Obstetrics

Question 1

Contractions in first stage of labour

Answer 1

15-30 mins apart and 10-30 secs duration

Engagement occurs as the infants head enters the true pelvis

Question 2

Signs of Imminent Delivery

Answer 2

Bulging or stretching perineum 
Presenting part on view 
Anal pouting
Uncontrollable urge to push 
Urge to purge
Grunting 
Show

Question 3

Second stage of labour

Answer 3

time between complete dilation or cervix until delivery of baby

Question 4

Crowning

Answer 4

exert gentle downward pressure flexion on foetal head

support the perineum and control the head

Question 5

Third stage of labour

Answer 5

placental separation, lengthening of the cord

twist the cord to aid complete delivery of the placenta

Question 6

APGAR

Answer 6

appearance - pale, blue, pink
Pulse - absent, less than 100, greater than 100
Grimace - flaccid, some flex extremities, well flexed
Activity - no repsonse, grimace, cry
Respiratory - absent, weak, good crying

Question 7

First breath

Answer 7

once Co2 is no longer removed by the placenta, acidosis occurs which excites the resp centres to trigger the first inspiration

Question 8

Antepartum Haemorrhage

Answer 8

bleeding from the genital tract in pregnancy after 20 weeks gestation and before onset of labour

Question 9

Causes of antepartum haemorrhage

Answer 9

placenta praevia
placental abruption
trauma
cervicitis 
genital tumours/infections

Question 10

Placenta Praevia

Answer 10

placenta is partially or wholly implanted in the lower uterine segment
as the uterus grows and stretches this may cause the placenta to separate

Question 11

Placental Abruption

Answer 11

the premature separation of a normally situated placenta occurring after 20 weeks gestation

Question 12

Causes of placental abruption

Answer 12

pre-eclampsia
sudden reduction in size of the uterus
direct trauma to the abdo
deliberate violence

Question 13

Cord Prolapse

Answer 13

umbilical cord lies in front or beside the presenting part in the presence of ruptured membranes
Blood flow to the fetus is compromised due to cord compression

Question 14

Pre-disposing factors of cord prolapse

Answer 14

high presenting part of the fetus
a woman who has had more than 5 babies
prematurity
multiple pregnancy
excessive liquor volume
breech

Question 15

Rubin’s manouvere

Answer 15

identify the posterior shoulder on vaginal examination and then push shoulder in the direction of fetal chest
this will then rotate the anterior shoulder away from the symphysis pubis

Question 16

Breech

Answer 16

fetus lies longitudinally with the buttocks in the lower pole of the uterus
place woman on her back, hands off the breech
Turn the back uppermost

Question 17

Post partum haemorrhage

Answer 17

excessive bleeding from the womans genital tract at any time following the baby’s birth up to 6 weeks after

Question 18

Causes of post partum haemorrhage

Answer 18

incomplete placental separation
retained cotyledones, membranes
 precipitate labour 
prolonged labour
infection
placenta praevia or abruption
multiple pregnancy
general anaesthesia
full bladder

Question 19

Risk factors of post partum haemorrhage

Answer 19

previous history of pph or retained placenta
high parity
presence of uterine fibroids
anaemia
trauma to uterus, vagina, pernieum or labia