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Question 1

What opioids can you use as pain relief in pregnancy and what are the SE and guidelines of it?

Answer 1

pethidine, diamorphine

SE: dizziness, nausea, vomiting

If given IV/IM = give an anti-emetic
Do not enter the pool within two hours

Question 2

What stage of labour does epidural analgesia prolong?

Answer 2

second stage of labour

Question 3

When should you offer a continuous CTG?

Answer 3

maternal pulse >120beats/min on two occasions 
epidural analgesia (offer for 30mins)
temperature 38 or above
suspected chorioamnitis/sepsis
presence of significant meconium
fresh vaginal bleeding in labour

Question 4

In a low risk labour, what foetal monitoring should you do?

Answer 4

intermittent auscultation of FHR after contraction for one minute every 15 minutes
palpate maternal pulse hourly

Question 5

If a rising baseline/decelerations are suspected, what foetal monitoring should you do?

If a rising baseline/decelerations are confirmed, what foetal monitoring should you do?

Answer 5

intermittent auscultation more frequently

summon help/advise continuous CTG

Question 6

Outline first, second, third and fourth degree perineal tears

Answer 6

1) fourchette, vaginal mucosa are damaged. underlying muscles are exposed, not torn
2) posterior vaginal walls and perineal muscles torn but anal sphincter intact
3) tear extends to anal sphincter but the rectal mucosa is intact
4) anal canal opened, rectum may be opened

Question 7

what are the indications for episiotomy?

Answer 7

rigid perineum
a tear seems imminent
instrumental delivery

mediolateral method is used

Question 8

what are the consequences of perineal trauma?

Answer 8

interfere with breast feeding and bonding of the baby
aggravate postpartum depression
incontinence

Question 9

what are risk factors for perineal tears?

Answer 9

primagravida
large babies
shoulder dystocia
forceps delivery

Question 10

What is the management of shoulder dystocia?

Answer 10

Stop mother pushing
McRoberts manouvre (patient hyperflexes and abducts hips against abdomen)
Rubin’s manouvre (reverse woods screw, post to ant)
Woods screw (ant to post)

Question 11

How does Erb’s palsy present?

Answer 11

Due to shoulder dystocia. brachial plexus palsy

‘waiter tip’ arm, slightly rotated

Question 12

What are the risk factors for stillbirth?

Answer 12

Fetal growth restriction
Preterm birth 
Afro-Caribbeans
Nulliparity 
Age <25 or >40
BMI >30

Question 13

List some possible causes of stillbirth

Answer 13

Congenital abnormality
Premature labour
P-PROM
IUGR
Cord prolapse

Question 14

What is the management of stillbirth?

Answer 14

When death is diagnosed antenatally = prostaglandins (2-3 days)
BP, urinalysis, temperature
FBC, clotting screen, Kleihaeur test HbA1c

Question 15

What is the initial management of a suspected antepartum haemorrhage?

Answer 15

Estimate amount of blood loss
Fetal distress = urgent delivery
Fetal monitoring
USS (exclude praevia)
FBC (group and save), clotting studies, Kleihauer test,

Question 16

What are the indications for instrumental delivery?

Answer 16

Failure to progress
Spinal cord injury
Myasthenia gravis 
Cardiovascular disease 
Hypertensive crisis 
Presumed fetal compromise

Question 17

What are the requirements for an instrumental delivery?

Answer 17

'FORCEPS'
Fully dilated cervix
Occipito-anterior position
Ruptured membranes 
Cephalic presentation
Engaged
Pain relief adequate 
Sphincter (bladder) empty

Question 18

What are common problems that occur in early puerperium?

Answer 18

Stress incontinence
Mastitis
Backache
Mental health problems

Question 19

When do you treat mastitis and how?

Answer 19

Treat if systemically unwell, if nipple fissure is present, or already been 12-24 hours

PO flucloxacillin 10-14 days
Continue breast feeding

Question 20

What score do you use to assess postpartum depression?

Answer 20

Edinburgh Postnatal Depression Scale

Question 21

How does ‘baby blues’ present?

Answer 21

3-7 days after birth
Anxious, tearful, irritable

Explanation and reassurance

Question 22

How does postnatal depression present?

Answer 22

Starts within a month, peaks at three months

Explanation and reassurance, CBT, sertraline/paroxetine can be used

Question 23

How does puerperal psychosis present?

Answer 23

Within 2-3 weeks following birth
Severe swings in mood and disordered perception

Admit to hospital

Question 24

How does puerperal pyrexia present? What are the causes? What is the management?

Answer 24

Temperature >38 in first 14 days after childbirth
Endometritis is the most common cause. Also caused by UTI/VTE/mastitis

If endometritis is suspected, refer to hospital: IV clindamycin and gentamicin