WEEK 2

Question 1

What is labor?

Answer 1

This is the presence of regular painful uterine contractions of increasing frequency and intensity that cause progressive cervical effacement and dilation, accompanied by pelvic descent and subsequent expulsion of the products of conception.

Question 2

What is your own understanding about a “show”?

Answer 2

This is a blood stained mucus released from the cervix and expelled through the vagina during the onset of labour.

Question 3

What is considered as normal pregnancy?

Answer 3

*Full term pregnancy ( 37-42/54 weeks)
*Singleton pregnancy ( birth of only one child during a single pregnancy with a gestation period of 20/54 weeks or more)
*Vertical presentation of the fetus
*The labour should be spontaneous
* Live fetus

Question 4

Briefly define the first stage of labour?

Answer 4

The 1st stage of labour begins with the onset of uterine contractions of sufficient frequency and intensity which subsequently lead to cervical effacement and dilation. The 1st stage of labour ends when cervix is fully dilated at 10cm.

Question 5

State the average and range of duration of the 1st stage of labour in primigravida and multigravida.

Answer 5

PRIMIGRAVIDA

 Average= 12/24hrs
 Range=      6-18/24hrs #MULTIGRAVIDA
   Average=7/24hrs
    Range= 2-10/24hrs

Question 6

In terms of labour progression and cervical changes occurring during labour, what difference will see in nulliparous woman and a woman of parity 2 or more.

Answer 6

With a nulliparous woman, duration of labour( 6-18hrs), and cervical effacement and dilation will occur within longer period
With a woman of parity 2 or more, duration of labour( 2-10hrs), and cervical effacement and dilation will occur within a short period.

Question 7

*Uterine contractions are less frequent
*They is slow effacement and dilation of the cervix
* Slow progression from onset of labour pains to 5cm cervical dilation.

Answer 7

Latent phase of the first stage of labour

Question 8

What are the characteristics of the active phase in the 1st stage of labour.

Answer 8

They is rapid progression from 6cm to full dilation of the cervix (10cm)
NOTE! Average progression cervical dilation:
1.2cm/hr in PG
1.5cm/hr in MG

Question 9

Starts from a fully dilated cervix and ends with the delivery of the fetus.

Answer 9

second stage of labour

Question 10

How do we assess progression during the second labour.

Answer 10

By assessing the descent of the presenting part.

Question 11

Drop of fetal head/fetus into the birth canal

Answer 11

Lightening

Question 12

What is used as a reference to assign numbers in the fetal station.

Answer 12

Ischial spines

Question 13

What enables extension of the head to occur during labour.

Answer 13

Anatomical position of vulvar; vulvar is directed upward and forward

Question 14

The fetal heart-rate intermittent observations are done immediately after uterine contraction. Preferably which position is best to conduct such observation

Answer 14

Left lateral position

Question 15

What is the normal heart beat range for a fetus.

Answer 15

110-160 bpm

Question 16

What is Ante-natal care

Answer 16

This involves a coordinated approach to medical care and psychosocial support that optimally begins before conception and extends throughout the antepartum period.

Question 17

“Ensuring that all women have access to the information and care they need to go safely through pregnancy, childbirth and puerperium”, is known as

Answer 17

Safe motherhood

Question 18

List the essential health sector interventions for safe motherhood

Answer 18

*Family planning
*Postabortion
*Antenatal care
*Clean/safe delivery
*Postpartum care
*Essential obstetric care

Question 19

How many scheduled visits are recommended during antepartum?

Answer 19

8 visits

Question 20

When should intermittent preventative treatment of malaria be initiated

Answer 20

13 weeks of pregnancy

Question 21

Defined as the time from the delivery of the placenta throughout until 6weeks post-partum.

Answer 21

Puerperium/ postnatal period

Question 22

List 3 objectives of postnatal care

Answer 22

*Prevent or detect and manage complications
*Promote and maintain well-being of the mother and child
*Contraception and resumption of sexual activity

Question 23

Explain what is meant by maternal death.

Answer 23

Death of a woman while pregnant or within 42days following termination of pregnancy, regardless of the duration and site of the pregnancy. The death was a result from pregnancy but not accidental causes.

Question 24

Differentiate between direct and indirect obstetric death

Answer 24

Direct obstetric death is death resulting from obstetric complications of pregnancy state, incorrect treatment and intervention WHILE Indirect obstetric death is death due to pre-existing or pregnancy acquired disease and are not due to direct obstetric causes

Question 25

Defined as deaths from unrelated causes which happened to have occurred in pregnancy or puerperium

Answer 25

Coincidental

Question 26

What are the leading causes of maternal death in Botswana

Answer 26

Haemorrhage ( 28%)
Eclampsia (16%)
Abortion ( 11%)

Question 27

List 4 approaches to measure maternal mortality

Answer 27

Civil registration system
Verbal autopsy
Census
Maternal mortality reviews

Question 28

List any 5 of the top ten leading causes of maternal death

Answer 28

Severe pre-eclampsia
Rupture of the uterus during labor
HELLP syndrome
Viral diseases complicating pregnancy, childbirth, and the puerperium
tubal pregnancy

Question 29

List any 4 interventions that can be adopted to reduce maternal morbidity and mortality

Answer 29

Early registration of pregnancy.
Community education through all platforms.
Prevent unwanted pregnancies ( use of contraceptives).
Maternal Mortality Audits and implementation of recommendations.

Question 30

Encirclement of the widest diameter of the fetal head by the vulvar ring

Answer 30

Crowning

Question 31

When to consider episiotomy?

Answer 31

*Risk of severe perineal tear
*Large baby
*Shoulder dystocia

Question 32

State the signs of placental separation

Answer 32

*Uterus becomes globular and firm
*There is a sudden gush of blood
*Umbilical cord protrudes farther out the vagina

Question 33

State 5 neonatal difficulties that may arise at birth.

Answer 33

*Lack of respiration effort
*Blockage of airways
*Impaired lung function
*Persistent increased pulmonary vascular resistance/ persistent pulmonary hypertension
*Abnormal cardiac structure