General Obstetrics and Intrapartum Care
Labour assessment begins with the Bishop score - dilatation, effacement, station, consistency and position - and with the modern definitions of active-phase arrest. In a nullipara with ruptured membranes and adequate contractions (generally 200 Montevideo units or more), no cervical change for 6 hours defines arrest; with inadequate contractions, 4 hours of adequate oxytocin-augmented labour is enough before caesarean. Second-stage duration limits differ by parity and epidural use, and should not be applied rigidly without assessing descent and fetal condition.
Fetal monitoring questions reward a structured reading: define risk, contractions, baseline rate, variability, accelerations, decelerations, overall assessment (DR C BRAVADO). Late decelerations imply uteroplacental insufficiency; variable decelerations imply cord compression; a prolonged deceleration beyond 3 minutes demands intrauterine resuscitation and preparation for delivery.
Postpartum haemorrhage is examined constantly: the four Ts - tone, trauma, tissue, thrombin - and uterotonic contraindications. Ergometrine is avoided in hypertension and pre-eclampsia, carboprost in asthma, and magnesium toxicity is reversed with calcium gluconate. Shoulder dystocia is a HELPERR drill: call for help, McRoberts, suprapubic pressure, and never fundal pressure.
Traps: confusing active-phase arrest with second-stage arrest; giving oxytocin for tachysystole with late decelerations instead of stopping it and using tocolysis; forgetting that operative vaginal delivery requires a fully dilated cervix, engaged head, known position and adequate pelvis; and missing sepsis or uterine rupture in a woman with persistent fetal tachycardia.
Rule of thumb: tachysystole plus late decelerations means stop oxytocin, left lateral position, fluids, tocolysis, and expedite delivery if not resolved.