Labor

Front 1

List the types of sutures of the fetal skull

Back 1

Frontal sutures

Coronal suture

Sagittal suture

Lambdoid suture

Front 2

List the fontanels of the fetal skull

Back 2

Anterior: diamond shaped formed at junction between sagittal and coronal suture about 3cm ossifies by the 18month of life and pathological if not ossified by 24 months

Posterior: triangular shaped, denoted position of maternal pelvis in relation to the head

Front 3

What is molding?

Back 3

Alterations in the shape of the fore-coming fetal head whiles passing through the resistant birth passage during labor

Front 4

Complications of moderate and severe molding

Back 4

Subdural hemorrhage

tearing of tentorium cerebelli

Front 5

List the ligaments supporting the female pelvis

Back 5

Sacrospinous

Sacrotuberous

Iliolumbar

Sacroiliac

Front 6

What is inclination?

Back 6

Erect position of pelvis is tilted forward such that the plane of inlet makes an angle of about 55 with the horizontal

Front 7

List the diameters of pelvic inlet

Back 7

AP diameter(true conjugate, anatomical conjugate, conjugate vera) 11cm

Obstetric conjugate 10cm

Diagonal conjugate 12cm

Transverse diameter 13cm

available or obstetric transverse lower

Front 8

Diameters of the outlet

Back 8

Bispinous diameter 10.5

AP 11cm

Front 9

What criteria defines Eutocia

Back 9

Spontaneous onset and in term

Vertex presentation

Without undue prolongation

Natural termination with minimal aid

without any complications affecting health of mother and or baby

Front 10

False labor

Back 10

This is pain that appears prior to onset of true labor pains about 1 to 2 weeks as a result of cervcal and lower uterine segement stretching which causes irritation

Front 11

What are features of a ripe cervix

Back 11

Soft

80 percent effaced

Admits one finger easily

Cervical canal dilatable

Front 12

What is true labor pain

Back 12

Painful uterine contractions of regular intervals

Frequency of contractions increasing gradually

Intensity and duration progressing

Descent of presenting part and formation of bag of forewater

Not relieved by enema or sedation

Front 13

Stages of labor and their durations

Back 13

First stage 12 hours primi 6hours multip

Second stage 2h primi 30min multip

Third stage 15 min passive 5 mins active

4th stage 1 hour

Front 14

What are Braxton Hicks contractions

Back 14

Throughout pregnancy there are irregular involuntary spasms of uterine contractions which are painless and do not lead to any changes in the cervix

Front 15

The probable causes of pain in uterine contractions

Back 15

Myometrial ischemia(angina)

Stretching of the cervix

Stretching of peritoneum over fundus

Stretching of ligaments around the uterus

Compression of nerve ganglia

Front 16

What is cervical effacement

Back 16

Process by which muscular fibres of the cervix are pulled upward and merges with the fibres of the lower uterine segment

Front 17

Where does placental separation occur

Back 17

Deep spongy layer of the decidua basalis

Front 18

What are the two ways placenta can separate

Back 18

Central separation

Marginal separation

Front 19

Mechanism of labor

Back 19

Engagement

Descent

Flexion(reduces shape and size of the plane of the advancing diameter of the head)

Internal rotation

Crowning(further descent occurs until subocciput lies below the pubic arch with no recession even when contraction ceases)

Extension

Restitution(visible passive movement of the head due to unwinding of the neck sustained during internal rotation)

External rotation(movement of rotation visible externally due to internal rotation of shoulders)

Front 20

What is Partograph

Back 20

Composite graphical record of cervical dilatation and descent of the head against duration of labor in hours. Also gives info about fetal and maternal conditions all recorded as a single sheet of paper

Front 21

What is the latent phase?

Back 21

Period between onset of true labor pain and the point when the cervical dilatation becomes 3 to 4 cm, primigravidae(20 hours average 8.6)

multipara(14 hours average 5.3)

Front 22

Active phase

Back 22

Dilatation of the cervix at a rate of 1cm per hour in primigravidae and 1.5cm in multigravidae beyond 4cm dilatation considered satisfactory

Front 23

What reflex initiates bearing down in second stage?

Back 23

Ferguson reflex: nerve reflex set up during the stretching of the vagina by the presenting part

Front 24

What are the signs that placenta has not separated

Back 24

Uterus shape is discoid

Firm uterus

Non ballotable

Fundal height reaches slightly below umbilicus

Slight trickling of blood per vaginum

Length of cord as visible from the outside remains static

Front 25

Signs of placenta separation

Back 25

Uterus is globular

Firm and ballotable

Fundal height is raised as placenta comes down and uterus sits on it

Slight bulging in suprapubic region due to distention of lower uterine segment by separated placenta

Slight gush of blood per vaginum

Permanent lengthening of the cord is established

Front 26

Information to be noted and recorded on the partograph during a VE

Back 26

Degree of cervical dilatation marked with X starting at 4cm

Degree of effacement

Status of membranes and if ruptured the color(I, M, R, C, B)

Presenting part and its position

Check for the fontanels

Caput and moulding

Station of the head

Front 27

what are the indications for vaginal examination

Back 27

At the onset of labor

Progress of labor: every 3 to 4 hours

Following rupture of membranes: exclude cord prolapse

Whenever interference is contemplated

To diagnose precisely the beginning of second stage

Front 28

Assessment of progress of labor on partograph

Back 28

Pulse: every 30mins

BP: every 1hour

Temp: every 2hours

Urine output:

Uterine contractions: every 30mins, mild less than 20sec, moderate 20 to 40 sec, very strong greater than 40sec

Front 29

What are the evidence of maternal distress during first stage?

Back 29

Anxious look with sunken eyes

Dry tongue

Acetone smell in breath

Scanty high colored urine with acetone

Hot dry vagina with offensive discharge

rising pulse rate

Front 30

What are the three phases of conducting a delivery

Back 30

Delivery of the head

Delivery of the shoulder

Delivery of the trunk

Front 31

What is the underlying principal involved in the active management of the third stage of labor

Back 31

To excite powerful uterine contractions within 1 minute of delivery of the baby by given parenteral oxytocin

Front 32

What is fetal lie

Back 32

The relationship of the long axis of the fetus to the long axis of the centralised uterus or maternal spine.

Front 33

Presentation

Back 33

Part of the fetus which occupies the pelvic brim(Cephalic, podalic, shoulder, compound)

Front 34

Presenting part

Back 34

The part of the presentation which overlies the internal OS and is felt by the examining finger through the cervical opening.

Cephalic presentation: vertex, brow, face

Podalic: complete breech, frank breech, footling

Front 35

Fetal attitude

Back 35

Relation of the different parts of the fetus to one another the universal attitude is flexion

Front 36

What is the denominator

Back 36

Arbitrary bony fixed point on the presenting part which comes in relation with the various quadrants of the maternal pelvis.

Front 37

What is fetal position

Back 37

Relationship of the denominator to the various quadrants of the pelvis

Front 38

Differentials for an SFH>period of amenorrhoea

Back 38

Mistaken date of LMP

Twins

Polhydramnios

Big baby

Pelvis tumors

Hydatiform mole

Concealed accidental hemorrhage

Front 39

SFH<period of amenorrhoea

Back 39

Mistaken date of LMP

Scanty liquor amnii

Fetal growth retardation

Intrauterine death