Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MRCOG part 2 > Intrapartum Care > Flashcards

Intrapartum Care Flashcards

1
Q

Factors reducing c/s

A

Continuous support from women
Partogram use
Involvement of consultant obstetrician in decision making

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cat 1 c/s

A

immediate threat to life of mother/fetus (uterine rupture, cord prolapse, fetal hypoxia/bradycardia)

Deliver within 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cat 2 c/s

A

Maternal or fetal compromise not immediately life threatening

Deliver within 75 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cat 3 c/s

A

No maternal or fetal compromise but needs early birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cat 4 c/s

A

Timed to suit the woman or healthcare provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

NICE definition of active management of labour

A

Established labour
Early routine amniotomy
2 hourly vaginal examination
Oxytocin if labour becomes slow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Maintenance of BP after spinal anaesthesia during c/s

A

Phenylephrine injection and IV crystalloid co-loading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aim to keep BP at ____ of normal during c/s

A

Between 80-90% of baseline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Reducing risk of aspiration during GA

A

Pre-oxygenation
Cricoid pressure
Rapid sequence induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Reducing infection after c/s

A

Chlorhexidine skin prep
(Iodine if not available)

Use aqueous iodine vaginal prep when PPROM (chlorhexidine if not available) to reduce endometritis

Using a separate knife makes no difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Blunt extension of uterine incision benefits

A

Less bleeding, PPH and need for transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk of fetal laceration during c/s

A

2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Uterotonics during c/s

A

Oxytocin 5 units slow IV infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Method of placental removal during c/s

A

Controlled cord traction to reduce endometritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cons of uterine exteriorisation

A

Increased pain
Does not reduce bleeding or infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Recommended closure of midline skin incision

A

Mass closure with slow absorbable suture to reduce incisional hernia and dehiscence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When to close the subcut layer during c/s

A

When more than 2cm fat is present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Recommended closure of the skin

A

Sutures over staples to reduce dehiscence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk of endometritis, UTI or wound infection after c/s

A

8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Post GA care

A

1 to 1 care until haemodynamically stable, talking and has airway control

30 minute obs for 2 hours then routine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Post spinal/epidural anaesthesia care

A

1 to 1 care until haemodynamically normalised then routine obs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Post spinal/epidural anaesthesia care for women with factors for respiratory depression

A

Hourly O2 monitoring, RR and sedation for 12 hours then routine observation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Risk of urinary tract injury during c/s

A

1 per 1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Overall Rate of assisted vaginal delivery

