Labour and delivery

Question 1

what is the first stage of labour

Answer 1

onset of labour true contractions until cervix is fully dilated to 10cm.
latent,active and transition

Braxton hicks contractions -durign 2nd and 3rd stage of labour - false contraction

Question 2

2nd stage of labour

Answer 2

10cm cervical dilation until delivery of baby

Question 3

3rd stage of labor

Answer 3

from delivery of baby to delivery of the placenta

Question 4

PROM means

Answer 4

the amintioc sac has ruptures before the onset of labour

Question 5

extreme preterm

Answer 5

under 28 weeks

very is 28 -32

moderate to late 32-37

Question 6

prophylaxis of preterm labour what can you do too prolong labour

Answer 6

vaginal progesterone - maintaining pregnancy and preventing labour by decreasing action of myometrium and prevent cervical moderation

cervical cerclage - stitch in cervix to add support to keep closed involving anaesthetic removed when in labour

Question 7

doubt of amintioc fluid rupture what tests

Answer 7

Insulin-like growth factor-binding protein-1 (IGFBP-1) is a protein present in high concentrations in amniotic fluid, which can be tested on vaginal fluid if there is doubt about rupture of membranes
Placental alpha-microglobin-1 (PAMG-1) is a similar alternative to IGFBP-1

prophalcic antiobitcs given to prevent chorioamnionitis

Question 8

when do you give antenatal steroids

Answer 8

Giving the mother corticosteroids helps to develop the fetal lungs and reduce respiratory distress syndrome after delivery. They are used in women with suspected preterm labour of babies less than 36 weeks gestation.

An example regime would be two doses of intramuscular betamethasone, 24 hours apart.

Question 9

what can you give to protect the brain during fatal delivery if premature.

This reduces the risk of cerebral palsy and severity. given within 24hr of delivery

Answer 9

IV magnesium sulfate

what magnesium toxicity

Question 10

signs of magnesium toxicity

Answer 10

Reduced respiratory rate
Reduced blood pressure
Absent reflexes

Question 11

Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death

Answer 11

indications of when to start labour

Question 12

what is the bishops score

Answer 12

The Bishop score is a scoring system used to determine whether to induce labour.]

A score of 8 or more predicts a successful induction of labour. A score below this suggests cervical ripening may be required to prepare the cervix.

used to monitor along with CTG

Question 13

how do you induce labour

Answer 13

membrane sweep
vagianl PGE2
cervical ripening balloon
oral mifepristone ) anti-progesterone plus misprostol induced labour where fatal death intrauterine has occurred

Question 14

CTG accelerations and deceerlaerations

Answer 14

Accelerations are generally a good sign that the fetus is healthy, particularly when occurring alongside contractions of the uterus.
Decelerations are a more concerning finding. The fetal heart rate drops in response to hypoxia. The fetal heart rate is slowing to conserve oxygen for the vital organs.

DR – Define Risk (define the risk based on the individual woman and pregnancy before assessing the CTG)
C – Contractions
BRa – Baseline Rate
V – Variability
A – Accelerations
D – Decelerations
O – Overall impression (given an overall impression of the CTG and clinical picture)

Question 15

Progress in labour is influenced by the three P’s:

Answer 15

Power (uterine contractions)
Passenger (size, presentation and position of the baby)
Passage (the shape and size of the pelvis and soft tissues)

Question 16

are NSAIDS avoided in pregnancy

Answer 16

yes

Question 17

simple analgesia in preg

Answer 17

paracetamol

other methods include entonox( nitrous oxide and oxygen) , diamorphen (opiod) , remifentanil patietn given , epidural

Question 18

what is cord prolapse

Answer 18

Cord prolapse is when the umbilical cord descends below the presenting part of the fetus and through the cervix into the vagina, after rupture of the fetal membranes. There is a significant danger of the presenting part compressing the cord, resulting in fetal hypoxia.

transverse or oblique lie past 37 weeks

Question 19

mangamnt of cord prolapse

Answer 19

emergency c section

women lie in left lateral position, knee chest position , tocolytic medication such as terbutaline used to minimise contractions whilst waiting fro c section

Question 20

what is shoulder dystocia

Answer 20

Shoulder dystocia is when the anterior shoulder of the baby becomes stuck behind the pubic symphysis of the pelvis, after the head has been delivered. This requires additional obstetric manoeuvres to enable delivery of the rest of the body. Shoulder dystocia is an obstetric emergency.

