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A. MLA Map Obstetrics and Gynaecology > Midwifery and Labour > Flashcards

Midwifery and Labour Flashcards

1
Q

Which of the following is NOT one of the 4 Ps that make up mechanical labour?

1 - Position
2 - Power
3 - Passenger
4 - Passage
5 - Psyche

A

1 - Position

  • psyche refers to the patients mindset in relating to labour and contractions
  • passenger relates to the babies position
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2
Q

Power is one of the 4Ps that make up the mechanical labour. Power refers to:
- uterine contraction
- maternal pushing

Which of the following is NOT as a direct response to involuntary uterine contractions?

1 - dilation of the cervix
2 - reduce maternal blood pressure
3 - effacement of the cervix
4 - facilitates baby descending in the uterus

A

2 - reduce maternal blood pressure

  • as the baby descends, pressure is applied to the vaginal walls and uterus that initiates maternal pushing
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3
Q

In active labour how regular should the uterine contractions be?

1 - every 1 minute
2 - every 5 minutes
3 - every 10 minutes
4 - every 30 minutes

A

3 - every 10 minutes

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4
Q

In active labour, contractions are expected every 10 minutes. Typically how many occur in that time period?

1 - 1-2 contractions
2 - 3-4 contractions
3 - 5-10 contractions
4 - 10-20 contractions

A

2 - 3-4 contractions
- each contraction should last around 10 seconds
- contractions can be strong or moderate to palpate

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5
Q

What medication is used in an attempt to induce contractions?

1 - oxytocin
2 - prostin
3 - propess
4 - prostaglandin

A

4 - prostaglandin
- soften the cervix and help open the cervix secreted from the decidua

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6
Q

In active labour what medication is used in an attempt to increase the strength and frequency of the contractions ?

1 - oxytocin
2 - prostin
3 - propess
4 - prostaglandin

A

1 - oxytocin

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7
Q

In active labour what medication can be used in an attempt to decrease or stop the contractions ?

1 - oxytocin
2 - toccolytics
3 - propess
4 - prostaglandin

A

2 - toccolytics
- suppress uterine contractions

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8
Q

Which of the following is NOT an example of mechanical methods to induce labour?

1 - dialpan rods
2 - rupture of membranes
3 - foleys catheter
4 - oxytocin

A

4 - oxytocin

  • balloon of foleys catheter is inflated to expand dilate and efface the cervix
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9
Q

Which of the following are used to assess the passage of labour?

1 - speculum
2 - manual vaginal examination
3 - episiotomy
4 - all of the above

A

4 - all of the above

  • episiotomy cuts transverse perineal muscle, bulbocavernosus muscle if perineum looks like it may rupture
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10
Q

The following are positions a foetus can be in. Which of the following is the optimal option for a vaginal delivery?

1 - breach
2 - longitudinal
3 - cephalic
4 - oblique

A

3 - cephalic
- use abdominal examination and ultrasound

  • all the other positions will need a C-section
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11
Q

When identifying the babies position we use 3 letters.

1st letter = baby is on left or right
2nd letter = part of baby in the pelvis
3rd letter = baby is in anterior or posterior part of pelvis

A

As an example R.O.P =

  • R = right
  • O = icciput
  • P = posterior part of pelvis
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12
Q

Which of the following are part of psyche, which relates to the patients psychological well being?

1 - birth choice
2 - anxiety
3 - exhaustion
4 - past experience
5 - expectations
6 - environment
7 - support
8 - all of the above

A

8 - all of the above

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13
Q

What is progress of labour determined by?

1 - babies head in relation to the ASIS
2 - babies head in relation to the ischial spine
3 - babies shoulders in relation to the ischial spine
4 - babies shoulders in relation to the ASIS

A

2 - babies head in relation to the ischial spine

  • a score of -5 indicates the baby is not that progressed -2 and -3 are a high head
  • a score of +5 indicates a baby is very progressed
  • a score of +3 means head would be visible at perineum
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14
Q

As labour progresses, which is assessed using the descent of the foetus head in relation to the ischial spines​, what happens to the babies position as it moves through the pelvis?

1 - must stay in a straight line to be delivered
2 - must turn over and leave face 1st
3 - leave feet 1st during labour
4 - twists and turns to pass through the cervix

A

4 - twists and turns, called the mechanism of labour

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15
Q

The stages of labour can be divided into 3 stages. The first stage is split into the latend phase and the established 1st phase. What is the latent phase of labour?

1 - cervix becomes soft and thin as it gets ready to dilate
2 - cervix is fully dilated, head descends the vagina, delivery of the baby
3 - delivery of the placenta & membranes
4 - regular painful contractions with progressive cervical dilatation from 4cm

A

1 - cervix becomes soft and thin as it gets ready to dilate

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16
Q

What are the 2nd and 3rd stages of normal labour?

