Childbirth

Question 1

How common is breech presentation?

Answer 1

2-3% at term

25% at 28 weeks gestation

Question 2

What are the four options for delivery of a breech baby?

Answer 2

Ce-section, ECV, vaginal breech delivery, do nothing (baby may correct position spontaneously)

Question 3

What are the risks associated with a C-section?

Answer 3

Infection, haemorrhage, VTE, urinary tract injury, anaesthesia complications, hernia, injury to baby, TTN

Question 4

At what gestation are planned C-sections usually performed?

Answer 4

Usually from 39 weeks = reduces respiratory issues in newborn (TTN, RDS)

Question 5

What pre-operative blood tests would be requested before a planned C-section?

Answer 5

FBC, group and save, coagulation screen if history of bleeding disorder

Question 6

What instructions are given to women before a planned C-section?

Answer 6

Nil by mouth for several hours beforehand
Can have clear fluids up until 2hrs before procedure
Give omeprazole to reduce aspiration risk

Question 7

What gestation are inductions of labour performed for macrosomia?

Answer 7

After 39 weeks gestation

Question 8

What are the methods of inducing labour?

Answer 8

Prostaglandins = given as pessary or gel

Membrane sweep or intracervical balloon

Question 9

What is the Bishop’s score?

Answer 9

Used to decide how likely it is someone will do into labour = used to determine if induction should be recommended (score >7 is favourable)

Question 10

When may a membrane sweep be performed?

Answer 10

During a vaginal examination to stimulate prostaglandins

Question 11

What are some problems that may occur during induction?

Answer 11

Hyperstimulation = corrected by trying to stop contractions with beta2 agonist injection
Unsuccessful induction = do C-section instead

Question 12

What medication would be given to a woman with intrauterine foetal death at 28 weeks?

Answer 12

Misoprostol = can’t be used for ectopic or molar pregnancy

Question 13

What medication would be given to a woman feeling nauseous after delivery?

Answer 13

Cyclizine = mostly well tolerated but previous adverse reaction would be contraindication

Question 14

What medication would you give to a woman about to have a planned C-section for placental praevia?

Answer 14

Tranexamic acid = use with caution if history of thrombosis

Question 15

What medication would you give for induction of labour for reduced foetal movements?

Answer 15

Propess = contraindicated in women with scarred uterus

Question 16

What medication would you give for a C-section for failure to progress at 2cm dilatation?

Answer 16

Ranitidine = mostly tolerated but previous adverse reaction would be contraindication

Question 17

What medication would you give for a woman with a BP of 150/98 mmHg?

Answer 17

Labetalol = use with caution in patients with history of asthma

Question 18

What medication would you give for preterm labour at 33 weeks?

Answer 18

Dexamethasone = contraindicated in severe sepsis

Question 19

What medication would you give for a woman with a temperature of 38C during labour?

Answer 19

Augmentin = contraindicated if patient has penicillin allergy

Question 20

What medication would you give for a woman with a headache and hyperreflexia?

Answer 20

Magnesium sulphate = contraindicated in renal impairment or failure

Question 21

What medication would be given to treat a gush of fresh blood 2hrs post delivery?

Answer 21

Ergometrine = contraindicated in hypertension

Question 22

What medication would be given to a woman who has just delivered a baby via spontaneous vaginal delivery?

Answer 22

Syntometrine = contraindicated in hypertension