Labour

Question 1

What is labour?

Answer 1

A physiological process in which the foetus, membranes, umbilical cord and placenta are expelled from the uterus.

Question 2

What hormones are involved in labour?

Answer 2

Progesterone
Oestrogen
Oxytocin

Question 3

What is crucial in allowing the cervix to dilate?

Answer 3

Cervical softening

Question 4

When does the 2nd stage of labour begin?

Answer 4

When the cervix is fully dilated.

Question 5

What is the best shape of pelvis to aid delivery of a foetus?

Answer 5

Gynaecoid

Question 6

Is the diameter of the pelvic inlet the same as the pelvic outlet?

Answer 6

No

Question 7

What is expulsed from the vagina first during delivery?

Answer 7

Head and then the anterior shoulder of the foetus.

Question 8

Should clamping of the umbilical cord be carried out ASAP?

Answer 8

No, delay of this maximises the RBC supply at birth.

Question 9

For how long is skin-to-skin contact recommended following birth?

Answer 9

Atleast an hour.

Question 10

What can be given to aid expulsion of the placenta in the 3rd stage of pregnancy?

Answer 10

Syntometerine

Question 11

What is a normal amount of blood to lose during pregnancy?

Answer 11

Around 500ml.

If over 1 litre - this is bad.

Question 12

What is the puerperium?

Answer 12

The period of recovery and repair following pregnancy.

Question 13

What is defined as preterm labour?

Answer 13

That occurring prior to 37 weeks gestation.

Question 14

What is defined as post-term labour?

Answer 14

That occurring after 42 weeks gestation.

Question 15

What is the most effective anaesthesia available in pregnancy?

Answer 15

Epidural

Question 16

How is progression of labour assessed?

Answer 16

Cervical dilatation
Descent of the presenting part
Monitoring for signs of obstruction

Question 17

What is the expected rate of progression during labour?

Answer 17

2cm every 4 hours.

Question 18

What is the most common reason for failure to progress during labour?

Answer 18

Deflexion of the foetal head.

Question 19

What is a partogram?

Answer 19

A graphic representation of labour progress.

Question 20

What is post-partum haemorrhage?

Answer 20

Any blood loss > 500ml in the 24 hours following birth.

Question 21

When is a PPH described as a major PPH?

Answer 21

If 1000ml of blood is lost.

Question 22

At what % blood loss does BP begin to drop?

Answer 22

Over 30%.

This is a late sign.

Question 23

What are the 4 ‘T’s responsible for PPH?

Answer 23

Tone
Trauma
Tissue
Thrombin

Question 24

What is the most common cause of PPH?

Answer 24

Uterine atony

Uterus fails to contract down following labour. This results in vessels remaining open, therefore bleeding occurs.

Question 25

How is PPH managed?

Answer 25

'ABCDE' Uterotonic drugs Tranexamic acid

Question 26

What are examples of uterotonic drugs?

Answer 26

Oxytocin Ergometrine Carboprost Misoprostol

Question 27

What is the action of uterotonic agents?

Answer 27

To initiate uterine contraction.

Question 28

What is the first-line surgical management of PPH?

Answer 28

Intrauterine balloon

Question 29

What is a complication of a morbidly adherent placenta?

Answer 29

Uterine inversion - can lead to prolapse. This is an obstetric emergency.

Question 30

What is shoulder dystocia?

Answer 30

When the shoulders of the foetus do not pass following the head, becoming wedged behind the mother's pubic symphysis.

Question 31

What may result from shoulder dystocia?

Answer 31

Irreversible injury to the brachial plexus.

Question 32

Is genital tract trauma common in pregnancy?

Answer 32

Yes, occurs in 95% of first-time mothers.

Question 33

What is the most common cause of post-partum sepsis?

Answer 33

Infection of the uterus (called endometritis).

Question 34

what are risk-factors for post-partum sepsis?

Answer 34

Prolonged rupture of membranes Use of instruments during labour Tissue left within the womb following delivery

Question 35

how is sepsis managed?

Answer 35

``` Give O2, keep sats >94% Take blood culture Give IV antibiotics (usually co-amoxiclav) Give fluid challenge Measure lactate Measure urine output ``` Think sepsis '6'.

Question 36

In those with a penicillin allergy, what is given instead of co-amoxiclav in the treatment of sepsis?

Answer 36

Clindamycin and gentamicin. Both given intravenously.