Stages of labour
Interventions of labour and delivery
Prescribing in pregnancy
Complications and emergencies!
Risk it for the biscuit!!
200

What are the four stages of labour and what separates/defines them?

First stage: to 10cm dilation
Second stage: delivery of baby
Third stage: delivery of placenta
Fourth stage: after

200

What is the difference between induction and augmentation? Give a simple example of when you'd use them. 

  • Induction: artificially initiating labour when labour has not started spontaneously. Used for postpartum pregnancy 
  • Augmentation: strengthening or improving labour when spontaneous labour has already started but progress is inadequate. Used when contractions are weak/infrequent 
200

What is an example of a category D medication?

Can this ever be used in pregnancy?

Warfarin, antihypertensives (ACEi, ARBs)

Can be used in life-threatening maternal conditions with no safer alternatives 

200

What are the 3 P's of labour and give an example of how they affect delivery

Power 

Passage 

Passenger 

200

What are the components of the APGAR score?

Appearance

Pulse

Grimace

Activity

Respiration 

400

How long is each stage of labour?

first = 12-19 (nulliparous), 10-14 (multiparous) 

second = 2-3 hours (or less) 

third = <30 minutes 

400

Name two methods of cervical ripening and briefly describe them

1. Prostaglandins 

2. Balloon catheter 

400

What anticoagulant can be used in pregnancy?

LMWH 

400

A woman develops heavy bleeding shortly after delivery. Give 3 causes of postpartum haemorrhage 

4 T's 

Tone (uterine atony), trauma, tissue, thrombin 

400

What are the components of the Bishop score?

Cervical dilation, effacement, consistency, position and foetal station. 

600

What are the 7 cardinal movements of labour?

Descent → engagement → flexion → internal rotation → extension → external rotation → expulsion

600

A woman is in labour but contractions are inadequate and cervical dilation has stalled. What intervention could be used? What are the main 2 methods?

Augmentation 

1. Artificial rupture of membranes 

2. IV oxytocin

600

What pain killers are safe in pregnancy? Which are not?

Safe = acetaminophen/paracetamol

Unsafe = NSAIDs, aspirin (can be taken in low doses if needed) 

600

What is considered a prolonged second stage of labour?

>3 hours nulliparous 

>2 hours multiparous 

+1 hour for epidural 

600

What is the foetal fibronectin test?

used as an indicator of high risk for preterm pregnancy 
800

What are the stages of the first phase of labour? What differentiates them?

Latent = irregular contractions, 4-5cm dilation

Active = regular contractions (every 5 minutes), >6cm dilated

Full = 10cm dilation 

800

Give 3 indications for assisted vaginal delivery and 3 prerequisites before performing it

Indications:

  • Prolonged second stage
  • Non-reassuring foetal heart rate
  • Maternal exhaustion/inability to push effectively
  • Maternal cardiopulmonary conditions where reducing pushing is beneficial

Prerequisites include:

  • Full cervical dilation
  • Engaged foetal head
  • Known foetal head position
  • Adequate maternal pelvis
  • Empty bladder
  • Skilled clinician
  • Appropriate foetal presentation/gestation depending on instrument
800

What do they Australian pregnancy drug categories A, B, C, D and X broadly indicate?

  • A: Used by many pregnant women without demonstrated increase in foetal harm.
  • B1/B2/B3: Limited human data; animal findings vary.
  • C: May cause harmful foetal/neonatal effects; use when benefits outweigh risks.
  • D: Evidence of foetal risk, but may be justified for serious maternal conditions.
  • X: High risk of permanent foetal harm; contraindicated in pregnancy. 
800

What is the difference between placenta previa and vasa previa?

Placenta previa: placenta over internal cervical os, more profound bleeding 

Vasa previa: blood vessels over internal cervical os, less bleeding

800

What medications are used for miscarriages/termination? Describe what they are and how they work

Mifepristone + misoprostol 

Mifepristone → progesterone antagonist → stops growth of pregnancy

Misoprostol → PGE analogue → uterine cramping and expulsion

OR

Methotrexate - stops folate dependent DNA synthesis 

1000

Compare vacuum, forceps and caesarean delivery and why you would pick one over the other (advantages vs disadvantages/risks) 

Vacuum

  • Assisted vaginal delivery using suction applied to the foetal scalp.
  • Requires an engaged head and full cervical dilation.
  • Associated with scalp injuries/cephalohaematoma.

Forceps

  • Instrument grasps the foetal head to assist delivery.
  • Requires full dilation, engaged head and known position.
  • Can be associated with maternal perineal trauma and foetal facial/scalp injury.

Caesarean

  • Surgical delivery through the abdomen and uterus.
  • Considered when vaginal delivery is not appropriate or cannot be achieved safely.

Decision depends on:

  • Foetal head station and position
  • Cervical dilation
  • Maternal and foetal condition
  • Severity of foetal compromise
  • Gestational age
  • Operator skill
  • Whether prerequisites for instrumental delivery are met.
1000

Rank the medications from most to least safe in pregnancy in moderation 

Aspirin, ibuprofen, paracetamol, opioids, ACE inhibitors

Paracetamol, opioids, aspirin, ibuprofen, ACEi

1000

What was the AFL grand final score on Saturday?

BONUS: who won the Norm Smith?

89 - 96


Shai Bolton (freo) 

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