Intrapartum Care Quiz (December 2010)

1. What maternal observations need to be taken during labour, and what is the mimimum frequency?
Pulse (every 30 minutes)
Blood pressure (every 4 hours)
Temperature (every 4 hours)

2. Katie is admitted in what appears to be labour, what needs to be done prior to vaginal examination?
Check placenta is clear of the os/cervix
Gain Katie’s consent
An abdominal palpation
Check fetal heart rate

3. Name 5 reasons why a woman may be advised to have continous fetal monitoring in labour
Multiple Pregnancy
Induction of labour
Epidural anaesthesia
Preterm birth (prior to 37 weeks)
Vaginal bleeding (more than just a ‘show’)
Suspected fetal distress heard on intermittent auscultation
Meconium stained liquor
Previous caesarean Section
Intrauterine Growth Retardation
Maternal diabetes
Pre-eclampsia
Augmentation of labour with syntocinon infusion

4. You are called to A&E where a woman is giving birth who had no idea she was pregnant, as you arrive the vertex is advancing fast and you get gloves on just in time to catch a small baby, who appears to weigh just over 2kg. He cries immediately. What do you do next?
Introduce yourself
Give baby to mum
Ask someone to bleep paed to come and review baby
Roughly assess the suspected gestational age of the baby and APGARs
Take blood pressure and pulse and temperature
Palpate uterus to feel if any extra babies hiding in there (deliver them if necessary)
Discuss third stage options with the mum and deliver placenta safely (using correct drug if active third chosen after ensuring you have delivered ALL the babies). Ensure placenta is complete.
Check perineum for damage and assess blood loss
Ask woman about her medical/obstetric history (for all you know that was a VBA4C!)
Find out blood group (if not sure take blood test and placental sample in case of rhesus negative)
Transfer to the ward, Debrief mum and do paperwork

5. What is a kleihauer test and when is it used on a labour ward?
A blood test used to determine how much of the fetal blood (haemoglobin) has been transferred to the mother’s blood stream. A maternal sample is taken approximately 15 minutes or more after the birth and is sent together with a sample from the umbilical cord. It is used in cases of rhesus negative mothers or in cases of stillbirth.

6. Stephanie is a gravid 2 para 1 who is in spontaneous labour at term. 1 hour ago she was 5cm dilated and is now involuntarily pushing. What signs may point to full dilation without the need to examine her vaginally?
The Rhombus of Michaelis visible on her lower back
The purple line reaching the top of the buttocks
The smell in the room may have changed
SROM often occurs at this point
You may see the head
Coldness in the legs reaching as far as the knees
Anal pouting
Passing of faeces (and/or urine)
Stephanie telling you that she can feel the baby moving down.
A heavy blood show
Early decelerations in the fetal heartrate as the head is squashed.

7. Name the three different presentations possible in labour
Cephalic (for any head down presentation – includes brows, faces as well as OA/OP)
Breech (for any bum/foot first presentation)
Shoulder (for a transverse lie, may involve an arm in the pelvis or nothing in pelvis at all)

8. Megan is a primip, when you look at the CTG monitor the fetal heart is showing as 80bpm, what could this be?
The monitor could be recording Megan’s pulse
There could be a bradycardia (FH below 110bpm for more than 3minutes)It could be a deceleration which is recovering to normal limits

9. In a low risk labour how often should the fetal heart be auscultated?
Every 15 minutes in the 1st stage, for a full minute after a contractionEvery 5 minutes in the 2nd stage, for a full minute after a contraction

10. Name 5 things which should be in a delivery pack
Artery / Spencer Wells forceps
Umbilical cord clamp
Episiotomy / Mayo scissors
Umbilical cord scissors
Swabs
Anal pads
Towel/Wrap for baby
Bowl/Receiver for placenta

BONUS What or who is Dr C Bravado?
A pneumonic for interpreting CTGs DR – define Risk, C – contractions, Bra – baseline rate, V – variability, A – accelerations, D – decelerations, O – overall impression and plan