1 - cervix becomes soft and thin as it gets ready to dilate
2 - cervix is fully dilated, head descends the vagina, delivery of the baby
3 - delivery of the placenta & membranes
4 - regular painful contractions with progressive cervical dilatation from 4cm

A 
2nd  = cervix is fully dilated, head descends the vagina, delivery of the baby
3rd = delivery of the placenta & membranes
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17
Q

The stages of labour can be divided into 3 stages. The first stage is split into the latend phase and the established 1st phase. What is the established 1st phase of labour?

1 - cervix becomes soft and thin as it gets ready to dilate
2 - cervix is fully dilated, head descends the vagina, delivery of the baby
3 - delivery of the placenta & membranes
4 - regular painful contractions with progressive cervical dilatation from 4cm

A

4 - regular painful contractions with progressive cervical dilatation from 4cm

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18
Q

The stages of labour can be divided into 3 stages. The first stage is split into the latend phase and the established 1st phase. What is the latent phase of labour?

1 - cervix becomes soft and thin as it gets ready to dilate
2 - cervix is fully dilated, head descends the vagina, delivery of the baby
3 - delivery of the placenta & membranes
4 - regular painful contractions with progressive cervical dilatation from 4cm

A

1 - cervix becomes soft and thin as it gets ready to dilate

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19
Q

What are the 2nd and 3rd stages of normal labour?

1 - cervix becomes soft and thin as it gets ready to dilate
2 - cervix is fully dilated, head descends the vagina, delivery of the baby
3 - delivery of the placenta & membranes
4 - regular painful contractions with progressive cervical dilatation from 4cm

A

2nd = cervix is fully dilated, head descends the vagina, delivery of the baby

3rd = delivery of the placenta & membranes
- uterus contracts to help detachment of placenta
- an active 3rd stage means medication has been given to help deliver the placenta, typically used for women at risk of PPH

20
Q

As labour progresses, which is assessed using the descent of the foetus head in relation to the ischial spines​, the baby twists and turns, called the mechanism of labour. Why does this occur and does it need assistance?

A
  • helps baby navigate through the shape and curves of the pelvis
  • this is a ‘hands off’ moment as could cause problems
21
Q

What is crowning?

A
  • the baby’s head can be seen completely at your vulva
  • most painful time for the mother and perineum needs to be protected
  • immenent for baby to be born now
  • head no longer moves in and out with contractions
22
Q

What is the Ferguson reflex?

A
  • a neuroendocrine reflex comprising the self-sustaining cycle of uterine contractions initiated by pressure at the cervix, more precisely, the internal end of cervix, or vaginal walls
23
Q

What is the partogram?

1 - monitor to record babies HR
2 - monitor to record maternal HR
3 - document to monitor medication given throughout labour
4 - document to record labour observations and progression

A

4 - document to record labour observations and progression

  • useful for identifying complications of labour, such as long or obstructed labour
24
Q

In labour how much is the cervix expected to dilate every 1 hour?

1 - 1-2cm
2 - 2-4cm
3 - 1-5cm
4 - 4-6cm

A

1 - 1-2cm
- used to identify if a women is not progressing in labour

25
Q

Which of the following are complications that could occur in abnormal labour?

1 - maternal infection (chorioamnionitis)
2 - foetal compromise
3 - uterine atony leading to PPH post delivery
4 - all of the above

A

4 - all of the above

26
Q

In active labour we need to monitor the foetal heart for how long after every contraction?

1 - every minute for 15 minutes
2 - every minute for 12 minutes
3 - every minute for 10 minutes
4 - every minute for 5 minutes

A

1 - every minute for 15 minutes

  • monitor foetal HR every 5 minutes for 1 minute in the 2nd stage of labour
27
Q

Patients at high risk in pregnancy should have continuous monitoring, some examples include:

  • Diabetic women on medication
  • Pre-eclampsia, Hypertension
  • Abnormal fetal dopplers
  • Prematurity (<37 weeks)
  • Gestation >42 weeks
  • Non-cephalic presentation
  • Multiple pregnancies
  • Reduced fetal movements in the last 24 hours
A
28
Q

What is the normal HR in pregnancy?

1 - 60-80bpm
2 - 80-100bpm
3 - 110-160bpm
4 - 150-200bpm

A

3 - 110-160bpm
- using the CTG we can identify any rise of fall in foetal HR

29
Q

Variation in the foetal HR is normal and is as a function of nervous system, baroreceptors, chemoreceptors and cardiac responsiveness. What is an acceptable variability?

1 - 1-10bpm
2 - 5-25bpm
3 - 25-50bpm
4 - 50-100bpm

A

2 - 5-25bpm

30
Q

Accelerations of HR, which are an increase in 15bpm for at least 15 seconds. Is this a good or bad things?

A
  • good thing
  • absence, or deceleration (>15bpm for >15 secs) can suggest umbilical cord compression during contractions
31
Q

Shoulder dystocia is when the baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body. Can this be dangerous?

