O&G Labour

Question 1

Normal progress of active first stage

Answer 1

1 cm every 2 hours

Question 2

Active mx of 3rd stage

Answer 2

10iu Oxytocin IM

Question 3

9 mechanisms of labour

Answer 3

1. Engagement
2. Descent
3. Flexion
4. Internal Rotation
5. Crowning
6. Extension
7. Restitution
8. External rotation
9. Delivery of shoulders and body

Question 4

Immediate care of newborn

Answer 4

Dry baby
Skin to skin 
Clamp and cut cord
Apgar 1, 5 and 10 mins 
Breastfeeding wishing first hr
Vitamin K IM

Question 5

Prevention of preterm labour

Answer 5

1. Vaginal progesterone (16-24w until at least 34w)
2. Prophylactic cervical cerclage (<25mm + hx)
3. Rescue cervical cerclage (dilation at 16-27+6w)

Question 6

Mx of preterm labour

Answer 6

Admit
Steroids (IM betamethasone 12mg x 2 doses 12 hours apart)
Tocolytics (1. nifedipine 2. Atosiban)
Neuro protection (MgSO4 IV loading of 4g over 15 mins then infusion of 1g/hr for 24 hrs or until birth)

Question 7

Monitoring for MgSO4

Answer 7

Beware maternal toxicity - resp distress and arrhythmias

Monitor OBS and deep tendon reflexes every 4 hrs

Antidote 10ml 10% calcium gluconate over 10 mins

Question 8

Antidote for Magnesium Sulphate toxicity

Answer 8

Antidote 10ml 10% calcium gluconate over 10 mins

Question 9

Dx of P-PROM

Answer 9

Speculum - amniotic fluid in vagina

If unsure:
IGFBP-1
PAMG-1

Question 10

Risk factors for P-PROM

Answer 10

Smoking
STI
Hx
Multiple pregnancy

Question 11

Risks of P-PROM

Answer 11

Chorioamnionitis

Premature labour

Question 12

P-PROM mx

Answer 12

Admit
Speculum exam
Prophylactic abc (PO erythromycin 250mg QDS for 10 days or until labour)
Steroids (IM beclametasone 2x12mg)
IV mag sulph if birth expected in 24hrs
No tocolytics due to infection risk
Delivery if mature or signs of infection

Question 13

3 types of breech

Answer 13

Complete (cannonball)
Frank (legs straight up)
Footling

Question 14

Contraindications for ECV

Answer 14

Where C section is required
Abnormal CTG
Uterine anomaly 
Recent APH
ROM
Multiple pregnancy

Question 15

Risks and benefits of Vaginal breech vs C section

Answer 15

Vaginal breech delivery

• 40% risk of C section
• contraindications: footling
• if successful has fewest complications

C section

• small reduction if fetal mortality
• risks for future pregnancy (Preavia, VBAC, uterine rupture)

Question 16

Risk factors for breech delivery

Answer 16

Uterine malformations
Fibroids
Placenta praevia
Polyhydramnios
Oligohydramnios
Foetal anomaly
Prematurity

Question 17

Risks of ECV

Answer 17

50% success rate
Placental abruption
Foetal distress
Emergency C section