A

10-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Rate of assisted vaginal delivery in primips
33%
26
Factors reducing assisted vaginal birth
One to one support Upright or lateral position (no epi) Lateral lying down position (with epi) Delay pushing 1-2 hours
27
Classification for assisted vaginal birth
Outlet - vertex visible or head on perineum Low - +2 station but not on perineum Mid - 0 to +1 station, 1/5th or less palpable per abdomen
28
Contraindications to assisted vaginal delivery
Suspected fetal bleeding disorder/risk of fractures Blood borne viruses (relative) Face presentation (ventouse)
29
Gestation for vacuum extraction
Contraindicated <32 weeks Caution from 32+0 to 36+0
30
Indications for assisted vaginal delivery
Suspected fetal compromise FTP in a primip for 3 hours with epidural FTP in a primip for 2 hours without epidural FTP in a multip for 2 hours with epidural FTP in a multip for 1 hour without epidural Maternal exhaustion Medical indication to avoid valsava manouvres
31
Rate of spontaneous vaginal delivery after assisted vagina birth
80% - 90% Compared to 30% after 2nd stage c/s
32
Factors reducing successful assisted vaginal birth
BMI >30 Short maternal stature Midcavity or 1/5 palpable PA EFW >4kg OP position
33
Maternal risks for assisted vaginal delivery
Haemorrhage Perineal trauma Episiotomy OASI Urinary/bowel incontinence
34
Fetal risks for assisted vaginal delivery
Fetal laceration Cephalhaematoma Intracranial haemorrhage Subgaleal haemorrhage Retinal haemorrhage Jaundice C spine injury (keillands) Skull fracture Facial nerve palsy Fetal death
35
Recommended pulls with vacuum
3 to bring fetal head onto perineum 3 gentle pulls to ease it out
36
Risks of sequential instrument delivery
Increased risk of fetal haemorrhage, feeding difficulty and OASI (17%)
37
Bladder care gate assisted vaginal birth
In dwelling if epidural/spinal Counsel women First void timed and measured Post void residual measured if retention is suspected (catheter or bladder scan) Offer physio (reduces risk of incontinence at 3 months only)
38
Latent first stage of labour
Painful contractions with effacement and and dilatation up to 4cm
39
Established first stage of labour
Regular painful contractions with progressive dilatation from 4cm
40
Passive second stage of labour
10cm prior to expulsion contractions
41
Active second stage
Baby is visible or expulsion contractions with full dilatation OR Active maternal effort after confirmation of full dilatation
42
FTP 2nd stage nulliparous
Inadequate progress after 2 hours active stage Offer amniotomy if membranes intact
43
FTP 2nd stage multip
Inadequate progress 1 hour Offer amniotomy
44
Sterile water injection protocol
0.1ml intracutaneous or 0.5 subcutaneous 4 injections around rhombus of michaelis
45
Asynclitism types
Anterior - saggital suture displaced posteriorly (naegele obliquity) Posterior - saggital suture displaced anteriorly (Litzman’s obliquity)
46
Facial nerve palsy incidence
7% normal births 9% forceps births
47
Incidence of face presentation
1 in 500 live births
48
Risk factors for face presentation
Multips Anencephaly (30%) Fetal anomaly (60%)
49
Face presentations and frequencies
Mento-anterior 70% Mento-posterior 20% Mento-transverse 10%
50
Forceps technique in mento-anterior position
Downward traction to maintain extension of the chin until clears symphysis pubis then flex until delivery
51
Shoulder dystocia incidence
6 in 1000
52
Rate of PPH after shoulder dystocia
11%
53
Risk of OASI after shoulder dystocia
3.8%
54
BPI risk shoulder dystocia
4-16% 10% permanent injury
55
Risk factors for shoulder dystocia
Previous (10x increase) Diabetes (2x increase) Macrosomia 4.5kg BMI >30 IOL prolonged 1st or 2nd stage Secondary arrest Synt augmentation Assisted vaginal delivery
56
Stillbirth rate
3.3 per 1000 (white) 7.5 per 1000 (black) 5.15 per 1000 (Asian)
57
SGA babies account for ____ of stillbirths
1/3
58
No cause is found for stillbirth in ____ cases
50%
59
Causes of stillbirth
Unknown Placenta Congenital anomaly (6%) Cord Infection
60
Investigations for IUFD
Bloods - FBC, U+E, LFT, CRP, BA, coag, kleihauer, HbA1c, TFT, thrombophilia, red cell antibodies, anti platelet antibodies, anti-ro/la Infection - urine/blood cultures, TORCH, rubella, CMV, HSV, syphillis, HVS, fetal and placental swabs Genetics - fetal and placental karyotype, parental karyotype Post-mortem exam and placental histology Cocaine screen
61
_____ % women labour spontaneously within _____ weeks of IUFD
85% 3 weeks
62
Risk of DIC after IUFD
10% within 4 weeks
63
Monitoring for DIC after IUFD
Twice weekly fibrinogen
64
Risk of uterine rupture with prostaglandin induction after 2 c/s
2.5%
65
Risk of infection with mechanical induction after IUFD
1-2%
66
Risk factors for uterine rupture with induction after IUFD
Previous c/s Parity >-= 5 Previous uterine surgery
67
Induction options for previous c/s after IUFD
Mifepristone alone 600mg OD for 2/7 Mifepristone alone 200mg TDS for 2/7 Mifepristone + low dose misoprostol (20-50 micrograms)
68
Regimen of IOL after IUFD up to 26+6
200mg mifepristone then (24hr later) 100 micrograms 6 hourly
69
Regimen of IOL for IUFD after 27+0
Mifepristone 200mg then (24hr) 25-50 micrograms misoprostol 4 hourly for up to 24 hrs
70
Karyotyping after IUFD
FISH or QF-PCR Results after 2 days
71
Sites for tissue culture after IUFD
Skin (60% failure) Cartilage and placenta (30% failure) Consider amniocentesis if being conservatively managed
72
Placental biopsy after IUFD technique
From fetal side near cord insertion 1cm diameter
73
Skin biopsy technique after IUFD
1cm in length Should include underlying muscle
74
Kleihaur test after IUFD should be ___
Repeated after 48 hours to ensure clearance of fetal red cells
75
Women are at risk of worsening faecal incontinence if_____
Symptomatic beyond 3 months

MRCOG part 2 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions