Chapter 17: Intervention In Obstetrics Flashcards
You are a trainee intern on the postnatal ward. You are seeing Roopi, a 32-year-old woman of Indian ethnicity. Roopi’s first baby was born 3 days ago and is in the neonatal unit. Roopi had an emergency caesarean section at 28 weeks’ gestation. The indication for caesarean section was placental abruption. Roopi asks you whether she can have a vaginal birth in her next pregnancy or whether she will need to have another caesarean section. You review the operation note from the caesarean section
Which of the following in the operation note would require a PLANNED REPEAT CAESAREAN section in the NEXT pregnancy?
Classical uterine incision
Bladder injury, repaired with vicryl
Baby transverse lie, delivered by breech extraction
Placenta 50% detached consistent with abruption
Pfannenstiel skin incision
Classical uterine incision
You are a trainee intern in antenatal clinic. Ayaan is a 32-year-old G2P1 Somali refugee who is now 38 weeks pregnant. In her last pregnancy, Ayaan required an emergency caesarean section at 36 weeks because of a placental abruption. No underlying cause for the abruption was found. Her daughter who is now 2 is doing well. This pregnancy, Ayaan wishes to have a vaginal birth. She has already had an antenatal consult with an obstetrician and has been told that she is a suitable candidate for a vaginal birth after caesarean (VBAC). Ayaan asks you about recommendations for her management in labour. From the following options, what would you advise for her intra-partum management?
Ayaan’s labour should be augmented with oxytocin
Ayaan should avoid an epidural in labour
Ayaan should be ‘nil by mouth’ during her labour
Ayaan should have blood cross-matched in labour
Ayaan should have continuous CTG monitoring during labour
Ayaan should have continuous CTG monitoring during labour
You are a trainee intern at an antenatal clinic. You are seeing Meghan, a 25-year-old Pākehā woman who is 41 weeks’ pregnant by certain dates. It has been recommended to Meghan that she have an induction of labour. The indication for induction of labour is ‘post-dates’. Meghan asks what could happen to her baby if she chooses to not have an induction of labour. From the following options, what complication is Meghan’s BABY at increased risk of if she does NOT have an induction?
Neonatal jaundice
Retinopathy
Hearing loss
Patent ductus arteriosus
Stillbirth
Stillbirth
You are a trainee intern at an antenatal clinic with Maria. Maria is a 25-year-old Pākehā woman who is 41 weeks’ pregnant in her first pregnancy. An induction of labour has been recommended at 41 +3 weeks. Maria’s pregnancy has otherwise been uncomplicated. She would prefer to avoid an induction of labour as she has heard they are unpleasant and she has read about the ‘cascade of intervention’. Of the following options, which of these complications is INCREASED with an induction of labour compared with conservative management?
Caesarean section
Transient tachypnoea of the newborn
Stillbirth
Uterine hyperstimulation
Maternal hypoglycaemia
Uterine hyperstimulation
You are a trainee intern at an antenatal clinic seeing Jayne. Jayne is a 34-year-old para 1 NZ European woman who is currently 36 weeks pregnant. In her previous pregnancy, Jayne had an induction of labour for pre-eclampsia. She required a caesarean section for delay in the first stage as her cervical dilatation never progressed beyond 6cm despite oxytocin augmentation. Her baby weighed 3.2kg. This pregnancy has been uncomplicated and there are no signs of pre-eclampsia. Her baby palpates as normally grown. Jayne is keen to try for a vaginal birth after caesarean (VBAC). Of the following options, which statement regarding planning Jayne’s birth is the MOST CORRECT?
If Jayne’s labour arrests in the presence of strong contractions, a caesarean section should be performed
If Jayne is in labour, opioid epidural analgesia should be avoided
CT pelvimetry is indicated before deciding on mode of birth to ensure an adequate pelvis
If Jayne develops pre-eclampsia, an elective caesarean section is recommended, even if the cervix is favourable
If Jayne requires induction of labour, prostaglandins should be used if the cervix is unfavourable
If Jayne’s labour arrests in the presence of strong contractions, a caesarean section should be performed
You are a trainee intern on the birthing suite seeing Shanaya. Shanaya is a 36-year-old Pākehā woman who is 41 +3 weeks pregnant in her first pregnancy. She is being admitted for an induction of labour. The indication for the induction is post-dates.
