Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
Q

Rate of assisted vaginal delivery in primips

A

33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Factors reducing assisted vaginal birth

A

One to one support
Upright or lateral position (no epi)
Lateral lying down position (with epi)
Delay pushing 1-2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Classification for assisted vaginal birth

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Contraindications to assisted vaginal delivery

A

Suspected fetal bleeding disorder/risk of fractures
Blood borne viruses (relative)
Face presentation (ventouse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Gestation for vacuum extraction

A

Contraindicated <32 weeks
Caution from 32+0 to 36+0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Indications for assisted vaginal delivery

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Rate of spontaneous vaginal delivery after assisted vagina birth

A

80% - 90%

Compared to 30% after 2nd stage c/s

32
Q

Factors reducing successful assisted vaginal birth

A

BMI >30
Short maternal stature
Midcavity or 1/5 palpable PA
EFW >4kg
OP position

33
Q

Maternal risks for assisted vaginal delivery

A

Haemorrhage
Perineal trauma
Episiotomy
OASI
Urinary/bowel incontinence

34
Q

Fetal risks for assisted vaginal delivery

A

Fetal laceration
Cephalhaematoma
Intracranial haemorrhage
Subgaleal haemorrhage
Retinal haemorrhage
Jaundice
C spine injury (keillands)
Skull fracture
Facial nerve palsy
Fetal death

35
Q

Recommended pulls with vacuum

A

3 to bring fetal head onto perineum
3 gentle pulls to ease it out

36
Q

Risks of sequential instrument delivery

A

Increased risk of fetal haemorrhage, feeding difficulty and OASI (17%)

37
Q

Bladder care gate assisted vaginal birth

A

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
Q

Latent first stage of labour

A

Painful contractions with effacement and and dilatation up to 4cm

39
Q

Established first stage of labour

A

Regular painful contractions with progressive dilatation from 4cm

40
Q

Passive second stage of labour

A

10cm prior to expulsion contractions

41
Q

Active second stage

A

Baby is visible or expulsion contractions with full dilatation
OR
Active maternal effort after confirmation of full dilatation

42
Q

FTP 2nd stage nulliparous

A

Inadequate progress after 2 hours active stage
Offer amniotomy if membranes intact

43
Q

FTP 2nd stage multip

A

Inadequate progress 1 hour
Offer amniotomy

44
Q

Sterile water injection protocol

A

0.1ml intracutaneous or 0.5 subcutaneous
4 injections around rhombus of michaelis

45
Q

Asynclitism types

A

Anterior - saggital suture displaced posteriorly (naegele obliquity)

Posterior - saggital suture displaced anteriorly (Litzman’s obliquity)

46
Q

Facial nerve palsy incidence

A

7% normal births
9% forceps births

47
Q

Incidence of face presentation

A

1 in 500 live births

48
Q

Risk factors for face presentation

A

Multips
Anencephaly (30%)
Fetal anomaly (60%)

49
Q

Face presentations and frequencies

A

Mento-anterior 70%
Mento-posterior 20%
Mento-transverse 10%

50
Q

Forceps technique in mento-anterior position

A

Downward traction to maintain extension of the chin until clears symphysis pubis then flex until delivery

51
Q

Shoulder dystocia incidence

A

6 in 1000

52
Q

Rate of PPH after shoulder dystocia

A

11%

53
Q

Risk of OASI after shoulder dystocia

A

3.8%

54
Q

BPI risk shoulder dystocia

A

4-16%
10% permanent injury

55
Q

Risk factors for shoulder dystocia

A

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
Q

Stillbirth rate

A

3.3 per 1000 (white)
7.5 per 1000 (black)
5.15 per 1000 (Asian)

57
Q

SGA babies account for ____ of stillbirths

A

1/3

58
Q

No cause is found for stillbirth in ____ cases

A

50%

59
Q

Causes of stillbirth

A

Unknown
Placenta
Congenital anomaly (6%)
Cord
Infection

60
Q

Investigations for IUFD

A

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
Q

_____ % women labour spontaneously within _____ weeks of IUFD

A

85%
3 weeks

62
Q

Risk of DIC after IUFD

A

10% within 4 weeks

63
Q

Monitoring for DIC after IUFD

A

Twice weekly fibrinogen

64
Q

Risk of uterine rupture with prostaglandin induction after 2 c/s

A

2.5%

65
Q

Risk of infection with mechanical induction after IUFD

A

1-2%

66
Q

Risk factors for uterine rupture with induction after IUFD

A

Previous c/s
Parity >-= 5
Previous uterine surgery

67
Q

Induction options for previous c/s after IUFD

A

Mifepristone alone 600mg OD for 2/7
Mifepristone alone 200mg TDS for 2/7
Mifepristone + low dose misoprostol (20-50 micrograms)

68
Q

Regimen of IOL after IUFD up to 26+6

A

200mg mifepristone then (24hr later)
100 micrograms 6 hourly

69
Q

Regimen of IOL for IUFD after 27+0

A

Mifepristone 200mg then (24hr) 25-50 micrograms misoprostol 4 hourly for up to 24 hrs

70
Q

Karyotyping after IUFD

A

FISH or QF-PCR
Results after 2 days

71
Q

Sites for tissue culture after IUFD

A

Skin (60% failure)
Cartilage and placenta (30% failure)
Consider amniocentesis if being conservatively managed

72
Q

Placental biopsy after IUFD technique

A

From fetal side near cord insertion 1cm diameter

73
Q

Skin biopsy technique after IUFD

A

1cm in length
Should include underlying muscle

74
Q

Kleihaur test after IUFD should be ___

A

Repeated after 48 hours to ensure clearance of fetal red cells

75
Q

Women are at risk of worsening faecal incontinence if_____

A

Symptomatic beyond 3 months

MRCOG part 2 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions