Abnormal Labour

Question 1

What is the normal position of the vertex at the pelvic inlet?

Answer 1

Occipitotransverse

Question 2

What is the normal position of the vertex at the pelvic outlet?

Answer 2

Occipitoanterior

Question 3

How often should you perform a PV exam to assess progress during labour?

Answer 3

Every 4 hours

Question 4

What is the name of the record that shows fetal HR, amniotic fluid, cervix dilation, descent, contractions, urinalysis and medications during labour?

Answer 4

Partogram

Question 5

What is an abnormal fetal HR during labour

Answer 5

Less than 100

More than 180

Question 6

How often should fetal HR be assessed during stage 1 of labour?

Answer 6

Every 15 minutes + after a contraction

NOT SURE IF THIS IS TRUE??

Question 7

How often should fetal HR be assessed during stage 2 of labour?

Answer 7

Every 5min + after a contraction

Question 8

What complication of IOL can prevent the progression of labour?

Answer 8

Hyperstimulation

Question 9

Give examples of malpositions

Answer 9

Occipito-posterior

R / L occipito-transverse

Question 10

What lie is normal? Which lies are malpresentation?

Answer 10

Normal longitudinal

Malpresentation transverse and oblique

Question 11

What signifies failure to progress in stage 1 of labour?

Answer 11

Less than 2 cm dilated in 4 hours

Question 12

What shape of pelvis is a risk factor for failure to progress?

Answer 12

Android

Question 13

What signifies failure to progress in stage 2 of labour in a prim mother? And what if they’ve had an epidural?

Answer 13

Longer than 2 hours

Longer than 3 hours if had epidural

Question 14

What signifies failure to progress in stage 2 of labour if this isn’t the mother’s birth?

Answer 14

Longer than 1 hour

Question 15

What is the active Mx of failure to progress in labour for a women with week contractions? And when is this contraindicated?

Answer 15

Syntocinon

CI malposition

Question 16

Molding, anuria, haematuria, and vulval edema are all signs of what in labour?

Answer 16

Obstruction eg. breech

Question 17

In shoulder _____ the _____ shoulder is stuck under the ______

Answer 17

In shoulder DYSTOCIA the ANTERIOR shoulder is stuck under the PUBIC SYMPHYSIS

Question 18

What is the Mx of cord prolapse?

Answer 18

Emergency C-section

Question 19

Give 6 examples of pain Mx in labour

Answer 19

TENS
Entonox
Paracetamol
Water bath
IM diamorphine
Regional anaesthetic

Question 20

What are the main risks of an epidural?

Answer 20

Prolongs stage 2 of labour
Hypotension
Retention

(Also HA, sore back, others)

Question 21

What are the 2 incision options in a ceaserean?

Answer 21

Lower segment and abdominal

Question 22

What are the 2 methods of operative vaginal delivery

Answer 22

Forceps and ventouse

Question 23

How would fetal distress present?

Answer 23

Fetal hypoxia
Meconium
Abnormal fetal HR

Question 24

What investigation should be done if there are signs of fetal distress e.g. meconium?

Answer 24

Fetal blood sampling

CTG

Question 25

What is given as prophylaxis of PPH during the 3rd stage of labour?

Answer 25

IM syntocinon or IV syntometrine

Question 26

What are the 2 ways of classifying PPH?

Answer 26

Minor (500-1000ml) v major (>100ml or shock)

Primary v secondary

Question 27

When is primary PPH?

Answer 27

Less than 24hr post delivery

Question 28

When is secondary PPH?

Answer 28

24hr-6wk post delivery

Question 29

What are the causes of PPH?

Answer 29

Tone, tissue, thrombin, trauma

Figure out what these mean

Question 30

What is the commonest cause of PPH?

Answer 30

Atonic uterus

Question 31

What medications are given to all PTx in PPH?

Answer 31

IV tranexamic acid
VTE prophylaxis
Uterotonic

Question 32

What is the 1st line uterotonic in PPH?

Answer 32

IV syntocinon

Question 33

What is the 2nd line uterotonic in PPH?

Answer 33

IV ergometrine

Question 34

What is the 3rd line uterotonic in PPH?

Answer 34

IM carboprost