Labour, and abnormal labour slides

Question 1

Are Braxton Hicks contractions painful?

Answer 1

No

Question 2

After how many weeks of gestation will Braxton Hicks contractions occur?

Answer 2

After 30 weeks of gestation

Question 3

Is progesterone pro-labor or pro-pregnancy?

How about oestrogen?

Answer 3

Progesterone is pro-pregnancy.

Oestrogen is pro-labor

Question 4

What are the pro-pregnancy factors?

Answer 4

Progesterone, Relaxin, Nitric oxide and Catecholamines

Question 5

What are the pro-labor factors?

Answer 5

Oestrogen, Prostaglandins, Prostaglandin dehydrogenase, Oxytocin, Inflammatory mediators

Question 6

How does the placenta and fetus contribute to the initiation of labour?

Answer 6

The placenta changes the ratio between progesterone (decreases) and oestrogen (increases).
Intrauterine maturation of fetus leads to increased ACTH and cortisol, while fetal membranes increase prostaglandin.

Question 7

What is the effect of oxytocin?

Answer 7

Oxytocin promotes uterine contractility

Question 8

What is the effect of oestrogen?

Answer 8

Oestrogen increases oxytocin receptor expression

Question 9

What is the effect of increased prostaglandin?

Answer 9

Prostaglandin causes cervical ripening and stimulates uterine contractility directly and indirectly by upregulating oxytocin receptors.

Question 10

What causes the cervix to soften?

Answer 10

The cervix softens due to increased water content and collagen lysis.

Question 11

In the active phase of the first stage of labour, what is the ideal minimum rate of cervical dilatation?

Answer 11

1cm/hour

Question 12

What should be done if the perineum appears to be tearing excessively?

Answer 12

Episiotomy

Question 13

What signs are assessed in the APGAR score?

Answer 13

Appearance, Pulse, Grimace, Activity, Respiration

How Ready Is This Child?
Heart rate, Respiratory effort, reflex irritability, Muscle tone, colour

Question 14

How is the respiratory effort in the APGAR score assess?

Answer 14

By the cry of the new-born

Question 15

What are the signs of placental separation?

Answer 15

Trickle of fresh blood
Cord lengthens
Uterus feels more firm and globular

Question 16

How much blood loss usually occurs in the third stage of labor?

Answer 16

Usually <500mL due to placental separation

Question 17

Define postpartum haemorrhage

Answer 17

Postpartum haemorrhage is the loss of 500-1000mL of blood within the first 24 hours following childbirth.

Question 18

What are the three interventions in the active management of 3rd stage labor (AMTSL)?

Answer 18

In the active management of 3rd stage labor:

1. Routine drug given to contract the uterus - uterotonic drug - syntocinon. Syntocinon is given just before, with or just after the birth of the new-born.
2. Early cord clamping and cutting
3. Controlled cord traction

Question 19

How does flexion help in the delivery of foetus?

Answer 19

Flexion decreases the diameter of presentation (suboccipito-bregmatic diameter = 9.5cm) of the foetus in the longitudinal presentation.

Question 20

Why does flexion occur during delivery?

Answer 20

Flexion occurs due to resistance from the cervix, the walls of the pelvis and the pelvic floor.

Question 21

At which level does internal rotation occur?

Answer 21

Internal rotation occurs at the level of the ischial spines

Question 22

According to the CTG, what will suggest fetal compromise?

Answer 22

Persistent tachycardia, 
Prolonged bradycardia,
Persistent atypical deceleration
Prolonged reduced variability
Combination of the above

Question 23

Define Preterm labour

Answer 23

Preterm labor is regular painful uterine contractions leading to cervical effacement and dilatation before 37 weeks of gestation.

Question 24

What are the spontaneous causes of preterm labour?

Answer 24

Cervical incompetence
Multiple pregnancies
Polyhydramnios
Chorioamnitis
Antepartum haemorrhage
Congenital uterine anomaly
Severe maternal illness or infection

Question 25

What will lead to elective preterm deliveries?

Answer 25

Maternal condition: Severe pre-eclampsia

Fetal condition: restricted growth

Question 26

What is the management of cervical incompetence?

Answer 26

Cerclage, which is the suturing of cervix closed to reinforce a weakened cervix, done between 14 and 16 weeks of gestation

Question 27

When will Cerclage not be eligible in the woman?

Answer 27

If there is irritation of the cervix, if the cervix is dilated >4cm, and if membranes have ruptured

Question 28

What are the other treatment options of preterm labour?

Answer 28

Tocolytic agents: Magnesium sulphate, indomethacin, and nifedipine.
Steroids if less than 34 weeks gestation to help with fetal lung development.

Question 29

When is syntocinon given?

Answer 29

Syntocinon is only given after delivery of the shoulder, so as to eliminate the risk of shoulder dystocia.

Question 30

What is the ideal position of the fetal head?

Answer 30

Occipito-anterior

Question 31

Is the anterior or posterior fontanelle diamond in shape?

Answer 31

Anterior fontanelle is diamond in shape.

Question 32

What is the condition of the cervix when the foetal head is engaged at +1/+2 station?

Answer 32

Cervix is fully dilated at +1/+2 station

Question 33

What is the rate of dilatation of the cervix in the active phase of stage 1 labour?

Answer 33

1cm/hour of cervical dilatation

Question 34

Vaginal examination (VE) is carried out at what interval?Estimate what is the minimum dilatation of cervix expected at each interval of VE?

Answer 34

Vaginal examination is carried out 4 hourly and the minimum dilatation of cervix expected after 4 hours is 2cm (since ideal rate of dilatation is 0.5-1cm/hour).

Question 35

Who are considered women of high dependency?

Answer 35

High dependency women are those who are diabetic, have pre-eclampsia, have intrapartum fever (>38 degrees celsius), previous history of stillbirth, uses drugs to augment labour such as syntocinon

Question 36

What is the hands-on technique for?

Answer 36

Hands-on technique is used to keep the foetal head flexed during its descend down the pelvis.