Labour

Question 1

Three phases of 1st stage of labour are..

Answer 1

Latent phase

Active phase

Transition phase

Question 2

In the latent phase of labour, there is _____ cervical dilation progressing at _____ an hour with _______ contractions

Answer 2

0-4cm dilation, 0.5cm an hour (nulliparous)

- Irregular contractions

Question 3

In the Active phase of labour, there is _____ cervical dilation progressing at _____ an hour with _______ contractions

Answer 3

4-7cm dilation, 1cm per hour

- Regular, longer contractions

Question 4

In the transitional phase of labour, there is _____ cervical dilation progressing at _____ an hour with _______ contractions every _____ minutes

Answer 4

7-10cm dilation

- Regular contractions every 2-3 mins

Question 5

Delay of the first labour stage occurs when there is _______

Answer 5

<2cm cervical dilation in 4 hours.

Question 6

First line management of crossing the ‘alert’ line in a partogram

Answer 6

Amniotomy, repeat assessment in 2 hours.

Question 7

First line management of crossing the ‘action’ line in a partogram

Answer 7

Escalation to obstetric-led care

Question 8

Delayed 2nd stage of labour occurs when…

Answer 8

Pushing lasts for >2 hours in nulliparous or 1 hour in multiparous

Question 9

Causes of delayed 2nd stage of labour

Answer 9

3 Ps

• Power: weak uterine contractions
• Passenger: fetal complications
• Passage: shape/size of pelvis

Question 10

Fetal qualities that can delay labour

Answer 10

Macrosomia
- shoulder dystocia can occur

Attitude
- Posture of the fetus

Lie
- Oblique and transverse

Presentation
- Breech/ shoulder

Question 11

Delayed 3rd stage of labour is defined as…

Answer 11

> 30 mins with active management

> 60mins with physiological management

Question 12

Risk factors for shoulder dystocia

Answer 12

Macrosomnia

Small pelvis

Question 13

Interventions for shoulder dystocia

Answer 13

1. McRoberts’s position (legs brought behind head)
2. Pressure on pubic symphysis (pressure on anterior shoulder)
3. Rubin’s manoevre
4. Wood’s screw manoevre

Question 14

Signs of shoulder dystocia

Answer 14

Obstruction in delivering shoulders

Failure of restitution (face remains downwards)

Turtle-neck sign (head retracting back to vagina)

Question 15

Rubins manoevre

Answer 15

Manoevre for shoulder dystocia

Involves putting forward pressure on posterior aspect of anterior shoulder

Question 15

The __________ manoeuver involves pushing the baby’s head back into the vagina during delivery for C-section

Answer 15

Zavanelli

Question 16

Shoulder dystocia complications

Answer 16

Fetal hypoxia/ brain damage

Brachial plexus injury (i.e. Erb’s palsy)

Perineal tear

PPH

Question 16

Shoulder dystocia complications

Answer 16

Fetal hypoxia/ brain damage

Brachial plexus injury (i.e. Erb’s palsy)

Perineal tear

PPH

Question 17

Risk factors for uterine rupture

Answer 17

Previous c-section/ uterine surgery

VBAC

Multiple pregnancy

Oxytocin use for contractions/ induced labour

Older age

Question 18

Methods for labour induction

Answer 18

1. Membrane sweep
2. Vaginal prostaglandin E2
3. Cervical ripening balloon
4. Artificial rupture of membranes

Question 19

Methods for labour induction

Answer 19

1. Membrane sweep
2. Vaginal prostaglandin E2
3. Cervical ripening balloon
4. Artificial rupture of membranes

Question 20

______ is used to induce labour in intrauterine foetal death

Answer 20

Oral mifepristone + misoprostol

Question 21

_______ is a complication of vaginal prostaglandins

Answer 21

Uterine hyperstimulation

Question 22

Uterine hyperstimulate describes

Answer 22

> 5 uterine contractions every 10 minutes

Question 23

Complications of uterine hyperstimulation

Answer 23

Foetal hypoxia/ distress Emergency C-section Uterine rupture

Question 24

Uterine hyperstimulation management

Answer 24

Stopping vaginal prostaglandins/ oxytocin Tocolysis (terbutaline)

Question 25

Neonatal resuscitation steps

Answer 25

1. Warm the baby 2. APGAR score (1, 5, 10 minuties) 3. Stimulate breathing 4. Inflation breaths - 2 rounds of 5 breaths (lasting 3 seconds) 5. Chest compressions - 3:1 with ventilation Severe - IV drugs and intubation - (Near term)= therapeutic hypothermia