Obstetrics (General questions)

Question 1

Do you apply oxygen to the mother in a cord prolapse? If so how much?

Answer 1

Yes, High flow non rebreather mask

Question 2

If birth is not imminent, how do you manage the cord?

Answer 2

• Minimise cord handling
• Keep cord warm and moist
• Use 2 fingers to gently place the cord into the vagina
• If unsuccessful cover with warm saline pack
• If there is pressure on the cord by the presenting part insert fingers into the vagina and push the presenting part away from the cord
• Maintain pressure until birth is commenced or advised to release

Question 3

What is the appropriate position for a women with a cord prolapse?

Answer 3

Semi prone with hips elevated over folded towels

Question 4

What are the key questions that should be asked when assessing a patient with a cord prolapse?

Answer 4

1. If membranes have ruptured and at what time
2. How long has the cord been visible
3. Due date
4. Foetal movement felt
5. Onset of Labout
6. Contractions present?
7. Foetal presentation (if known)
8. PV bleeding

Question 5

When performing a focused maternity assessment what other questions need to be asked in addition to a routine history/examination?

Answer 5

• Previous pregnancies Any/number of previous pregnancies?
• Prior C sections/interventions?
• Complications/problems with previous pregnancies
• Length of previous labours

Current pregnancy

• How many weeks pregnant are you
• Are you expecting singleton or multiple pregnancies?
• Have the membranes ruptured? What is the colour of the amniotic fluid?
• Are you having contractions? Assess the frequency and duration
• Do you have the urge to push?
• have you felt foetal movements? more/less or same as normal?
• Hospital interventions (if any)?
• Do you anticipate any problems/complications (baby/mother)?
• Have you had any antenatal care?
• Any current complaints?
  
  • Vaginal bleeding/PV blood loss
  • High BP
  • Trauma
  • Any other issues

Question 6

What are the stages of labour?

Answer 6

• 1st stage: regular 20-60 second painful contractions @ 2-20 mins
• 2nd stage: up to birth of baby
• 3rd stage: placental delivery
• Rupture of membranes

Question 7

What are the signs of imminent birth?

Answer 7

• active pushing/grunting
• rectal pressure - urge to use bowels or bladder
• anal pouting/bulging perineum
• strong unstoppable urge to push
• presenting part (babys head) on view “crowning”
• Mothers statement: “I am going to have the baby”

Question 8

Where do you transport the patient is birth is imminent?

Answer 8

• to the closest hospital with a maternity service