Obstetrics and Maternity

Question 1

What are the week ranges for the three trimesters of pregnancy?

Answer 1

• 1st Trimester
  
  • Weeks 1-12
• 2nd Trimester
  
  • Weeks 13-28
• 3rd Trimester
  
  • Weeks 29-40+

Question 2

What are definitions for “term” and “pre-term” delivery according to the CPGs?

Answer 2

• Term = 37⁰-40+ weeks gestation
• Pre-term = 24⁰-36⁶ weeks gestation

• Note: Superscripts are used to show days of gestation, so 36⁶ reads as “36 and 6” or “36 weeks and 6 days”.*
• Note: Definitions for minimum age of viability are variable. The standard for BCEHS is 24⁰ (CPG L01). Deliveries before this day are considered spontaneous abortions, and not pre-term deliveries*

Question 3

Describe the stages of labour

Answer 3

1. Contractions and Dilation (up to 12 hours or more)
   
   • Separated into “latent” phase with spordic, irregular contractions, and the “active” phase with regular, strong contractions and cervical dilation
2. Delivery of Child (up to 2 to 3 hours, shorter with multiparity)
   
   • involves the cardinal movements of birth. Head begins to be visible
3. Delivery of Placenta
   
   • May take up to 1 hr, but 15-30 minutes is usual
4. Recovery of Birthing parent

Question 4

Is hypertension normal in pregnancy? What are considered abnormal values for blood pressure in pregnancy?

Answer 4

NO!

SBP > 160 or DBP > 110 are signs of gestational hypertension/pre-eclampsia and warrant further investigation. Prepare for seizures!

Question 5

What are three critical types of information to establish when responding to a person in labour

Answer 5

• What is the birthing plan and is this a deviation?
• Is delivery imminent?
• Are there likely to be complications?

Question 6

What is Mark’s mnemonic to figure out if delivery is imminent, i.e. is the kid coming like a GMC TRUCK?

Answer 6

• Gestational age
  
  • Pre-term labours tend to be shorter
• Multiplets/more than one
  
  • Multiplets have shorter labour
• Contractions
  
  • Duration? Intensity? Timing?
• Time labour began
• Rupture of membranes
  
  • When? Color?
• Urge to push
• Crowning (and other visible signs)
  
  • Perineal bulging? Anal puckering?
• Kids before
  
  • How many? How long did they take?

Question 7

What are your endpoints/lines in the sand for transporting in active labour?