Shanaya has a BMI of 52. Shanaya’s Bishop score is 5, meaning that her cervix is not yet favourable, and she will have a prostaglandin for cervical ripening (Prostin or Cervidil or Misoprostol, depending on your local unit protocol).
You discuss fetal monitoring in active labour.
From the following options, what is the BEST method of fetal surveillance in active labour for SHANAYA?
Intermittent scalp lactate measurements
Intermittent transabdominal CTG
Continuous CTG via fetal scalp electrode (FSE)
Intermittent transabdominal auscultation
Continuous transabdominal CTG
Continuous CTG via fetal scalp electrode (FSE)
You are a trainee intern in antenatal clinic seeing Elaine. Elaine is a 28-year-old Irish woman who is 41 weeks pregnant in her first pregnancy. She has been booked for an induction of labour in 3 days’ time. Elaine would prefer to avoid an induction if possible and asks what she can do to increase her chance of going into spontaneous labour. From the following options, what has been shown to INCREASE the chance of spontaneous labour?
Sexual intercourse
Nipple stimulation
A ‘stretch and sweep’
Eating curry
Alcohol
A ‘stretch and sweep’
You are a trainee intern in birthing suite seeing Sarah. Sarah is a 36-year-old Samoan lawyer who is 38 weeks pregnant in her first pregnancy. Her membranes ruptured 3 hours ago and the liquor was clear. The baby is moving well. Sarah’s midwife advised her to attend birthing suite for assessment. On examination Sarah is afebrile. Abdominally the lie is longitudinal and a breech presentation is suspected. On speculum examination ruptured membranes are confirmed. The cervix is 1cm dilated and 1cm long. A portable ultrasound confirms that the presentation is breech. On closer assessment the ultrasound shows that the baby is in a footling breech presentation. The CTG is reassuring. Of the following options, what management will MOST LIKELY be recommended for Sarah?
Induction of labour with prostaglandins (Cervidil, Prostin or Misoprostol)
Await spontaneous labour but give antibiotics to prevent infection
Induction of labour with a Foley Balloon catheter
Induction of labour with oxytocin
Caesarean section delivery
Caesarean section delivery
You are a trainee intern on birthing suite. Ana is a 34-year-old Tongan lady who has had 3 previous vaginal births. She is 40 weeks’ gestation and is in early labour. Ana has consented for you to be present for her labour and birth. You perform an abdominal examination under the supervision of the LMC midwife and find that the head is not engaged. Two hours later, the membranes rupture spontaneously. Ana’s midwife performs a vaginal examination and can feel umbilical cord in the vagina. The cervix is 3cm dilated. The fetal heart rate is 120. Of the following options, what is the MOST APPROPRIATE management?
Wait for Ana to be fasted then perform a caesarean section
Caesarean section as soon as possible
Augment labour with oxytocin
Perform a breech extraction
Allow labour to continue
Caesarean section as soon as possible
You are a trainee intern in antenatal clinic with Titi, a 30-year-old para 1 Samoan woman. In her last pregnancy, Titi had an elective caesarean section for a breech presentation. She is currently 32 weeks pregnant and you are discussing mode of birth this pregnancy. Titi is aware that she can try for a vaginal birth after caesarean section or have a planned repeat caesarean section. Titi asks you about the risks to the baby and whether an elective caesarean increases the risk of fetal complications. From the following options, which complication is MORE LIKELY after a planned repeat caesarean section than a vaginal birth?
Jaundice
Hypoxic ischaemic encephalopathy
Transient tachypnoea of the newborn
Meconium aspiration
Patent ductus arteriosus
Transient tachypnoea of the newborn
You are a trainee intern in birthing suite with Sandy. Sandy is a 20-year-old Pākehā woman in her first pregnancy who has consented to you being present for her labour and birth.
Sandy has had an uncomplicated pregnancy and has laboured spontaneously at term. She has an epidural for analgesia.
