Chapter 7: Anatomy + Physiology Of Labour Flashcards
ou are a trainee intern on a postnatal ward round. You are seeing Jenny, a 25 year old G1P1 Pākehā woman who had a caesarean section the previous day. Jenny is 145cm tall. Jenny’s labour progressed to full dilatation with oxytocin augmentation. She had an epidural placed at 5cm dilatation. Once she was fully dilated, she had an hour of passive descent and then pushed for 2 hours. The contractions were deemed satisfactory. When she was assessed after having pushed for 2 hours there was 3/5 of head palpable abdominally. On vaginal examination, the cervix was 10cm dilated, the baby’s head was in the ROT (right occiput transverse) position with the posterior fontanelle felt more easily than the anterior fontanelle. The station of the baby’s head was -2 i.e. 2cm above the ischial spines. The baby weighed 3400 grams. Jenny asks why she was unable to birth her baby vaginally. From the options provided, which is MOST LIKELY to be correct?
Due to Jenny’s short stature, the inlet of her pelvis is likely to be smaller than normal
Jenny pushed for 2 hours and she should have pushed for 3 hours
Due to Jenny’s short stature, the inlet of her pelvis is likely to be the wrong shape
Due to Jenny’s short stature, the axis of her pelvic cavity is more likely to be straight rather than curved
The baby’s head was in the wrong position, and so could not descend into the pelvis and twist into the OA position as normally occurs during labour
Due to Jenny’s short stature, the inlet of her pelvis is likely to be smaller than normal
You are a trainee intern on the postnatal ward round. You are reviewing Sefina, a 25 year old G1P1 Tongan woman who had an emergency caesarean section yesterday. The indication for the caesarean section was prolonged second stage and unsuccessful instrumental delivery. Sefina is a well lady; weight 70kg, height 167cm (BMI = 25). Sefina had gone into spontaneous labour at 40 weeks’ gestation. She had an epidural for analgesia when she was 5cm dilated. Oxytocin augmentation was commenced to make the contractions effective. The first stage of labour lasted 8 hours. After reaching full dilatation, Sefina pushed for 2 hours and was then assessed by the obstetrician. When assessed, there was 1/5 of head palpable abdominally. On vaginal examination Sefina was fully dilated. The baby’s head was in the direct OP (occiput posterior) position and the anterior fontanelle was easily felt. The station of the presenting part was +1 (1cm below the ischial spines). The obstetrician attempted a ventouse delivery but could not achieve flexion, descent or rotation. The ventouse was abandoned and the baby was born by caesarean section. The baby weighed 3400g. Sefina asks you why she was unable to birth her baby vaginally. From the options provided, which is MOST LIKELY to be correct?
The baby’s head did not flex and then rotate as it should to allow descent in the cavity of the pelvis
The inlet of Sefina’s pelvis is likely to be smaller than normal
Although the baby’s head was flexed, it not descend into the pelvis and rotate into the OA position as would be expected with normal labour
Sefina’s pelvic outlet is likely narrowed anteriorly, thereby preventing normal rotation of the head to OA position
The inlet of Sefina’s pelvis is likely to be the wrong shape
The baby’s head did not flex and then rotate as it should to allow descent in the cavity of the pelvis
Kristine is a 25 year old para 1 Pākehā woman who had an emergency caesarean section performed yesterday at 36 weeks’ gestation. The baby is healthy and weighed 2400 grams. The indication for the caesarean was abnormal lie; Kristine was in labour (5cm dilated) and her baby was a transverse lie. The membranes were intact. Kristine is otherwise well and her antenatal progress had been normal. Her baby had been noted to be lying transverse since 28 weeks. Height and weight are normal. She asks you what the most likely reason for the abnormal lie was. From the options provided, which is MOST LIKELY to be correct?