Question 21

main cause of shoulder dystocia

common presentation of head and signs

Answer 21

macrosomia secondary to gestational diabetes.

face downwards (occipito-anterior

turtle neck sign

Question 22

what is mcroberts manoeuvre

Answer 22

hyeprflexion of mother at the hip knees to abdomen provides psotieor pelvic tilt lifting the PS out the way in shoulder dystocia

Rubins manoeuvre involves reaching into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder to help it move under the pubic symphysis.

Wood’s screw manoeuvre is performed during a Rubins manoeuvre. The other hand is used to reach in the vagina and put pressure on the anterior aspect of the posterior shoulder. The top shoulder is pushed forwards, and the bottom shoulder is pushed backwards, rotating the baby and helping delivery. If this does not work, the reverse motion can be tried, pushing the top shoulder backwards and the bottom shoulder forwards.

Zavanelli manoeuver involves pushing the baby’s head back into the vagina so that the baby can be delivered by emergency caesarean section.

Question 23

4 main complications of shoulder dystocia

Answer 23

Fetal hypoxia (and subsequent cerebral palsy)
Brachial plexus injury and Erb’s palsy
Perineal tears
Postpartum haemorrhage

Question 24

a single dose of what is recommended after instrumental delivery to reduce the risk of maternal infection

Answer 24

co-amoxiclav

Question 25

indications for instrumental delivery

Answer 25

Failure to progress Fetal distress Maternal exhaustion Control of the head in various fetal positions

Question 26

main complication of ventouse

Answer 26

cephalohaematoma.

Question 27

nerves injured in instrumental delivery

Answer 27

femoral and obturator nerve lateral cuanoeus nerve lumbosarcal plexus common perineal nerve

Question 28

when does a perineal tear occur

Answer 28

A perineal tear occurs where the external vaginal opening is too narrow to accommodate the baby. This leads to the skin and tissues in that area tearing as the baby’s head passes. Perineal tears are more common with: ``` First births (nulliparity) Large babies (over 4kg) Shoulder dystocia Asian ethnicity Occipito-posterior position Instrumental deliveries ```

Question 29

third stage of labour wither physiological management mother does it or achieve managemten with what

Answer 29

IM oxytocin and cord clamped and cut within 5 minutes of birth

Question 30

classification of post part haemorrhage

Answer 30

t can be classified as: Minor PPH – under 1000ml blood loss Major PPH – over 1000ml blood loss Major PPH can be further sub-classified as: Moderate PPH – 1000 – 2000ml blood loss Severe PPH – over 2000ml blood loss It can also be categorised as: Primary PPH: bleeding within 24 hours of birth Secondary PPH: from 24 hours to 12 weeks after birth

Question 31

causes of PPH

Answer 31

T – Tone (uterine atony – the most common cause) T – Trauma (e.g. perineal tear) T – Tissue (retained placenta) T – Thrombin (bleeding disorder)

Question 32

preventative measure ofPPH

Answer 32

Treating anaemia during the antenatal period Giving birth with an empty bladder (a full bladder reduces uterine contraction) Active management of the third stage (with intramuscular oxytocin in the third stage) Intravenous tranexamic acid can be used during caesarean section (in the third stage) in higher-risk patients

Question 33

The most commonly used skin incision for c section. is a transverse lower uterine segment incision. There are two possible incisions: Pfannenstiel incision is a curved incision two fingers width above the pubic symphysis Joel-cohen incision is a straight incision that is slightly higher (this is the recommended incision) what are the layers that need to be dissected

Answer 33

Skin Subcutaneous tissue Fascia / rectus sheath (the aponeurosis of the transversus abdominis and external and internal oblique muscles) Rectus abdominis muscles (separated vertically) Peritoneum Vesicouterine peritoneum (and bladder) – the bladder is separated from the uterus with a bladder flap Uterus (perimetrium, myometrium and endometrium) amntioci sac There is a risk of aspiration pneumonitis during caesarean section, caused by acid reflux and aspiration during the prolonged period lying flat. H2 receptor antagonists (e.g. ranitidine) or proton pump inhibitors (e.g. omeprazole) are given before the procedure to reduce the risk of this happening.