Sandy is in the second stage of labour. She is pushing well with contractions. The CTG has deteriorated and there is now a fetal bradycardia that has been present for 6 minutes. The obstetric registrar attends.
On abdominal examination the presentation is cephalic and 0/5 of head is palpable abdominally. On vaginal examination the cervix is fully dilated. The fetal head is left occipito-anterior position at station +2 cm. There is minimal caput and moulding present.
From the following options, which is the BEST management for urgent delivery of Sandy’s baby?
A rotational ventouse is required because the fetal head is in an abnormal position
An episiotomy should be cut to effect delivery with maternal effort
Oxytocin augmentation to strengthen the contractions and speed up the birth
An instrumental delivery should be performed for suspected fetal compromise
An urgent caesarean section should be performed for fetal distress
An instrumental delivery should be performed for suspected fetal compromise
You are a trainee intern in birthing suite with Anahera. Anahera is a 39-year-old para 2 Māori woman who is 40 weeks’ gestation who has consented for you to be present for her labour and birth.
Anahera presented with prelabour rupture of membranes. A sterile speculum examination confirmed ruptured membranes with meconium staining. Anahera’s cervix was 3cm dilated and fully effaced, and a CTG showed a normal fetal heart pattern, so oxytocin augmentation was commenced.
Anahera’s contractions increase. The CTG deteriorates and now shows a baseline fetal tachycardia with complicated, deep decelerations. She is contracting strongly ‘6 in 10’ (6 contractions every 10 minutes). The obstetric registrar is called to review the abnormal CTG.
On vaginal examination, Anahera is 6cm dilated. The station is -1. The position is Left Occiput Anterior (LOA).
Of the following options, what is the MOST APPROPRIATE next management step?
Assisted vaginal delivery using forceps
Give Anahera oxygen and continue
Stop the oxytocin and consider tocolysis
A caesarean section under general anaesthetic
Assisted vaginal delivery using ventouse
Stop the oxytocin and consider tocolysis
You are a trainee intern in antenatal clinic seeing Shihong, a 20-year-old nursing student of Chinese ethnicity. Shihong is 32 weeks pregnant in her first pregnancy. Shihong is a healthy non-smoker and has a BMI of 21. Her pregnancy is progressing uneventfully. Shihong attended an antenatal class last night when assisted vaginal birth was discussed. Shihong is asking you about forceps and ventouse births and their complications. From the following options, which complication is MORE LIKELY with a ventouse birth than a forceps
Third degree tear in the mother
Subgaleal haematoma in the baby
Shoulder dystocia during delivery
Retained placenta in mother
Facial nerve palsy in baby
Subgaleal haematoma in the baby
You are a trainee intern in antenatal clinic seeing Meera, a 26-year-old nulliparous woman of Indian ethnicity. Meera is 34 weeks pregnant in her first pregnancy. Her sister has just had her first baby and had a shoulder dystocia. The baby has a brachial nerve palsy. Meera is worried about her risk of having a shoulder dystocia. Of the following options, which aspect of Meera’s history would INCREASE her risk of having a shoulder dystocia?
Having iron deficiency anaemia
Being 1.64m tall
Being a smoker
Having a BMI of 21
Having gestational diabetes
Having gestational diabetes
Big baby
You are a trainee intern in antenatal clinic seeing Aria, a 32-year-old Māori lady who is 28 weeks pregnant in her second pregnancy. In her first pregnancy, Aria had an elective caesarean section for a breech presentation. She is here to discuss mode of birth.
You discuss vaginal birth after caesarean (VBAC) and its benefits and risks with Aria. Aria is planning on having 3 children in total. She is considering a planned repeat caesarean section for this pregnancy.
Aria asks you if having a planned repeat caesarean section this pregnancy places her at increased risk of complications in another pregnancy.
Of the following options, which complication would Aria be more likely to have in future pregnancies if she has a caesarean this pregnancy than if she has a vaginal birth?
Hyperemesis gravidarum
Pre-eclampsia
Gestational diabetes
Baby with a neural tube defect
Placenta accreta
Placenta accreta
Placenta grows into the uterus scar
