Abnormal labour

Question 1

If there is umbilical cord prolapse, how is this managed?

Answer 1

Category I caesarean section

• urgent
• baby delivered within 30 mins of diagnosis

Question 2

Malpresentation

Answer 2

Non-cephalic (non-vertex) presentation of the foetus

Question 3

Malpresentation - name 4

Answer 3

Breech
Transverse
Shoulder/arm
Face

Question 4

Malpresentation - breech - name the 3 categories

Answer 4

Complete breech
Footling breech
Frank breech

Question 5

Malpresentation - complete breech

Answer 5

Legs are flexed and at level of baby’s bottom

Question 6

Malpresentation - footling breech

Answer 6

One (or both) feet point down so the legs emerge first

There is therefore nothing pressing on the cervix to make it dilate

Question 7

Malpresentation - frank breech

Answer 7

Legs are extended and point up with feet by baby’s head so bottom emerges first

Question 8

It is posible to deliver a transverse baby vaginally. True or false?

Answer 8

False

• caesarean section needed
• or try to turn baby with hand

Question 9

Malposition - definition

Answer 9

When the baby is not in the occipito-anterior (OA) position where the baby’s head should come out looking downwards

Question 10

Examples of malposition

Answer 10

Occipito-posterior (OP)

Occipito-transverse (OT)

Question 11

It is possible to deliver an OP baby vaginally. True or false?

Answer 11

True

Question 12

It is possible to deliver and OT baby vaginally. true or false?

Answer 12

False

Question 13

At which gestation is a baby considered to be preterm

Answer 13

Less than 37 weeks

Question 14

At which gestation is a baby considered to be post-term

Answer 14

Over 42 weeks

Question 15

If the mother is 42 weeks gestation and there is no sign of labour, what happens?

Answer 15

Induction of labour

Question 16

During stage 1 labour, when is it suggested there is an obstructed labour / failure to progress?

Answer 16

If there is less than 2cm dilation in 4 hours

Question 17

What is considered the normal number of contractions in a 10 minute period?

Answer 17

3-5 contractions

Question 18

What is hyper stimulation?

Answer 18

More than 5 contractions in 10 mins

Question 19

If the patient is having less than 3 contractions every 10 minutes, how do you manage this?

Answer 19

Give IV oxytocin

Question 20

Assessment during labour

Answer 20

Abdominal examination
Vaginal examination (every 4hr)

Question 21

What is the “station”

Answer 21

Where is the presenting part (head, hopefully) in relation to the ischial spine

Question 22

List some signs of obstructed labour

Answer 22

Moulding 
Caput 
Anuria 
Haematuria 
Vulval oedema

Question 23

Caput

Answer 23

Swelling of the head

Question 24

Moulding

Answer 24

Baby tries to narrow the diameter of its head to fit through for delivery
Overlapping of fontanelles

Question 25

If the labour is very slow and the patient is making very little progress however the patient and her baby are well and there are no complications, what should you do?

Answer 25

``` Consider syntocinon (oxytocin) - this will increase frequency and strength of contractions ``` Aim for normal vaginal delivery

Question 26

Oxytocin and syntocinon are the same thing. True or false ?

Answer 26

True

Question 27

What do you do if the baby is in foetal distress?

Answer 27

Doppler auscultation CTG Check colour of amniotic fluid

Question 28

Doppler auscultation in a distressed foetus during stage 1 labour

Answer 28

Listen during and after a contraction every 15 mins | Listen for late decelerations as this is a sign of hypoxia

Question 29

Doppler auscultation in a distressed foetus during stage 2 labour

Answer 29

Listen at least every 5 minutes during and after a contraction for 1 whole minute

Question 30

What is some abnormal colours of amniotic fluid?

Answer 30

Red | Green/brown = meconium

Question 31

Foetal distress - risk factors

Answer 31

``` SGA foetus Preterm/post dates APH Hypertension / pre-eclampsia Diabetes Meconium Induction of labour Epidural analgesia ```

Question 32

Foetal distress - management

Answer 32

``` Change maternal position IV fluids Stop syntocinon Scalp stimulation Foetal blood sampling (if cervix is more than 4cm dilated) ```

Question 33

Maternal collapse - aortocaval compression

Answer 33

From 20 weeks gestation, in the supine position, the uterus can compress the IVC and aorta, reducing venous return. This decreases CO causing supine hypotension.

Question 34

Maternal collapse - aortocaval compression - how do you manage this?

Answer 34

Instead of lying supine, lie in the left lateral position

Question 35

Maternal collapse - if there is no response to CPR within 4 minutes, what should be the next step?

Answer 35

Delivery should be undertaken (perimortem C section)

Question 36

Which anaesthesia is used for vaginal labour

Answer 36

Epidural

Question 37

Which anaesthesia is used for an emergency delivery if you are rushed for time: spinal or GA?

Answer 37

GA

Question 38

Which anaesthesia is most commonly used for caesarian section

Answer 38

Spinal

Question 39

Which 2 instruments can be used in operative vaginal delivery?

Answer 39

Forceps (first line) | Ventouse

Question 40

Indications for operative vaginal delivery?

Answer 40

Delay (failure to progress to stage 2) | Foetal distress

Question 41

What are the main indications for caesarian section?

Answer 41

``` Previous C-section Foetal distress Failure to progress in labour Breech presentation Maternal request ```