Labour

Question 1

which hormone makes the uterus contract

Answer 1

oestrogen
oxytocin

Question 2

oxytocin role in labour

Answer 2

initiates and sustains contractions

Question 3

what is the bishop score

Answer 3

determines if it’s safe to induce labour.
5 things, and we need at least 4/5

Question 4

what are the elements of bishop score

Answer 4

dilatation
effacement
station
cervical consistency
cervix position

Question 5

first stage of labour

Answer 5

latent phase, up to 3-4cm dilatation

Question 6

full dilatation cervix measurement

Answer 6

10cm dilatation

Question 7

active phase

Answer 7

4cm onwards to full dilatation

Question 8

second stage

Answer 8

full dilatation to delivery of baby

Question 9

third stage of labour

Answer 9

delivery of baby to expulsion of the placenta and fetal membranes

Question 10

average duration of third stage

Answer 10

10 mins

Question 11

how long do we give the third stage before we intervene with surgery to get the placenta out

Answer 11

1 hour

Question 12

what drugs can be used to help get the placenta out

Answer 12

oxytocic drugs

Question 13

what are braxton hicks contractions

Answer 13

give the woman a false sensation that she is having real contractions.
Tightening of the uterine muscles, thought to aid the body prepare for birth

Question 14

where is smooth muscle of uterus at its highest density?

Answer 14

fundus

Question 15

normal frequency of contractions

Answer 15

3-4 in 10 mins
initially 10-15 seconds, max 45 secs

Question 16

cervical assessment

Answer 16

effacement
dilatation
firmness
position
level of presenting part or station (where is the head in relation to ischial spines)

Question 17

7 cardinal movements

Answer 17

1. engagement
2. descent
3. flexion
4. internal rotation
5. crowning and extension
6. restitution and external rotation (head adopts optimal position for shoulder)
7. expulsion, anterior shoulder first

Question 18

how often should vaginal examination be carried out in normal labour

Answer 18

approx 4 hourly

Question 19

delayed cord clamping

Answer 19

give at least a minute

Question 20

when does expulsion of the placenta usually occur

Answer 20

5-10 mins after delivery, considered normal up to 30 mins

Question 21

normal blood loss

Answer 21

<500mls

Question 22

what is puerperium

Answer 22

the 6 weeks after birth

Question 23

methods to induce labour

Answer 23

• artificial rupture of membranes
• Propess (vaginal prostaglandin)
• Cooks balloon (mechanical cervical dilatation)

Question 24

signs of failure to progress (FTP) / obstructed labour

Answer 24

• slow/no cervical dilatation
• no descent or high presenting part
• caput / moulding of presenting part
• haematuria
• “too good” a CTG with no stress on baby despite regular contractions
• ascites at c-section
• Bandl’s ring at c-section

Question 25

should baby present OA, OP or OT

Answer 25

OA

Question 26

What do we do if baby presents transverse/oblique lie at delivery

Answer 26

Needs section due to risks of cord presentation and prolapse at SRM

Question 27

what is chorioamnionitis?

Answer 27

Intrauterine infection (amniotic fluid and placenta) that can be life threatening to baby and to mother

Question 28

when do the risks of chorioamnionitis increase?

Answer 28

duration of time between SRM and delivery, particularly if pre-term

Question 29

what is PPROM

Answer 29

Pre-term, pre-labour rupture of membranes

Question 30

what is PROM

Answer 30

Prelonged rupture of membranes

Question 31

in PPROM, what antibiotic is given as prophylaxis

Answer 31

erythromycin

Question 32

signs and symptoms of chorioamnionitis

Answer 32

• Maternal signs of sepsis/abnormal bloods
• Fetal tachycardia/abnormal CTG
• Offensive/blood stained liquor
• Abdominal pain
• Intrauterine pus at section

Question 33

antepartum haemorrhage definition

Answer 33

Vaginal bleeding from 24+0 until delivery

Question 34

in antepartum haemorrhage, what needs excluded before going ahead with a digital examination?

Answer 34

placenta praevia

Question 35

what serious pathologies need ruled out in antepartum haemorrhage?

Answer 35

placental abruption, uterine rupture, chorioamnionitis

Question 36

Primary post partum haemorrhage vs secondary

Answer 36

Primary PPH within 24 hours and secondary PPH thereafter

Question 37

post partum haemorrhage 4 Ts

Answer 37

Tone – Use uterotonics to improve

Trauma – Repair tear/uterus

Tissue – Make sure uterus is empty with no placental tissue/membranes

Thrombin – Consider blood products, tranexamic acid

Question 38

cord prolapse definition

Answer 38

Descent/prolapse of umbilical cord following rupture of membranes

Question 39

why is cord prolapse life threatening to baby

Answer 39

vasospasm and impaired blood supply to baby

Question 40

cord prolapse management

Answer 40

rapid delivery via section coupled with displacing PP off cord to relieve pressure (manually or via bladder insufflation)

Question 41

risk factors for cord prolapse

Answer 41

transverse/unstable lie, polyhydramnios, induced labour with high PP

Question 42

shoulder dystocia definition

Answer 42

Bony obstruction of fetal shoulder against maternal pelvis causing delayed delivery and hypoxia

Question 43

shoulder dystocia risk factors

Answer 43

Previous shoulder dystocia
Diabetes (T1>T2>GDM) even without macrosomia
Fetal macrosomia (i.e. EFW >97th centile, LBW >4.5kg)
Narrow pelvic outlet

Question 44

how many contractions is expected in 10 mins in active labour

Answer 44

3-4