The baby’s head or breech may have been too large to fit in the pelvic inlet
Kristine’s pelvic inlet may be too small to allow the head or breech to fit
The lower segment of the uterus may not have formed
Kristine’s uterus may have an abnormal shape
There may have been more amniotic fluid around the baby relative to its size
Kristine’s uterus may have an abnormal shape
You are a trainee intern in a postnatal ward seeing Fleur who had an elective caesarean section yesterday. Fleur is a 40 year old para 4 Pākehā woman whose first 3 children were all born by caesarean section. The first caesarean section was performed for delay in the first stage and the next 2 caesareans were performed electively. This pregnancy her baby was found to be in a transverse lie at 34 weeks and remained this way until birth. Her pregnancy was otherwise uncomplicated. Her baby weighed 3.2kg. At the caesarean, a 5cm fibroid was noted in the uterine lower segment. This fibroid had been present at her morphology scan. Fleur asks you why her baby was in a transverse lie. From the options provided, which answer is MOST LIKELY to be correct?
The baby’s head or breech may have been too large to fit in the pelvic inlet
Forming of the lower segment of your uterus may not have been possible because of scarring from the three previous caesarean sections
There may have been more fluid around the baby relative to its size
The shape of the uterus may be congenitally abnormal
The fibroid may have prevented the presenting part from engaging
The fibroid may have prevented the presenting part from engaging
You are a trainee intern in birthing suite with Diane, a 30 year old gravida 3, para 2 Pākehā woman who is in labour at term. Diane is contracting every 3 minutes. Her previous children were both born at term, and were normal vaginal deliveries. She had a normal antenatal period.
Diane presented to birthing suite in labour an hour ago. Her observations and the fetal heart rate were normal. On abdominal examination the head was engaged but 2/5 was still palpable abdominally. On vaginal examination, the cervix was fully effaced and she was 6cm dilated with the head in the ROT (right occiput transverse) position at station -1 (i.e. 1cm above the ischial spines). The membranes were left intact. No analgesia has been required or requested. The Lead Maternity Carer (LMC) midwife asks you what you would expect to find in 4 hours’ time? If Diane has normal labour progress what is the most likely finding vaginally when she is reassessed in 4 hours’ time?
Cervix 7cm dilated, station +1, ROA, membranes intact
Cervix fully effaced 5cm dilated, station -1, ROT, membranes intact
Cervix 9cm dilated Station 0, ROP, membranes have ruptured with clear liquor
Cervix fully effaced 7cm dilated, station -1, ROT, membranes intact
Cervix fully dilated, station +3 OA, membranes have ruptured with clear liquor
Cervix fully dilated, station +3 OA, membranes have ruptured with clear liquor
You are a trainee intern on the postnatal ward round. You are reviewing Nanaia, a 25 year old para 1 wahine Māori who had an emergency caesarean section yesterday at 36 weeks’ gestation. The indication for the caesarean section was abnormal lie. The baby was lying transverse with its back down. Nanaia was 5cm dilated in established labour. The membranes were intact. Nanaia’s baby is healthy and weighed 2500 grams. Her antenatal progress had been normal and she is of normal height and weight. Nanaia asks why she needed a caesarean section. Which of the following options is the primary indication Nanaia required delivery by caesarean section?
The baby was too large
Prolapse of the cord was likely
The uterine contractions were likely to become incoordinate
There was insufficient amniotic fluid
Vaginal birth was not likely
The uterus was likely to rupture
Vaginal birth was not likely
You are a trainee intern in birthing suite with Gillian, a 28 year old para 2 New Zealand European woman who is about to birth at term. Her previous two children were birthed normally after uncomplicated pregnancies. The LMC midwife and the Gillian agree for you to conduct the birth. The head is crowning, and the anus and perineum are very distended, with the chin palpable at the coccyx. From the options provided, which is the MOST IMPORTANT to prevent a third degree tear of the perineum?
Cut a mediolateral episiotomy
Control the extension of the head
After delivery of the head, assist restitution of the baby’s head to the lateral position
Assist the head to rotate anteriorly
Keep the head well flexed until there is further descent
Control the extension of the head
You are a trainee intern in birthing suite with Rachel, a 28 year old para 0 Indian woman who is in labour at term and has recently been admitted to birthing suite. Rachel’s antenatal progress was uncomplicated. Rachel is contracting strongly every 3 minutes. Her observations and the fetal heart rate were normal. On abdominal examination the head was engaged but about 2/5 was still palpable. On vaginal examination, the cervix was fully effaced and Rachel was 4cms dilated with the head in the ROT (right occiput transverse) position at station -1. The membranes were left intact. No analgesia has been required or requested. The LMC midwife asks you what you would expect to find in 4 hours’ time if labour progresses normally? From the options provided, what is the MOST LIKELY examination finding when Rachel is reassessed in 4 hours’ time if progress has been normal?
Cervix fully effaced 5cm dilated, station -1, ROP (Right Occiput Posterior), membranes intact
Cervix fully dilated, station +3, OP (Occiput Posterior), membranes intact
Cervix 9cm dilated Station 0, ROP (Right Occiput Posterior), membranes ruptured
Cervix fully effaced 6cm dilated, station -1, ROT (Right Occiput Transverse), membranes intact
Cervix 8cm dilated, station +1, ROA (Right Occiput Anterior), membranes ruptured
Cervix 8cm dilated, station +1, ROA (Right Occiput Anterior), membranes ruptured
You are a trainee intern in birthing suite with Susan, a 28 year old Pākehā primiparous woman who is in labour at term. She is contracting every 3 minutes. Susan’s antenatal progress was normal. Her general observations and the fetal heart rate are normal. On abdominal examination the head was engaged with 2/5 still palpable abdominally. On vaginal examination, the cervix was fully effaced and she was 3cms dilated with the head in the ROT (right occiput transverse) position at station -1. The membranes were left intact. Susan is distressed with the contractions. The LMC midwife plans to reassess the progress vaginally in four hours. From the options provided, which is the MOST APPROPRIATE management prior to the next planned vaginal reassessment?
Inserting an IV line and taking bloods for FBC and Group and Screen.
Analgesia administration
Continuous CTG monitoring
Bladder catheterisation
Give IV fluids (normal saline 2 litres over 4 hours).
General observations of maternal pulse, BP, and respiratory rate every 2 hrs
Analgesia administration
You are a trainee intern in birthing suite with Hine, a 30 year old G3P2 wahine Māori. Hine is in spontaneous labour at term and is contracting every 3 minutes. Her previous children were both born normally at term. Hine did not require any intra-partum analgesia in her previous labours. Her antenatal progress in this pregnancy was normal. Hine has just been admitted and examined - her general recordings and the fetal heart rate were normal. On abdominal examination the head was engaged but about 2/5 was still palpable abdominally. On vaginal examination, the cervix was fully effaced and she was 6cms dilated with the head in the ROT (right occiput transverse) position at station -1. The membranes were left intact. No analgesia has been required or requested. The LMC plans to reassess the situation in four hours if Hine has not birthed her baby yet. From the options provided, what is the MOST LIKELY management from now?
Fetal Heart Rate auscultation at least every 15 minutes
Analgesic administration
Introduction of an IV line
General observations of maternal pulse, BP, and respiratory rate every 2 hrs
Bladder catheterisation
Epidural insertion
Continuous CTG monitoring
Fetal Heart Rate auscultation at least every 15 minutes
You are a trainee intern in birthing suite with Min, a 28 year old nulliparous woman of Chinese ethnicity. Min is in labour at 38 weeks’ gestation and is contracting every 3 minutes. She has just been admitted and examined. Her antenatal progress was uncomplicated. Min’s blood pressure, pulse and temperature were normal. On abdominal examination the head was engaged with 2/5 still palpable abdominally. On vaginal examination, the cervix was fully effaced and she was 3cms dilated with the head in the ROT (right occiput transverse) position at station -1. The membranes had ruptured spontaneously and the liquor was clear. No analgesia has been required or requested. You are listening with Doppler to the fetal heart for the LMC every 15 minutes. Min asks whether she will need continuous CTG monitoring later in her labour. Of the following options, which would be an indication for continuous CTG monitoring?
If birth is imminent when reassessed vaginally in four hours
If Min has an epidural for analgesia
If Min needed narcotic analgesia
If Min’s temperature rises to 37.4o
If Min’s urine starts to show ketones
If Min has an epidural for analgesia
