Answer 11

Power - inadequate contractions
Passages - short stature/trauma
Passenger - big baby/malposition

Question 12

What is assessed on a partogram?

Answer 12

Fetal heart
Amniotic fluid
Cervical dilatation
Descent
Contractions
Obstruction

Question 13

When is CTG carried out during the first stage of labour?

Answer 13

During and after a contraction

Every 15 minutes

Question 14

When is CTG carried out during the second stage of labour?

Answer 14

Every 5 minutes

After a contraction for 1 whole minute

Question 15

Why is the fetal heart listened to after a contraction?

Answer 15

As it could show decelerations which are a sign of hypoxia

Question 16

Give some risk factors for fetal hypoxia

Answer 16

Small fetus
Antepartum haemorrhage
Hypertension/pre-eclapsia
Diabetes
Meconium

Question 17

What is measured on the CTG assessment?

Answer 17

Recording of contractions
Accelerations/decelerations
Variability
Baseline heart rate

Question 18

What is the normal range for fetal heart rate?

Answer 18

110-150bpm

Question 19

What should be assessed when reviewing the CTG?

Answer 19

Baseline fetal heart rate
Baseline variability
Presence/absence of decelerations
Presence of accelerations

Question 20

Give some methods of managing fetal distress

Answer 20

Change maternal position
IV fluids
Scalp stimulation
Tocolysis (too many contractions)
Fetal blood sampling

Question 21

What is measured on fetal blood sampling?

Answer 21

Scalp pH

Question 22

When is scalp pH considered abnormal?

Answer 22

<7.2

Question 23

Give some indications for performing an operative delivery

Answer 23

Failure to progress to stage 2
Fetal distress
Maternal cardiac disease
Severe PET

Question 24

What surgical tools can be used for performing an operative delivery?

Answer 24

Ventouse

Forceps

Question 25

Give some indications for performing a C-section

Answer 25

Previous C-section
Fetal distress
Failure to progress in labour
Breech
Maternal request

Question 26

What is aortocaval compression?

Answer 26

When the gravid uterus compresses the IVC and aorta decreasing cardiac output and precipitating collapse

Question 27

After how many minutes of no response to correctly performed CPR in a pregnant mother should a C-section be performed?

Answer 27

4 minutes