Session 10: Group Work

Question 1

Give factors that may restrict fetal growth.

Answer 1

Malnutrition

Hypoxaemia

Alcohol

Smkoing

Infection

Hereditary

Question 2

Names some USS measurements that are routinely taken to monitor fetal growth later in pregancy.

Answer 2

Abdo circumference

Biparietal diameter

Femur length

Question 3

What is asymmetrical growth restriction?

Answer 3

When the head doesn’t stop growing (as well as other vital organs) but the rest of the body does.

If there is asymmetrical growth usually later in pregnancy when vital organs have developed.

Question 4

Which organs are being assessed by each parameter.

Fetal movement

Fetal breathing movement

Fetal tone

Amniotic fluid volume

Fetal heart rate response to movement

Answer 4

FM - Nervous system , MSK

FBM - Resp/MSK

FT - MSK

Amniotic fluid volume - Urinary, GI, Resp

Fetal heart rate response to movement - Cardiovascular/nervous

Question 5

In a non-stress test, 3 or more fetal movements should be
accompanied by a rise in fetal heart rate. Over a 30-minute period you record neither fetal movement nor- change in heart rate. Should you be concerned?

Answer 5

Not necessarily. The fetus could be sleeping during that time period. Usually the fetus only sleep for about 40 minutes so there might be concern to be raised.

Question 6

Why is oligohydramnios associated with compromise of the uteroplacental circulation like pre-eclampsia.

Answer 6

Poor uteroplacental circulation like placental insufficiency due to less blood to placenta and fetus.

This leads to a redirection of the blood to the brain of the fetus.

Less blood goes to abdo and kidneys and this means less urine output -> less amniotic fluid.

Question 7

Fetal urine contributes to the volume of amniotic fluid. At what stage is urine first produced?

Answer 7

9 weeks

Question 8

Prior to this, how is amniotic fluid produced.

Answer 8

Maternal plasma through the placental membrane.

Question 9

How might uteroplacental or fetoplactental circulations be investigated.

Answer 9

Doppler sonography (USS)

Question 10

As the fetus swallows and digests amniotic fluid. Identify a fetal GI tract defect that might lead to excessive amniotic fluid volume.

Answer 10

Tracheo-oesophageal fistula

Question 11

What is the aerage fetal heart rate at term?

Answer 11

110-160 bpm

Question 12

What are the advantages of a scalp electrode in monitoring fetal heart rate?

Answer 12

Continuous monitoring

Nothing obstructive in the way as well.

Question 13

What signs could suggest fetal distress?

Answer 13

Bradycardia

Meconium staining

Reduced movement

Question 14

Which cells secrete surfactant?

Answer 14

Pneumocytes type 2

Question 15

At what gestational age does surfactant production begin and how is this significant in prematurity?

Answer 15

Week 26-30

Not enough surfactant can lead to respiratory distress.

This can be treated with corticosteroids.

Question 16

What is the difference between effacement and dilation of the cervix?

Answer 16

Effacement is the thinning of the cervix

Dilation - increased diameter

Question 17

What feature of uterine smooth muscle contributes to the shortening of the cervix?

Answer 17

Brachystasis where when the myometrium contracts they won’t relax fully again.

Question 18

What maternal and fetal landmarks are used to assess fetal head position in the birth canal?

Answer 18

Maternal - Ischial spine

Fetal - fontanelles

Question 19

An epidural is a common procedure for analgesia during labour. What ligaments of the spine will the needle pass through in this procedure?

Answer 19

Supraspinous ligament

Interspinous ligament

Ligamentum flavum

(Dura)

Question 20

What neurological structure in the fetus is at risk of damage during delivery of a fetus in shoulder dystocia?

Answer 20

Brachial plexus

Question 21

What would you exptect to see on examination if the upper part C5-C6 of the brachial plexus is damaged during delivery?

Answer 21

Erb’s palsy

Waiter’s tip where the arm is internally rotated

Elbow is extended

Wrist is flexed

Question 22

What would you expect to see on examination of the lower part C8-T1 of the brachial plexus is damaged during delivery?

Answer 22

Klumpske’s palsy

Claw hand deformity

Hyperextension of MCPJs and flexion och PIPs and DIPs

Question 23

Give a cause of shoulder dystocia.

Answer 23

Gestational diabetes

Question 24

Define post-partum.

Answer 24

Excessive haemorrhage per vaginum after delivery til 6 weeks.

Primary - <24 hrs

Secondary >24 hrs to 6 weeks.

Question 25

What is the most common cause of PPH?

Answer 25

Uterine atony

Question 26

What effect does oxytocin have during delivery?

Answer 26

Causes increased uterine contraction frequency and amplitude

Question 27

Therefore why can oxytocin sometimes be used to treat PPH?

Answer 27

More forceful contraction (or in case of generally weak contraction) leads to compression of the blood vessels and prevents bleeding.

Question 28

What physiological mechanism exists?

Answer 28

Increased clotting

Question 29

If the uterus is firm on palpation with continuous bleeding, what other cause should you consider?

Answer 29

Retained uterus

Question 30

The patient has lost 1.5 l of blood. What state will likely result from this degree of blood loss?

Answer 30

Hypovolaemic shock (not necessarily the case since increased blood volume (mainly plasma))

Question 31

What additional symptoms and/or signs might you expect to be present in this case?

Answer 31

Tachycardia

Pallor

Hypotension

Cold, clammy hands

Dizziness

Confusion

Tachypnoea