Labor Management and Epidural Analgesia Quiz

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What is recommended for women using epidural analgesia in the second stage of labor to increase the rate of spontaneous vaginal birth?

Supine positions

Upright positions

Sitting positions

Lying down lateral positions (correct)

In nulliparous women with epidural analgesia, how long is delayed pushing recommended for to potentially reduce the need for rotational and midpelvic assisted vaginal birth?

1–2 hours (correct)

30 minutes

5–6 hours

3–4 hours

Why is it advised not to routinely discontinue epidural analgesia during pushing?

To avoid increased pain without reducing the incidence of assisted vaginal birth (correct)

To reduce labor time

To decrease the risk of infection

To increase maternal comfort

What does the text suggest regarding recommending a specific regional analgesia technique to reduce the incidence of assisted vaginal birth?

It states there is insufficient evidence to recommend any particular technique Signup and view all the answers

What does the text say about routine prophylactic manual rotation of fetal malposition in the second stage of labor?

It suggests manual rotation may be effective but more research is needed Signup and view all the answers

What position is recommended for women using epidural analgesia in the second stage of labor?

Lying down lateral Signup and view all the answers

Why is delayed pushing recommended for nulliparous women with epidural analgesia?

To potentially reduce the need for rotational and midpelvic assisted vaginal birth Signup and view all the answers

What is the risk of obstetric anal sphincter injuries (OASIS) in ventouse deliveries without episiotomy compared to forceps deliveries without episiotomy?

6.53 times greater Signup and view all the answers

Which group reported that episiotomy in vacuum birth may increase maternal morbidity in parous women?

Israeli group Signup and view all the answers

What was the odds ratio (OR) for postpartum hemorrhage associated with episiotomy compared to no episiotomy?

1.72 Signup and view all the answers

In which group of women is mediolateral or lateral episiotomy considered protective against obstetric anal sphincter injuries (OASIS)?

Nulliparous women Signup and view all the answers

Based on the text, what is the risk of OASIS in ventouse deliveries without episiotomy?

5.57 times greater Signup and view all the answers

Which study design was used in assessing the relationship between mediolateral episiotomy and OASIS in parous women?

Observational study Signup and view all the answers

What did the Danish group recommend in terms of the use of mediolateral or lateral episiotomy during vacuum birth?

Protective against OASIS in nulliparous women Signup and view all the answers

What was the non-significant relationship found between mediolateral episiotomy and OASIS in nulliparous women?

$OR = 0.68$ Signup and view all the answers

What is the primary risk associated with Caesarean birth in the second stage of labour compared to completed assisted vaginal birth?

Major obstetric haemorrhage Signup and view all the answers

When comparing the use of two instruments versus failed forceps proceeding to Caesarean birth, what is the primary concern?

Intracranial haemorrhage Signup and view all the answers

In a population-based retrospective analysis in the US, what was the reported outcome associated with sequential use of vacuum and forceps compared to forceps alone?

Need for mechanical ventilation Signup and view all the answers

What is the risk of intracranial haemorrhage for two instruments versus failed forceps proceeding to Caesarean birth?

1 in 256 births Signup and view all the answers

Which birthing method is associated with a prolonged hospital stay according to the text?

Caesarean birth in the second stage of labour Signup and view all the answers

In the US study, what was the adjusted odds ratio (aOR) for the need for mechanical ventilation with sequential use of vacuum and forceps compared to forceps alone?

2.22 Signup and view all the answers

What is the main risk associated with using two instruments during delivery according to the text?

Increased risk of neonatal trauma Signup and view all the answers

Which type of birth leads to an increased risk of admission of the baby to the neonatal unit?

Caesarean birth in the second stage of labour Signup and view all the answers

What is recommended for women who have received regional analgesia for a trial of assisted vaginal birth in theatre?

Indwelling catheter in situ after birth Signup and view all the answers

What should be monitored and documented in postpartum women according to the text?

First void urine timing and volume Signup and view all the answers

What is associated with an increased risk of postpartum urinary retention?

Assisted vaginal birth Signup and view all the answers

What should be measured if urinary retention is suspected according to the text?

Post void residual Signup and view all the answers

What is recommended to reduce the risk of postpartum urinary incontinence at 3 months?

Physiotherapy-directed strategies Signup and view all the answers

What can be used as an alternative to catheterisation to measure residual urine, if appropriate training has been undertaken?

Bladder scanning Signup and view all the answers

What type of trial suggests that systematic intermittent bladder catheterisation at 2 hours post birth reduces the risk of covert postpartum urinary retention after assisted vaginal birth?

'Before and after' trial Signup and view all the answers

What was the main finding of the ANODE trial regarding women who received prophylactic antibiotics after assisted vaginal birth?

They were less likely to have a confirmed or suspected maternal infection. Signup and view all the answers

Which group was less likely to require primary care physician or hospital outpatient visits related to concerns about their perineum in the ANODE trial?

Antibiotics group Signup and view all the answers

What is recommended for obstetricians to reduce infection and prevent contamination during assisted vaginal births?

Wearing personal protection equipment like gloves and aprons Signup and view all the answers

Why is it suggested that obstetricians should practice good aseptic techniques during assisted vaginal births?

To reduce infection and prevent contamination Signup and view all the answers

What should be done after an assisted vaginal birth in terms of assessing thromboembolism risk according to the text?

Assess women for venous thromboembolism risk and the need for thromboprophylaxis Signup and view all the answers

Why is there a lack of data to evaluate the independent risk of assisted vaginal birth for thromboembolism according to the text?

There are too many identified risk factors for thromboembolism Signup and view all the answers