Question 34

Venous Thromboembolism Having a caesarean section is likely to lead to a period of reduced mobility. Women should have a VTE risk assessment performed to determine the type and duration of VTE prophylaxis (follow local guidelines). Prophylaxis for VTE involves: Early mobilisation Anti-embolism stockings or intermittent pneumatic compression of the legs Low molecular weight heparin (e.g. enoxaparin)

Answer 34

contradinidcatd for c section

Question 35

Two key causes of sepsis in pregnancy are:

Answer 35

Chorioamnionitis | Urinary tract infections

Question 36

All patients admitted to maternity inpatient units, such as at the antenatal ward and labour ward, will have monitoring on a MEOWS chart. MEOWS stands for

Answer 36

maternity early obstetric warning system The non-specific signs of sepsis include: ``` Fever Tachycardia Raised respiratory rate (often an early sign) Reduced oxygen saturations Low blood pressure Altered consciousness Reduced urine output Raised white blood cells on a full blood count Evidence of fetal compromise on a CTG ``` Additional signs and symptoms related to chorioamnionitis include: Abdominal pain Uterine tenderness Vaginal discharge Additional signs and symptoms related to a urinary tract infection include: ``` Dysuria Urinary frequency Suprapubic pain or discomfort Renal angle pain (with pyelonephritis) Vomiting (with pyelonephritis) ```

Question 37

amniotic fluid embolism

Answer 37

amniotic fluid passes into the mother’s blood. The amniotic fluid contains fetal tissue, causing an immune reaction from the mother. This immune reaction to cells from the foetus leads to a systemic illne

Question 38

risk factors for amniotic fluid embolism

Answer 38

Increasing maternal age Induction of labour Caesarean section Multiple pregnancy

Question 39

symptoms of amniotic fluid syndrome

Answer 39

``` Shortness of breath Hypoxia Hypotension Coagulopathy Haemorrhage Tachycardia Confusion Seizures Cardiac arrest ``` A – Airway: Secure the airway B – Breathing: Provide oxygen for hypoxia C – Circulation: IV fluids to treat hypotension and blood transfusion in haemorrhage D – Disability: Treat seizures and consider other neurological deficits E – Exposure

Question 40

uterine rupture is what layer

Answer 40

myometrium Uterine rupture leads to significant bleeding. The baby may be released from the uterus into the peritoneal cavity. It has a high morbidity and mortality for both the baby and mother.

Question 41

The main risk factor for uterine rupture is a

Answer 41

previous c section

Question 42

symptoms of uterine rupture

Answer 42

``` Abdominal pain Vaginal bleeding Ceasing of uterine contractions Hypotension Tachycardia Collapse ``` main one Is cease of uterine contractions

Question 43

mamagement for uterien rutprue

Answer 43

emergency c section

Question 44

uterine inversion

Answer 44

fundus of the uterus drops down through the uterine cavity and cervix, turning the uterus inside out. Uterine inversion typically presents with a large postpartum haemorrhage. There may be maternal shock or collapse.

Question 45

management of uterine inversion

Answer 45

There are three options for treating uterine inversion: Johnson manoeuvre Hydrostatic methods Surgery Initial management of an inverted uterus is with the Johnson manoeuvre, which involves using a hand to push the fundus back up into the abdomen and the correct position. It is held in place for several minutes, and medications are used to create a uterine contraction (i.e. oxytocin). The ligaments and uterus need to generate enough tension to remain in place. Where the Johnson manoeuvre fails, hydrostatic methods can be used. This involves filling the vagina with fluid to “inflate” the uterus back to the normal position. It requires a tight seal Where both non-surgical methods fail, surgery is required. A laparotomy is performed (opening the abdomen) and the uterus is returned to the normal position. For example, they may require resuscitation, treatment of postpartum haemorrhage and blood transfusion.