Labour

Question 1

From what gestational week onward should labour induction be offered in uncomplicated pregnancy?

Answer 1

41 weeks

Women with hypertension and pre-eclampsia are normally delivered by induction at this point to prevent risk.

Question 2

Rupture of membranes
Painless Vaginal Bleeding
Fetal bradycardia

Answer 2

Vasa Praevia - Fetal blood vessels cross or run near the internal orifice of the uterus. Compromised when membrane rupture occurs

• No maternal risk as is present in placenta praevia.

Question 3

Painless Vaginal Bleeding
Non-tender uterus
Abnormal lie and presentation

Answer 3

Placental Praevia

I - Low lying
II - Covers margin of internal os
III - Covers part of internal cervical os
IV - covers all of internal cervical os

Question 4

Variable decelerations

Answer 4

Decelerations independent of contractions.

Indicative of cord compression

Question 5

Requirements for instrumental delivery

Answer 5

Mnemonic FORCEPS

Fully dilated cervix
O OA or OP presentation
R Ruptured membranes
C Cephalic Presentation
E Engaged presenting part
P Pain relief
S Sphincter (Bladder Empty)

Question 6

Managing Placenta Praevia

Answer 6

Rescan at 34 weeks then if still present continually scan ever 34 weeks.
Can be delivered vaginally if grade 1.

C Section for grades 3/4 betwene 37-38 weeks.

Question 7

What week can ECV be offered from?

Answer 7

36 week if nulliparous

37 weeks if multiparous.

Question 8

Risk factors for breach presentation

Answer 8

Uterine Malformations 
Placenta Praevia
Aminotic Fluid Abnormalities
Fetal abnormalities 
Prematurity

Question 9

Kleihauer Test

Answer 9

Looks for percentage of fetal cells in maternal blood circulation using acid. Determines dosing of Anti-D

Question 10

1. Sensitising Events for Rh - Mother
   (There are 7)
2. When are larger doses of Anti- D required?

Answer 10

1.

i) Delivery of Rh +ve infant
ii) TOP
iii) Miscarriage if >12 weeks gestation
iv) ectopic pregnancy (if surgically managed)
v) ECV
vi) Antepartum Haemorrhage
vii) Amniocentesis, Chorionic Villus Sampling, Fetal Blood Sampling

2. Sensitising Events occurring in the 2nd or 3rd trimester alongside kleihauer test

Question 11

Management of PPH

Answer 11

Uterine Massage
Iv Syntocin
IM carboprost
(If uterine atony suspected to be the cause --> Intrauterine baloon)
B Lynch Suture
Uterine artery ligation 
Hysterectomy

Question 12

What does a bishop score of 3 indicate?

Answer 12

Labour unlikely to start without induction.

Station: in centimetres how far the ahead is above or below ischial spines

Bishop score:

<5 unlikely to start without induction
>9 likely to commence spontaneously

5 Domains:

Cervical position
Cervical Consistency
Cervical Effacement
Cervical Dilation
Fetal Station

Question 13

Medical management of PPH

Answer 13

Syntocin 5 units by slow IV injection
Ergometrine (not in hypertensive patients)
Syntocin Infusion
Carboprost (not in asthmatics)
Misoprotol (1000 mg rectally)