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Test 2: Monitoring the condition of the fetus during the first stage of labour

  1. Compression of the fetal head during labour:
    • Usually does not harm the fetus
    • Usually damages the fetal brain
    • Usually causes blindness in the newborn infant
    • Usually kills the fetus
  2. What is the commonest cause of a reduced supply of oxygen to the fetus during labour?
    • Uterine contractions
    • Partial placental separation
    • Placental insufficiency
    • Infection of the membranes
  3. How does the fetus usually respond to a lack of oxygen during labour?
    • There is an increase in fetal movements.
    • There is a decrease in the fetal heart rate.
    • There is an increase in the fetal heart rate.
    • There is a decrease in fetal movements.
  4. How should the fetal heart rate be monitored in labour?
    • A cardiotocograph (CTG machine) should preferably be used in all labours.
    • A doptone is the preferred method in primary care clinics and hospitals.
    • A fetal stethoscope is the best method for most labours.
    • The fetal heart rate does not need to be monitored in all low risk pregnancies.
  5. The fetal heart rate pattern should be monitored:
    • During a contraction
    • Before a contraction
    • After a contraction
    • Before, during and after a contraction
  6. How often should the fetal heart rate be monitored during the first stage of labour in low risk pregnancies where there is no meconium staining of the liquor?
    • Every three hours during the latent phase
    • Every two hours during the latent phase
    • Every two hours during the active phase
    • Every 15 minutes during the active phase
  7. What is the normal baseline fetal heart rate in labour?
    • 100–120 beats per minute
    • 120–140 beats per minute
    • 140–160 beats per minute
    • 100–160 beats per minute
  8. Early decelerations:
    • Start at the beginning of a contraction and return to the baseline at the end of a contraction
    • Start at the beginning of a contraction and end 30 seconds or more after the contraction
    • Do not have any relation to contractions
    • Occur during the period of uterine relaxation
  9. Early decelerations are usually caused by:
    • Intracranial haemorrhage
    • Compression of the fetal head
    • A short umbilical cord
    • A decreased supply of oxygen to the fetus
  10. What are late decelerations?
    • Decelerations that occur after 38 weeks gestation
    • Decelerations that are only present at the end of the first stage of labour
    • Decelerations that start 30 seconds or more after the beginning of the contraction
    • Decelerations that return to the baseline 30 seconds or more after the end of the contraction
  11. Late decelerations:
    • Always indicate fetal distress
    • Only suggest that fetal distress may be present
    • May be normal
    • Cannot be diagnosed with a fetal stethoscope
  12. A baseline tachycardia:
    • Indicates that the fetus is in good condition
    • Is common when the mother is given pethidine
    • May be caused by infection of the placenta and membranes
    • Indicates that the fetus is dying from lack of oxygen
  13. A baseline bradycardia:
    • Is a safe pattern
    • Is a pattern which indicates an increased risk of fetal distress
    • Indicates severe fetal distress
    • Is usually caused by infection of the placenta and membranes
  14. Which fetal heart rate pattern warns that there is an increased risk of fetal distress?
    • Early decelerations
    • Late decelerations
    • Baseline bradycardia
    • Late decelerations plus a baseline bradycardia
  15. When can you be confident that the fetal condition is good?
    • When the baseline fetal heart rate is normal and there are no decelerations
    • When the baseline fetal heart rate is normal and there are only early decelerations
    • When fetal tachycardia is present and there are no decelerations
    • All of the above
  16. Meconium staining of the liquor:
    • Is uncommon
    • Occurs in 10–20% of patients
    • Occurs in 30–40% of patients
    • Occurs in most patients
  17. Meconium staining of the liquor is commonest in:
    • Patients in postterm labour
    • Patients in term labour
    • Patients in preterm labour
    • Patients whose fetuses move a lot during pregnancy
  18. Which form of meconium in the liquor is most likely to indicate the presence of fetal distress?
    • Fresh meconium indicates definite fetal distress and is an indication for an emergency Caesarean section
    • Old meconium indicates that there was a problem but that there is no need to be concerned
    • Yellow meconium is of no clinical importance
    • The management is the same as it does not matter what the consistency or colour of the meconium is
  19. Why does a fetus pass meconium during labour?
    • Because there is fetal hypoxia
    • Because it makes the second stage of labour shorter
    • Because the mother has been given liquid paraffin
    • Because it is mature and ready for delivery
  20. What is the correct management when the liquor is meconium stained?
    • Monitor the fetal heart rate carefully.
    • Deliver the fetus immediately by Caesarean section.
    • Give the patient an oxytocin infusion to shorten labour.
    • Transfer the patient urgently to a level 3 hospital.