Intrapartum Care

Question 1

aim for how many contractions/10mins during labour?

-what can be given to help increase contractions?

Answer 1

4-5x per 10mins

-can give syntocinon (synthetic oxytocin)

Question 2

What is the risk of too frequent contractions?

Answer 2

Hypoxic injury to the baby

Question 3

What is the ideal range of foetal heart rate in labour?

What are drops from the baseline referred to as?

Answer 3

110-160 bpm

-drops in HR are called ‘decelerations’

Question 4

Foetal HR should be 110-160 bpm during labour
Variation = the beat to beat variation, what should it be greater than in labour?
What is an acceleration?

Answer 4

• greater than 5bpm variability

- HR shoots up then back down again, healthy sign that baby is fine

Question 5

What is the risk of excess oxytocin use to foetus and uterus?

Answer 5

Hyperstimulation: too many contractions –> abnormal foetal HR and foetal distress, HR drops down because cord is compressed and blood supply strained
-uterine rupture is rare but possible

Question 6

Oxytocin has a similar structure to ADH, so if giving too much syntocinon, what are the risks related to this? name 3

Answer 6

• urine retention, water retention
• water intoxication
• hyponatraemia
• cerebral oedema (!)

Question 7

Name 4 complications of slow labour?

Answer 7

Maternal dehydration/exhaustion
Infection (vagina has lots of bacteria) foetal/maternal
-foetal distress (forceps/ventouse)
-operative delivery risks
-uterine rupture
-post partum haemorrhage
-increased maternal and foetal morbidity (pelvic floor injury, incontinence..)

Question 8

There are many pre-requisites for assisted delivery, name 5

Answer 8

• head 0/5 or 1/5 palpable
• not a large baby
• cervix fully dilated
• membranes ruptures
• not excessive caput/moulding
• satisfactory foetal condition
• empty bladder
• suitable position/presentation
• descent with contraction and bearing down effort

Question 9

How can the 3rd stage be managed actively?

Answer 9

• give IM syntometrine (combo of syntocinon and ergometrine) given to deltoid or leg when the anterior shoulder is delivered
• to contract the uterus and detach the placenta
• guard uterus in place w left hand, use right hand to do controlled cord traction on cord until placenta delivered

Question 10

Tears Degrees: (NB: 1st and 2nd can be repaired in room under LA , 3rd and 4th -> theatre
1
2
3a
3b
3c
4

Answer 10

-1 : tear of vaginal mucosa
-2 - tear affecting the perineal muscles
3a - involving <50% of external anal sphincter
-3b - involving >50% of external anal sphincter
-3c - internal anal sphincter is affected
-4 - anal mucosa affected

Question 11

Suggest 3 complications of the 3rd stage of labour:

Answer 11

• retained placenta (will need manual removal in theatre)
• post partum haemorrhage
• perineal trauma (tears)
• perineal/pelvic haematoma (vessels bleeding behind tear so thoroughly examine)
• uterine inversion