General Obstetrics: Perinatal & Intrapartum Care

Question 1

Calculate the BPP. Baby has 35 s of fetal breath movements, moves legs twice, opens and closes hand once and there is a 2x2cm of amniotic fluid volume.

Answer 1

BPP = 6/8

Question 2

Calculate the BPP. Baby has one episode of active extension and flexion of the R leg, 2 2x2 cm pockets of amniotic fluid, 40s of breathing movements and 4 trunkal movements.

Answer 2

BPP = 8

Question 3

Kayla is a 40 week G2P1 who presents to hospital with contractions. Her GBS swab at 36 weeks was negative. However, her previous child was infected with GBS. What is the appropriate management?
A. Penicillin G not indicated as GBS swab is negative
B. Give mom Penicillin G
C. Give mom Cloxacillin
D. Give baby Penicillin G immediately following delivery

Answer 3

B. Always give antibiotics (regardless of screen results) if previous infant with infection or mom with GBS in urine during the current pregnancy. Other RFs for GBS include prolonged rupture of membranes (>/=18 hrs), <37 weeks or <2500g. Treat mom with IV antibiotics during labour (Penicillin G 5 million units IV then 2.5 million units IV q4h).

Question 4

Which of the following is the best for pain control in labour?
A. Morphine + Gravel
B. Hypnosis
C. Epidural
D. Nitrous Oxide

Answer 4

C. Epidural is the best pain control in labour. The other options are commonly used pain relievers for labour (except hypnosis - although this is becoming a popular option for many women).

Question 5

What are the cardinal movements of fetal vertex during labour?

Answer 5

1. Engagement (lowest portion of occiput at the level of the ischial spines; station 0)
2. Descent
3. Flexion (passive)
4. Internal rotation (OT to OA ideally)
5. Extension
6. External rotation
7. Expulsion

Question 6

Define the latent phase of labour.

Answer 6

Latent phase = onset of labour to 3-4 cm. It is part of the first stage of labour.

Question 7

Define labour.

Answer 7

Labour = progressive dilatation and thinning (effacement) of the cervix associated with uterine contractions

Question 8

Define the active phase of labour.

Answer 8

Active phase = 3-4cm to 10 cm dilatation. It is part of the first stage of labour.

Question 9

What is the DDx for PPH (4 Ts)?

Answer 9

Tone: uterine atony is the most common cause; there is a failure of the uterus to contract after delivery
Trauma: laceration (vaginal, cervical, perineal), incision, vaginal hematoma, uterine inversion, uterine rupture
Tissue: retained placenta or clots
Thrombin: coagulopathy (acquired or congenital)

Question 10

A 36 year old G2P1 presents to the ED with vaginal bleeding. She is in intense pain, her abdomen is peritonitic. Her BP is 85/40 and HR is 150. What is your diagnosis? Management?

Answer 10

Placental Abruption

Management

• ABCs and call for help
• Assess maternal vitals and FHR tracing
• If preterm and stable = expectant management
• If term OR unstable = deliver baby

Question 11

A 45 year old G3P2 presents with painless vaginal bleeding. Which of the following would be an appropriate step in the W/U of this patient?
A. Sterile Speculum Exam
B. U/S
C. Bimanual exam
D. CXR

Answer 11

B. U/S or review previous U/S history. You must rule out a placenta previa before ANY vaginal exam. A and C are a big NO. In placenta previa, if the patient is stable/minor bleeding you can admit for observation and schedule the C-section for 36 weeks. If unstable/major bleeding = C. section.

Question 12

What is the dose for WinRho/Rhogam?

Answer 12

300ug