week 4

Question 1

Visceral Pain

Answer 1

distension of the lower uterine segment, stretching of cervical tissues as it effaces and dilates, pressure and traction on adjacent structures (e.g., fallopian tubes, ovaries, ligaments) and nerves, and uterine ischemia

Question 2

Referred Pain

Answer 2

originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs

Question 3

Somatic Pain

Answer 3

intense, sharp, burning, and well localized

Question 4

Nerve Block Analgesia and Anaesthesia

Answer 4

local infiltration anaesthsia
spinal nerve block
epidural
nitrous oxide

Question 5

Maternal Hypotension

Answer 5

signs drop 20% from pre block baseline or less than 100mmHg systolic
fetal bradycardia
absent or minimal fetal heart variabiltiy

Question 6

Preterm Labour

Answer 6

Regular uterine contractions with cervical effacement and dilation before end of week 37
One of most common obstetric complications
Can be spontaneous or indicated
Tocolytic drugs: none first-line; may prolong pregnancy for 2 to 7 days while steroids are given to promote fetal lung maturity

Question 7

What is magnesium sulphate used for?

Answer 7

fetal neuroprotection

Question 8

What is Nifedipine used for?

Answer 8

Blocks calcium movement into muscle cells, inhibits uterine activity to reduce or arrest preterm labour

Question 9

What is Indomethacin used for?

Answer 9

Inhibits prostaglandin synthesis (stimulates contractions), therefore reduces uterine activity to delay or arrest preterm labour

Question 10

What is Betamethasone used for

Answer 10

Promotes fetal lung maturity by stimulating surfactant production; prevents or reduces risk of respiratory distress syndrome and intraventricular hemorrhage in the preterm neonate less than 34 weeks’ gestation

Question 11

Post Term Pregnancy

Answer 11

pregnancy continuing past 42 weeks gestation

Question 12

Maternal risks for Post Term Pregnancy

Answer 12

Caesarean birth, dystocia, birth trauma, postpartum hemorrhage, and infection

Question 13

Fetal Risks for Post Term Pregnancy

Answer 13

Macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, and cephalopelvic disproportion

Question 14

What is Dystocia?

Answer 14

Abnormally slow progress of labour caused by various conditions related to the five P’s of labour

Question 15

Induction of Labour

Answer 15

The deliberate initiation of labour through medical means:
Induction
Augmentation

Question 16

Induction:

Answer 16

Use of indwelling catheter
Use of osmotic dilator
Use of prostaglandins (Cervidil, Prostin, misoprostol)
Use of oxytocin
Artificial Rupture of Membranes (ARM)

Question 17

Forceps or Vacuum Assisted Birth

Answer 17

Application of traction to fetal head

Question 18

Operative Vaginal Deliveries

Answer 18

Application of forceps or a vacuum extractor to the fetal head to assist during the 2nd stage of labour and facilitate delivery.

Question 19

Caesarean Birth

Answer 19

Classic or low transverse incision
Major surgical procedure with accompanying risks

Question 20

Vaginal Birth After c Section

Answer 20

Controversy related to risk of uterine rupture and hemorrhage
Contraindications
Special areas of focus: consent, documentation, surveillance, and readiness for emergency

Question 21

5 P’s of labour

Answer 21

passenger, passage, powers, placenta, and psychology