Key things to know

Question 1

What result for pH of a fetal blood sample result is normal?

Answer 1

7.25 or above
Borderline- 7.21-7.25
Abnormal- 7.2 or below
According to NICE

Question 2

What results for lactate of a fetal blood sample is normal ?

Answer 2

4.1 mmol/l or below is normal
4.2-4.8mmol/l is borderline
4.9 mmol/l or above is abnormal
According to NICE

Question 3

Pre labour ROM risk to neonate compared to women with intact membranes

Answer 3

Risk of serious infection is 1% compared to 0.5% for women with intact membranes

Question 4

What percentage of women withe prelabour ROM will go into labour within 24 hours ?

Answer 4

60%

Question 5

IOL is appropriate how long after ROM ?

Answer 5

24 hours

Question 6

What to advise women who ROM before labour ?

Answer 6

Report any change in colour or smell of vaginal loss

Bath or shower not associated with increased risk of infection but sexual intercourse may be

Question 7

If a women’s labour has not started 24 hours after ROM how long should she stay in hospital for after birth?

Answer 7

At least 12 hours

Question 8

Average length of established labour for primiparous women?

Answer 8

On average 8 hours and unlikely to last more than 18 hours

Question 9

How long do established labours for parous women last?

Answer 9

Average 5 hours. Unlikely to last over 12 hours

Question 10

How frequently should we recorded the frequency of contractions in the first stage labour ?

Answer 10

Half hourly

Question 11

How frequently should we record maternal pulse in the first stage labour ?

Answer 11

Hourly

Question 12

How often should we record temp and BP in the first stage labour??

Answer 12

4 hourly

Question 13

How often should a VE be offered in the first stage of labour

Answer 13

4 hourly or If concern about progress in labour - after abdominal palpations and assessment of vaginal loss

Question 14

Amniotomy offered is delay in first stage of established labour suspected. What should explain about consequences of procedure?

Answer 14

Shorten labour by about an hour and may increase strength and pain of contractions

Question 15

In the 2nd stage of labour how often should frequency of contractions be documented, how frequently should BP be documented, how frequently should temp be documented and passing of urine should also be recorded?

Answer 15

Half hourly frequency of contractions
Half hourly BP
4 hourly temp

Question 16

In active second stage how often should VEs be offered ?

Answer 16

Hourly or in response to women’s wishes

Question 17

During the second stage of active labour how often should the fetal heart rate being auscultation ?

Answer 17

Immediately after contractions for at least a minute , at least every 5 minutes. And palpate the women’s pulse every 15 mins to differentiate between heart rates

Question 18

For nulliparous women how long after active second stage should the birth be expected to take place ?

Answer 18

Within 3 hours
Diagnose delay in active second stage when it has lasted 2 hours and refer to healthcare professionals.
However after an hour suspect delay in terms of rotation or descent of presenting part

Question 19

For multiparous women how long after active second stage should the birth be expected to take place ?

Answer 19

2 hours after start of active stage.
Diagnose delay in active second stage when it has lasted 1 hour and refer.
I’d delay is suspected due to rotation or descent or presenting part then suspect delay in progress after 30 mins.

Question 20

When do u diagnose a prolonged 3rd stage if active management?

Answer 20

30 mins

Question 21

When do u diagnose a prolonged 3rd stage with physiological management ?

Answer 21

60 minutes

Question 22

What to explain to some about active management of 3rd stage ?

Answer 22

Shortens the 3rd stage compared to physiological management.

Associated with nausea and colonising in about 1 in 10

Associated with 13 in 1000 haemorrhage more than 1 litre

Associated with 14 in 1000 blood transfusion

Question 23

What to explain to a women about the physiological management of the 3rd stage?

Answer 23

I’d associated with nausea and committing in 50 in 1000 women compared to 100 in 1000 with active management.

Is associated with 29 in 1000 haemorrhages more than 1 litre compared to 13 in 1000 with active management.

Is associated with 40 in 1000 blood transfusions compared to 14 in 1000 with active management

Question 24

How much oxytocin is administered for active management of 3rd stage

Answer 24

10IU IM with birth of anterior shoulder or immediately after birth of baby. Before cord is clamped and cut. Oxytocin is associated with fewer side effects than oxytocin plus ergometrine.

Question 25

When to clamp the cord earlier than 1 minute from birth?

Answer 25

If concern about integrity of cord or the baby has a heart rate below 60 and not getting faster.

Question 26

When should clamp cord If all is fine?

Answer 26

Before 5 minutes in order to perform controlled cord traction as part of active management.

Question 27

When do u perform controlled cord traction?

Answer 27

After cord cut. After admin of oxytocin and signs of separation of the placenta.

Question 28

When to go from physiological management of 3rd stage to active ?

Answer 28

Is haemorrhage or if placenta not delivered within an hour after birth of baby

Question 29

Antental risk for postpartum haemorrhage

Answer 29

Previous PPH or previous retained placenta
Maternal haemoglobin below 85g/litre at onset of labour
BMI greater than 35 kg/m^2
Antepartum haemorrhage
Overdistention of the uterus ( multiple pregnancy, polyhydramnios or macrosomnia)
Existing uterine abnormalities
Low lying placenta
Maternal age 35 or older

Question 30

Risk factors for haemorrhage in labour

Answer 30

Induction 
Prolonged first , second or third stage in labour
Oxytocin has 
Precipitate labour 
Operative birth of Caesarean section

Question 31

Management of PPH

Answer 31

Call for help
Empty bladder, uterine massage, uterotonic drugs, IV fluids, controlled cord traction if placement not out
Assess blood loss and identify source of bleeding
Give oxygen
Arrange to transfer for obstetric led unit.

Question 32

What drugs would you administer a bolus of as first line of treatment for postpartum haemorrhage?

Answer 32

10IU IV oxytocin
Ergometrine 0.5mg IM
Oxytocin (5IU) and ergometrine ( 0.5mg) IM

Question 33

If there has been significant meconium what observations and when should these observations of the baby take place ?

Answer 33

At 1 hour, at 2 hour, and then 2 hourly until 12 hours of age

Question 34

If there has been non-significant meconium how frequently should the baby have obs

Answer 34

At 1 hour and 2 hours of age

Question 35

What respiration rate if any degree of meconium will a neonatologist need to assess the baby ?

Answer 35

Reps above 60

Question 36

All factors where is any meconium a neonatologist is required

Answer 36

Resps above 60
Grunting
Heart rate below 10 or above 160
Capillary refill time above 3 seconds
Body temp 38 or 37.5 on 2 occasions 30 mins apart
Oxygen sats below 95
Presence Of central cyanosis , confirmed by pulse oximetry if available.

Question 37

If pre labour ROM more than 24 hours before onset of established labour at term how long obs on baby for

Answer 37

First 12 hours of life. At 1 hour, 2 hour, and 6 hours and 12 hours.