Childbirth

Question 1

another name for childbirth

Answer 1

partuition

Question 2

which hormone increased contractility (2)

Answer 2

oestrogen

oxytocin

Question 3

which hormone decreases contractility

Answer 3

progesterone

Question 4

what change in the cervix causes oxytocin release

Answer 4

cervix stretch

= oxytocin release = increase contractions

Question 5

what does oxytocin make the uterine wall release

Answer 5

prostaglandins

Question 6

what happens to the interval of contractions over time

what does it end up as in true labour

Answer 6

gets shorter and shorter

ends up 3-4 in 10mins

Question 7

what happens to length of contraction over time

what does it end up as in true labour

Answer 7

increases over time

45seconds

Question 8

what are Braxton hicks contractions

when do they occur

Answer 8

‘false labour’
occur towards the end of pregnancy
not as strong as real contractions

Question 9

what resolves Braxton hicks contractions

Answer 9

lying down

Question 10

which stage of labour to the waters break in

Answer 10

any stage!

Question 11

what is normal blood loss during labour

Answer 11

<500ml

Question 12

what happens during stage 1 of labour

Answer 12

cervical dilatation

Question 13

what is the end point of stage 1 of labour (how can you tell)

Answer 13

10cm dilated

Question 14

up to what dilatation is the latent phase of stage 1 of labour

Answer 14

<4cm dilatation

Question 15

up to what dilatation is the active phase of stage 1 of labour

Answer 15

4-10cm dilatation (full dilatation)

Question 16

which part of stage 1 of labour (latent or active) is the descend of the presenting part

Answer 16

active stage 1 (full dilatation also occurs here)

Question 17

what is stage 2 of labour

Answer 17

passage through the birth canal

Question 18

how long does stage 1 of labour normally last

Answer 18

8-24 hours

Question 19

how long does stage 2 of labour normally last

Answer 19

0-120 mins

Question 20

what is classed as prolonged stage 2 of labour in a nulliparous woman (this is her first child)

Answer 20

> 3 hours with analgesia

or >2 hours without analgesia

Question 21

what is classed as prolonged stage 2 of labour in a multiparous woman (this is not her first child)

Answer 21

> 2 hours with analgesia

or >1 hours without analgesia

Question 22

what is stage 3 of labour

Answer 22

expulsion of placenta

Question 23

what happens to the uterus in stage 3 of labour just before the placenta is expulsed

Answer 23

it hardens and contracts

Question 24

what is usually given to mums to induce stage 3 of labour

Answer 24

oxytocin

Question 25

what method can be used to help ease the placenta out during stage 3 of labour

Answer 25

cord traction

Question 26

how long after birth of baby does stage 3 usually happen

Answer 26

3-10 mins | >1 hour abnormal

Question 27

if after 1 hour placenta hasn't came out, what do you do

Answer 27

surgery to remove it

Question 28

what does bishops score assess

Answer 28

likelihood of woman going into labour

Question 29

what does partogram assess

Answer 29

progress of labour

Question 30

normal fetal heart rate

Answer 30

120-160

Question 31

if meconium in liquor (amniotic fluid) what should you check

Answer 31

if breech

Question 32

at station 0 what orientation should the babies head be in

Answer 32

occiput-anterior

Question 33

what is the normal rate of descent of presenting part

Answer 33

1cm/hour

Question 34

what dilatation of the cervix is full dilatation

Answer 34

10cm dilatation

Question 35

how many contractions per 10 mins is normal

Answer 35

3-4

Question 36

what is a cardiotograph used for

Answer 36

to assess fetal distress

Question 37

how do you interpret a cardiotograph (mneumonic)

Answer 37

DR C BRAVADO ``` Define Risk Contractions Baseline RAte Variability Acceleration Deceleration Overall ```

Question 38

in CTG how do you 'Define Risk'

Answer 38

any risk factors for fetal distress eg prolonged labour

Question 39

in CTG what is normal Contraction rate

Answer 39

3 in 10 mins

Question 40

in CTG what is normal Baseline RAte what is abnormal

Answer 40

average fetal heart rate 120-160 >160 tachycardic <120 bradycardic

Question 41

in CTG how do you measure Variability what is normal

Answer 41

diff between highest and lowest values (hr) normal variation = 5-25bpm

Question 42

in CTG how do you measure Accelerations

Answer 42

are there any abnormally high peaks??

Question 43

in CTG how do you measure Decelerations

Answer 43

are there any abnormally low peaks??

Question 44

what is the line at the top of the graph in CTG what is the line at the bottom of the graph in CTG

Answer 44

fetal heart rate contractions (peaks are contractions)

Question 45

what are the 3 possible causes of problems in labour

Answer 45

3Ps passage -pelvis too small/wrong shape (eg android) passenger - babys head too big power - reduced/inadequate uterine contraction

Question 46

sign on the babys head that the head is too big or the passage (pelvis) is too small (2)

Answer 46

caput - swelling in scalp through fontanelles | moulding - when the skull bones overlap (via fontanelles)

Question 47

5 components of vaginal exam during labour

Answer 47

``` effacement dilatation firmness fetal head position station ```

Question 48

which examination tells you the lie of the baby what is the lie of the baby what are the 3 options

Answer 48

abdo exam where the baby is lying in respect to longitudinal axis options; longitudinal (normal), transverse (diagonal), oblique

Question 49

if the presenting part of the baby is the vertex, what is the presentation of the baby

Answer 49

cephalic (normal)

Question 50

if the presenting part of the baby is the bottom/arm/shoulder, and the head is felt in the upper abdomen, what is the presentation of the baby

Answer 50

breech

Question 51

what is the normal fetal head position when above the ischial spines (ie -ve station, going through pelvic inlet)

Answer 51

right/left occipito transverse

Question 52

what is the normal fetal head position when below the ischial spines (ie +ve station, going through the pelvic outlet)

Answer 52

occipitoanterior

Question 53

how do you figure out station of baby

Answer 53

how many cm biparietal diameter is above/below the ischial spines

Question 54

7 cardinal movements

Answer 54

``` engagement descent flexion -chin to chest internal rotation crowning and extension - when exiting vagina restitution and external rotation expulsion of rest of body ```

Question 55

how do you measure engagement

Answer 55

how many /5 are in pelvis

Question 56

most common form of analgesia | who can give it

Answer 56

Entonox - gas and air | can be given by midwives

Question 57

if Entonox (gas and air) not effective, what is the next best option of pain relief in labor

Answer 57

epidural anaesthesia

Question 58

what does an epidural anesthesia numb

Answer 58

everything below T12 - cant feel what theyre doing when pushing

Question 59

side effects of epidural anesthesia

Answer 59

hypotension

Question 60

alternative to epidural anaesthesia

Answer 60

diamorphine - uncommon

Question 61

which layers do you go through when administering an epidural anaesthesia which layer do you end up in

Answer 61

supraspinous ligament interspinous ligament ligamentum flavum epidural space - end up in epidural space

Question 62

which layers do you go through when administering spinal anaesthesia which layer do you end up in

Answer 62

``` supraspinous ligament interspinous ligament ligamentum flavum epidural space dura mater arachnoid mater subarachnoid mater ``` - end up in subarachnoid space

Question 63

which nerve level do you administer epidural/spinal anaesthesia

Answer 63

L3/4

Question 64

what position must you administer spinal anaesthesia in

Answer 64

standing/sitting (NOT lying down as can go to head and increase ICP = headache)

Question 65

what does spinal aneasthesia do

Answer 65

blocks all sympathetic flow from nerves below L2 eg pudendal, femoral, sciatic, obturator = VASODILATION of lower limbs also hypotension

Question 66

which one causes headache - spinal or epidural anaesthesia

Answer 66

spinal anaesthesia

Question 67

where does a pudendal nerve block innervate

Answer 67

perineum only (not anterior labia)

Question 68

how do you find pudendal nerve is doing a pudendal nerve block

Answer 68

feel for ischial spines (4 and 8 oclock positions), travels round ischial spine

Question 69

when is a perineal nerve block used

Answer 69

episiotomy incision forceps delivery painful vaginal delivery perineal stitching post delivery

Question 70

if fetal distress and you do fetal blood sampling, what pH is abnormal what do you do

Answer 70

<7.20 abnormal = DELIVER baby

Question 71

if abnormal labour (fetal distress or failure to progress) what are your options (3)

Answer 71

episiotomy operative vaginal delivery - forceps or ventouse (suction) c section

Question 72

if doin episiotomy, which direction do you cut

Answer 72

mediolateral into ischioanal fossa

Question 73

why don't you cut straight down in episiotomy

Answer 73

bc if the cut tears further = goes into rectum/anal sphincter

Question 74

requirements for forceps/ventouse delivery (dilatation and engagement)

Answer 74

``` full dilatation (10cm) - if 9cm needs c section 2/5s descent - if higher needs c section ```

Question 75

indications for c section delivery (over forceps/ventouse) if failure to progress in labour (4)

Answer 75

not full cervical dilatation (eg 9cm or below) >2/5 engagement breech maternal request

Question 76

indications for induction of labour

Answer 76

pre eclampsia antepartum haemorrhage - eg placenta praveia, placental abruption post dates pregnancy

Question 77

what 2 drugs can be used to induce labour

Answer 77

prostaglandins | IV syntocinon

Question 78

what method can be used to artificially break someones waters (rupture their membranes)

Answer 78

amniotomy

Question 79

what can immediate cord clamping cause how do you prevent this

Answer 79

decreased RBC = anaemia want to allow them to get as much as possible from the placenta delay cord clamping

Question 80

what do you recommend mum to do immediately after birth

Answer 80

skin to skin contact for 1 hour

Question 81

who repairs a 1st or 2nd degree vaginal tear/episiotomy

Answer 81

midwife

Question 82

who repairs a 3rd or 4th degree vaginal tear/episiotomy

Answer 82

obstetrician - need pudendal nerve block

Question 83

which vitamin is given within minutes of delivery given via.. why

Answer 83

vitamin K IM to prevent haemorrhagic disease of the newborn

Question 84

which vaccination is usually given at 2 months old, but is given immediately if the mum is known to be affected

Answer 84

hep B vaccination

Question 85

what 4 screening tools are used in newborns

Answer 85

top to toe exam at birth newborn assessment - from dr between 6-24 hours universal hearing screening test blood spot (Guthrie card)

Question 86

what is the blood spot/gurthrie card/new born screening card used to test for (4)

Answer 86

cystic fibrosis hypothyroidism haemoglobinopathies eg sickle cell 6 metabolic things eg PKU

Question 87

how does spinal anaesthesia cause hypotension

Answer 87

blockade of sympathetics to blood vessels = vasodilation

Question 88

treatment of hypotension caused by spinal anaesthesia

Answer 88

ephedrine (=release of noradrenaline = sympathetics to blood vessels = increases bp)