Labour and Birth

Question 1

describe degrees of perineal trauma

Answer 1

1st- skin + mucosa
2nd- perineal muscles, but not involving anal sphincter
3rd - injury to perineum and involving anal sphincter
* 3a- <50% of external anal sphincter thickness torn
* 3b- >50% external anal sphincter thickness torn
* 3c - both EAS and internal anal sphincter torn

4th- injury to anal sphincter and anorectal mucosa

Question 2

Describe a normal FHR trace

Answer 2

baseline - 110-160bpm
normal variability- 6-25 bpm
accelerations present (15bpm above baseline / lasting >15 sec)
no decels (15bpm below baseline, lasting >15 sec)

Question 3

what are contraindications of epidural

Answer 3

abnormal spinal anatomy
hypovolaemia (low plasma vol- can be caused by excess vomiting / diarrhoea / bleeding)
localised skin infection
coagulopathy
anticoagulant therapy
cardiovascular instability

Question 4

how do you set up NB resus?

Answer 4

Neopuff
* PIP- 30 cm/ h20
* peep- 5 cm / h20

blender - 21% oxygen
flow rate- 10

Question 5

what are key steps to a NB resus?

Answer 5

1st min
dry and stimulate baby
ensure open airway
check breathing or crying / tone / HR >100?

If not breathing / low tone / HR<100bpm, go to resus
* 5 inflation breaths -check airways open (if not, reposition mask, head tilt, shoulder roll)
* ventilation breaths (40-60 rpm)
Add oxygen sat probe

check HR after 30 sec
- if <100 - continue ventilation. consider increasing pressure + oxygen
- if <60bpm- commence chest compressions + increase oxygen to 100%