Quiz 7: Monitoring the condition of the fetus during the first stage of labour

Please choose the one, most correct answer to each question or statement.

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 3 hours during the latent phase
   • Every 2 hours during the latent phase
   • Every 2 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
   • 110–160 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 post-term 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.