Management Of Labour

Question 1

Causes of an abnormal ctg trace?

Answer 1

1. Maternal hypotension
2. Uterine hypertonus
   3 placental separation
   4 prolapsed cord
   5 drug effects

Question 2

At what ph of the fetal blood sample is immediate action (delivery) required?

Answer 2

7.20

Question 3

Causes of fetal bradycardia

Answer 3

1. Asphyxial stress
   2) arrhythmias
2. Drugs- beta blockers and local anaesthetics
3. Hypothermia

Question 4

Causes of fetal tachycardia

Answer 4

1. Asphyxia
2. Maternal infection or fetal infection
3. Beta sympathomimetics
4. Extreme immaturity

Question 5

Causes of decreased baseline variability

Answer 5

1 asphyxia

2. Drugs
3. An absent cerebral cortex (anencephaly)

Question 6

Causes of falsely low scalp ph

Answer 6

Supine hypotension, ketoacidosis, decreased perfusion, heparin, amniotic fluid contamination and delay in measurement

Question 7

Causes of falsely high scalp ph

Answer 7

Intermittent insult and buffered, hyperventilation and infection, use of plastic tubes.

Question 8

Indications of inserting an intra uterine catheter

Answer 8

1. Trial of scar
   2 multiparous patient (especially if using oxytocin)
   3, trial of labour, variable indications
2. Poor progress of labour

Question 9

What parameters of uterine activity does the iuc measure vs the ctg

Answer 9

Iuc: intensity of contraction
Ctg: frequency and duration

Question 10

What are the hazards of oxytocin

Answer 10

1) excess uterine activity resulting in hypoxia of the fetus
2) water retention and intoxication
3) uterine rupture
4) hyperbilirubinaemia which is dose related

Question 11

How are oxytocic drugs administered in the second and third stage of labour

Answer 11

5 units of syntocinon IM as deliveryof the anterior shoulder occurs, 0,5 units ergometrine after delivery of the placenta

Question 12

What are the steps in delivering the placenta?

Answer 12

1 divide the umbilical cord between clamps
2 placental end can remain clamped or be allowed to drain
3 wait for the uterus to contract strongly - accompanied by strong bleeding to indicate placental separation
4 deliver the placenta by steady controlled cord traction. Counter traction being applied to the uterus supra pubically in a cranial direction
5. After delivery of the placenta, rub up the uterus until firmly contracted and administer ergometrine unless contra indicated

Question 13

What is the management of retained placenta without haemorrhage?

Answer 13

1. Wait 30 minutes
   2 repeat controlled cord traction
2. Perform a gentle vaginal examination:
   - placenta in vagina: remove
   - placenta trapped in cervix: usually will deliver in 30 minutes. If not: administer salbutamol. Give 2.5 ml over two minutes. Attempt controlled cord traction and if successful administer ergometrine 0.5 mg im after delivery of placenta
   - placenta in uterus: start iv infusion and arrange for manual removal in theatre