Obstetrics and Gynaecology

Question 1

Benefits of delayed cord clamping

Answer 1

1. Higher birth weight
2. Higher haemoglobin concentration
3. Improved iron stores at 6months
4. Improved respiratory transition

Question 2

3 stages of labour

Answer 2

1. From onset of regular contractions to full dilatation of the cervix
2. From full dilatation of the cervix to delivery of the baby
3. From delivery of the baby to delivery of the placenta

Question 3

Three classical signs of placental separation

Answer 3

1. Lengthening of the umbilical cord
2. Gush of blood from the vagina, signifying separation of the placenta from the uterine wall
3. Change in the shape of uterine funds from discoid to globular, with elevation of fundal height

Question 4

Risk factors for PPH

Answer 4

Antenatal factors:
1. Mother's age >35yrs
2. Asian ethnicity
3. Obesity (BMI >35)
4. Grand multiparity
5. Existing uterine abnormalities
6. Maternal blood disorders
7. History of previous PPH or retained placenta
8. Anemia of <9g/dl at onset of labour
9. APH associated with suspected or proven abrutio placentae/placenta praaevia
10. Over distension of uterus: multigravida, polyhydramnios, macrosomia (>4kg)
Intrapartum factors:
1. Prolonged labour
2. Chorioamnionitis, fever during labour
3. Amniotic fluid embolism/ DIC
4. Uterine inversion
5. Genital tract trauma
Post natal:
1. Retained products
2. Amniotic fluid embolism/DIC
3. Drug induced hypotonia
4. Bladder distension preventing uterine contraction