Maternity

Question 1

Name 3 cardiovascular changes that occur in pregnancy

Answer 1

-increased BP
-increased HR
- increased CO

Question 2

Miscarriages occur within the first __ weeks of pregnancy

Answer 2

23 weeks

Question 3

What does Gravida mean?

Answer 3

number of pregnancies

Question 4

what does parity mean?

Answer 4

how many times woman has given birth including, live births, stillbirths and terminations

Question 5

What is classed as pre-term birth?

Answer 5

under 37 weeks classed as premature
21 weeks + 6 days- comfort management

Question 6

How do you measure symphysis fundal height?

Answer 6

-Locate at the top of pubic bone, place tape measure
- measure to top of the uterus
- measurements should be in centimetres the number of weeks pregnant
- 20-36 weeks +/-2cm
- 36-40 weeks +/-3cm
- 40+ weeks +/-4cm
- Fundus at the level of the umbilicus is roughly 22 weeks.
- Fundal height below the umbilicus = <22 weeks = unlikely to survive pre-term birth.

Question 7

What question should we ask about foetal movement and position?

Answer 7

When did mum last feel baby move?
1. Longitudinal- head palpable over lower pelvis
2. Oblique- head palpable in the iliac fossa, but nothing in the lower uterine
3. Transverse- foetal felt in flanks, but nothing above

Question 8

Describe Cord management after birth

Answer 8

-Baby fully delivered, crying, dry, in mother’s arms/breastfeeding.
-Cord has stopped pulsating.
-Apply clamp 15cm from the baby umbilicus and apply second clamp 3cm further along.
-Cut between the two clamps, ensuring no part of the baby is in the way.

Question 9

what is a poor APGAR score?

Answer 9

<4= poor
4-6= fair
>7 Good

Question 10

When is the McRoberts manoeuvre used?

Answer 10

shoulder dystocia- knees to chest

Question 11

What is the next move in shoulder dystocia if McRoberts manoeuvre does not work?

Answer 11

suprapubic pressure-using CPR hands apply sustained pressure to the fetal back in a downward and lateral direction above the mother’s pubic symphysis. If continuous pressure is not successful a rocking movement may be tried. Do not apply fundal pressure.
- if unsuccessful- move mother onto all fours

Question 12

What do you do in a cord prolapse?

Answer 12

-don’t touch it with anything but a dry [ad to gently replace it with the vulva, keeps warm and prevents spasms, use a pad to prevent further prolapse
- walk to ambo- avoid chair or sitting position

Question 13

What does breech mean?

Answer 13

baby’s feet or buttocks are visible instead of head

Question 14

What do you do in a breech?

Answer 14

Position with legs supported or sitting on edge of chair or on all fours.
Observe for descent, hands poised ready to receive the baby or intervene.
Allow the baby to descend spontaneously - this will usually be in the sacroiliac (tum to bum) orientation.
Start a timer once the buttocks are delivered and encourage continuous pushing.
Allow the body to hang until the nape of the neck is seen and then support spontaneous birth of the head.
Do not clamp or cut the cord until the head has been delivered.
If delivery is delayed, the following additional manoeuvres should be considered:
Apply pressure behind the knees (Pinards manoeuvre) to help release the legs.
If the arms don’t deliver spontaneously, once the elbow is visible apply gentle pressure in the antecubital fossa to flex and release the arm.
Use Lovset’s manoeuvre to facilitate release the arms if they are extended behind the neck e.g. nuchal arm.
Use supra-pubic pressure and Mariceau-Smellie-Veit manoeuvre to aid delivery of the head if semi-recumbant.
Use shoulder press manoeuvre to aid delivery of the head if on all fours.

Question 15

What does En Caul mean?

Answer 15

baby and placenta born with amniotic sac intact

Question 16

What do you do in En Caul?

Answer 16

• pinch an area with thumb and forefingers away from placenta/ baby, attempt to rip open, if mo success, make a 1-2cm cut.
  Assess the baby using the normal birth/ NLS algorithm.
  -Note the colour/ odour of amniotic fluid.

Question 17

Describe the treatment plan for PPH

Answer 17

• Palpate the top of the uterus/ fundus (around umbilicus level), and massage with a cupped hand in a circular motion- EXCEPT IF PLACENTA IS UNDELIVERED.
• Will become firm and may be uncomfortable.
• IM syntometrine/SLG Misoprostol.
• Wide-bore IV access.
• IV TXA/IV fluids.
• Dress any tears.

Question 18

What direction do you displace the uterus to in a maternal cardiac arrest?

Answer 18

the left

Question 19

what positives does tilting the uterus to the left do in a maternity cardiac arrest?

Answer 19

relieves pressure of the vena cava

Question 20

When is misoprostol administered?

Answer 20

• PPH when syntometrine is contra-indicated or unavailable
• excessive bleeding from confirmed miscarriage

Question 21

When is syntometrine indicated?

Answer 21

-PPH
- confirmed miscarriage with excessive bleeding.

Question 22

When is Syntometrine contra-indicated?

Answer 22

• current severe hypertension (where BP is 140/90) or more or where systolic BP is 150mmHg or more consider alternatives e.g misoprostol
• known anaphylaxis to the active substances (ergometrine maleate with oxytocin injection).
  -Severe cardiac, liver or kidney disease. Consider administering even with severe cardiac, liver or kidney disease if bleeding is catastrophic.

Question 23

What is Syntometrine? and what does it do?

Answer 23

The oxytocin in Syntometrine® is a synthetic form which stimulates contraction of the uterus. Ergometrine also produces a sustained uterine contraction for the control of bleeding after birth.
Onset of action 2–7 minutes.

Question 24

What are the contra-indications of misoprostol?

Answer 24

-If there is any specific reason to suspect another fetus is in the uterus, do not administer any uterotonics.
-Known anaphylaxis to misoprostol or any other component of the product, or to other prostaglandins.