A
  • yes
  • obstetric emergency
32
Q

In shoulder dystocia, is it more common for the anterior or posterior shoulder of the baby to become lodged in the female pelvis?

A
  • anterior shoulder
33
Q

In shoulder dystocia, is it more common for the anterior shoulder of the baby to become lodged in the female pelvis. Specifically where does it become lodged on?

1 - pubic symphysis
2 - ischial spine
3 - sacral promontary
4 - coccyx

A

1 - pubic bone

34
Q

In shoulder dystocia, is it more common for the anterior shoulder of the baby to become lodged in the female pelvis. Specifically where does it become lodged on?

1 - pubic symphysis
2 - ischial spine
3 - sacral promontary
4 - coccyx

A

3 - sacral promontary

35
Q

It can be hard to predict shoulder dystocia. Which of the following is NOT a risk factor for shoulder dystocia?

1 - maternal diabetes / high BMI
2 - previous shoulder dystocia
3 - prolonged labour
4 - microsomia
5 - induced labour
6 - post term labour
7 - instrumental delivery

A

4 - microsomia
- macrosomia is a risk factor

36
Q

Which 2 of the following are maternal complications following shoulder dystocia?

1 - post partum haemorrhage
2 - new onset diabetes
3 - 3rd or 4th degree tears
4 - infection

A

1 - post partum haemorrhage
3 - 3rd or 4th degree tears

37
Q

Which of the following is NOT a foetal complications following shoulder dystocia?

1 - brachial plexus damage
2 - death
3 - hypoxic-ischaemic encephalopathy
4 - infection

A

4 - infection

38
Q

In a patient with suspected shoulder dystocia you should call for help and tell the mother to stop pushing. All of the following are management options, but which would be 1st line?

1 - Episiotomy
2 - Mcroberts manoeuvre
3 - Deliver posterior arm
4 - Internal rotation (corkscrew)

A

2 - Mcroberts manoeuvre
- hyperflex maternal hips to widen pelvic outlet (90% success alone) (1)
- then apply suprapubic pressure behind anterior shoulder (2)

  • if this fails try deliverying posterior shoulder and corkscrew, and if that fails move to episiotomy
39
Q

What % of pregnancies occur when baby is in breech position?

1 - 3-4%
2 - 10-20%
3 - 30-40%
4 - 50-60%

A

1 - 3-4%
- babies buttocks are in bottom segment of pelvis

40
Q

Match the type of breech with the image?

1 - footling breech
2 - frank breech
3 - complete breech

A

From left to right:

2 - frank breech
3 - complete breech
1 - footling breech

41
Q

Which of the following is NOT a risk factor for a breech position?

1 - Nulliparity
2 - Fibroids
3 - Placenta praevia
4 - Prematurity
5 - Macrosomia
6 - Polyhydramnios (raised amniotic fluid index)
7 - Multiple pregnancy
8 - Abnormality (e.g. anencephaly)

A

1 - Nulliparity
- multiparty is a risk factor

42
Q

If a patient is in breech position and is at term they should have a planned vaginal breechdelivery. Which of the following is NOT a management plan as part of this type of delivery?

1 - Deliver on labour ward
2 - IV cannula inserted
3 - CEFM by CTG
4 - experienced staff present
5 - Paediatric team on stand by
6 - Caesarean is inevitable

A

6 - Caesarean is inevitable
- this may be needed and surgery and anaesthetist should be aware, but NOT inevitable

43
Q

In a planned breech vaginal delivery, which of the following should be 1st line?

1 - c-section
2 - hands off approach
3 - lovest manoeuvre
4 - episiotomy with manual delivery

A

2 - hands off approach
- if no signs of foetal distress of hypoxia then wait up to 1h to allow descent of presenting part
- if possible allow women to push

44
Q

Which 2 of the following are optimal positions for delivery in a planned vaginal breech delivery?

1 - standing
2 - waterbath
3 - all fours
4 - semi-recumbent

A

3 - all fours
4 - semi-recumbent

45
Q

In a breech vaginal delivery, should the body of the foetus be guided or pulled through the vagina?

A
  • guided to keep the back in the uppermost position
  • no pulling
46
Q

Which manoeuvre can be used to deliver the arms when a baby is in the breech position?

1 - Lovsett’s manoeuvre
2 - Mauriceau–Smellie–Veit maneuver
3 - McRoberts maneuver
4 - Any of the above

A

1 - Lovsett’s manoeuvre

47
Q

Which manoeuvre can be used to deliver the head when a baby is in the breech position?

1 - Lovsett’s manoeuvre
2 - Mauriceau–Smellie–Veit maneuver
3 - McRoberts maneuver
4 - Any of the above

A

2 - Mauriceau–Smellie–Veit maneuver
- purpose is to flex the head

A. MLA Map Obstetrics and Gynaecology (29 decks)

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