Abnormal labour

Question 1

Causes of failure to progress

Answer 1

Power - passenger - passage

Inadequate uterine activity, malposition or malrotation, inadequate pelvis

Question 2

Management of failure to progress in 1st stage

Answer 2

Amniotomy (ARM) + reassess in 2 hours

Oxytocin infusion

Lower segment CS

Question 3

Indications for induction

Answer 3

Uteroplacental insufficiency

Prolonged pregnancy

IUGR

Oligo/ anhydraminos

Non reassuring

CTG

Severe pre-eclampsia

PROM

APH

Choriamnionitis

Uncontrolled DM, HTN, renal disease or malignancy

Question 4

Bishops score - what does it measure, what does a score <6 mean?

Answer 4

Measures position of cervix, length of cervix, consistency and dilatation, and station of presenting part

Score of <6 indicates labour is unlikely to be spontaneous

Question 5

Induction of labour methods (order)

Answer 5

Stretch + sweep

Prostaglandin pessary

ARM

Oxytocin infusion

Question 6

Risks of induction of labour

Answer 6

Prematurity

Cord prolapse

CS due to failure

Atonic postpartum haemorrhage

Side effects: pain, uterine hyperstimulation, fetal distress, uterine rupture N+V, diarrhoea

Question 7

Malposition - what is it, causes

Answer 7

Should be OA - any other position is malposition

Causes: multiparity, tumours, uterine abnormalities, prematurity, multiple pregnancy, macrosomia, placenta praevia, polyhydraminos

Question 8

Cord presentation - what is it, causes, risks + management

Answer 8

Cord lying below presenting part

Associated with malpresentation + a high head

Can cause cord compression

ARM is contraindicated. CS needed.

Position on knees + elbows until CS

Question 9

Malpresentation - what is it, risk factors for it

Answer 9

All presentations other than vertex

RF: prematurity, multiple pregnancy, abnormalities of uterus, placenta praevia, polyhydraminos

Question 10

Unstable lie

Answer 10

Lie is constantly changing after 37 weeks

Question 11

Risks of abnormal lie

Answer 11

Obstructed labour, uterine rupture, cord prolapse

Question 12

Types of breech

Answer 12

Extended (70%) = both legs extended with feet by head, presenting part is bum (frank)

Flexed (15%) = legs flexed, presenting part is feet and buttocks

Footling (15%) = one leg extended, one leg flexed

Question 13

Risks of breech presentation

Answer 13

Risk of hypoxia, trauma in labour

Question 14

Risks of ECV

Answer 14

Pain, immediate delivery by CS, precipitation of labour, placental abruption, cord accidents

Question 15

Criteria for operative delivery

Answer 15

Fully dilated cervix

Obstruction excluded

Ruptured membranes

Consent, catheterise

Epidural

Presentation + position

Station of presenting part

If delivery not after 3 pulls, need to do CS

Question 16

Indications for operative delivery

Answer 16

Prophylaxis to prevent pushing in women

Breech

Prolonged 2nd stage

Fetal distress

Question 17

Ventouse vs forceps

Answer 17

Ventouse more likely to fail, can cause fetal trauma (cephalohaematoma)

Forceps causing maternal trauma.

Can cause facial bruising and swelling

Question 18

Indications for cat 1 CS

Answer 18

Placental abruption

Cord prolapse

Scar rupture

Prolonged bradycardia

Scalp ph <7.2

Question 19

Indications for cat 2 CS

Answer 19

Failure to progress with pathological CTG

Question 20

Indications for cat 3 CS

Answer 20

Severe pre-eclampsia

IUGR

Failured IoL

Question 21

Indications for cat 4 CS

Answer 21

Singleton breech

Twin pregnancy

Maternal HIV

Herpes

Placenta praevia

Previous CS

Question 22

Complications of CS

Answer 22

Uterine lacerations

Blood loss

Hysterectomy

Bladder/ bowel injury

Endometriosis

Wound infection

VTE

UTI

Question 23

Risks to future pregnancies from CS

Answer 23

Uterine rupture

Placenta praevia

Placenta accreta

Stillbirth

Question 24

Preterm labour risk factors

Answer 24

Previous preterm

Multiple pregnancy

Cervical surgery

Uterine abnormalities I

nfection (STI, PPROM, UTI)

Polyhydraminos

Fetal abnormalities

APH

Pre-eclampsia, IUGR, medical conditions

Question 25

Neonatal complications from preterm labour

Answer 25

CP, chronic lung disease, retinopathy, necrotising entercolitis

Question 26

Management of preterm labour

Answer 26

12mg betametasone IM x2 doses

Tocolysis (nifedipine, atosiban, terbutaline)

IV abx

Question 27

Causes of antepartum haemorrhage

Answer 27

Placenta praevia

Placental abruption

Cervical erosion/ polyp

Trauma

Question 28

Causes of postpartum haemorrhage

Answer 28

Primary - more than 500ml within 24hrs of delivery.

Secondary = more than 24hrs after delivery

Tone - atonic uterus

Trauma

Tissue - retained products

Thrombin - abnormal clotting

Question 29

Management of atonic uterus

Answer 29

Give ergometrine/ syntocinon/ prostaglandins

Question 30

PE S+S

Answer 30

Pleuritic chest pain

SOB Collapse

Hypotension Tachycardia

Question 31

Management of PE

Answer 31

CXR then V/Q scan if normal, CTPA if abnormal

anticoagulate

Question 32

Episiotomy indications

Answer 32

Complicated vaginal delivery: breech, shoulder dystocia, forceps, ventouse FGM, poorly healed tears, fetal distress

Question 33

Perineal tear classification

Answer 33

1st: injury to skin only
2nd: perineum including perineal muscles
3rd: involving anal sphincter complex
a) <50% external anal sphincter
b) >50% external anal sphincter
c) internal anal sphincter torn
4th: injury to anal sphincter + anal epithelium

Question 34

How long should the 2nd stage take (max)?

Answer 34

4 hours

Question 35

What parameter on growth scan changes with maternal diabetes?

Answer 35

AC due to glycogen storage

Question 36

What dilation can you do a FBS?

Answer 36

3cm

Question 37

Dose of ergometrine to give in PPH

Answer 37

500 micrograms