SOGC 336 Term labour

Question 1

Dystocia definition

Answer 1

Greater than 4 hours of < 0.5cm/hr
or
no cervical dilatation over 2 hours
 or
no descent in second stage for >1 hour (active pushing)

Question 2

Obesity increases what stage of labour?

Answer 2

First stage

Question 3

Epidural increases the length of what stage of labour?

Answer 3

Second stage

Question 4

Maximum dose of :

a) Lidocaine
b) Lidocaine with epinephrine
c) bupivacaine
d) bupivacaine with epineprhine

Answer 4

a) Lidocaine 4-5 mg/kg (300 mg max)
b) Lidocaine with epinephrine 7 mg/kg (500 mg max)
c) bupivacaine 2.5 mg/kg (175 mg max)
d) bupivacaine with epineprhine 3 mg/kg (225 mg max)

Question 5

Second stage of labour duration for:

a) nullip no epidural
b) nullip with epidural
c) multip no epidural
d) multip with epidural

How long can you wait for passive descent?

Reassess need for assisted delivery after how many hours of active pushing?

Answer 5

a) nullip no epidural–> 3 hours
b) nullip with epidural–> 4 hours
c) multip no epidural–>2 hours
d) multip with epidural–> 3 hours

Passive descent up to 2 hours (except multip with no epidural 1 hour)

2 hours

Question 6

Delayed cord clamping is associated with

a) term (2)
b) preterm

Answer 6

Term cord clamping > 60 secs:

• greater Hgb
• more frequent phototherapy

Pre-term cord clamping 60-180 sec

• decrease IVH
• less need for transfusion
• less risk of NEC

Question 7

Complications of oxytocin (4)

Answer 7

Fetal compromise (tachysystole)
Hypotension
Uterine rupture
Water intoxication (ADH effect)

Question 8

What are the risks associated with prolonged second stage >3 hours in nullip and >2 hours in multips?

Answer 8

PPH
Febrile mortality
Maternal OB trauma
Low APGARS
NICU admission
Birth depression

Question 9

Interventions for dystocia (5)

Answer 9

Rest
Analgesia
ARM
Oxytocin
Operative vaginal delivery