2) Vaginal Delivery - Early Signs, Stages; Management of Labor - Mechanism in Occiput Anterior / Posterior Presentations

Question 1

What is the Definition of “Labor”?

Answer 1

• Physiological Process characterised by Contractions
• Causing CERVICAL Dilation and EXPULSION of FOETUS + PLACENTA
• Where contractions INCREASE in Frequency + Intensity
• TERM Pregnancy is between 37 - 42 G-Weeks

Question 2

What are the Causes of Labour? {OCPP-M}

Answer 2

• Oxytocin STIMULATION
• Foetal Cortisol Levels
• Progesterone WITHDRAWAL
• Prostaglandin RELEASE
• Decreasing levels of MAGNESIUM

Question 3

What are the SIGNS of Labour?

Answer 3

• Uterine BOTTOM drops 2-3 Weeks BEFORE releasing PRESSURE on DIAPHRAGM
• Presenting LOWER Parts
• Cervix shows MATURITY Sign = Positions on AXIS of PELVIS
• THICK Mucous SECRETION from Cervix BEFORE Labour
• Slight MASS Decrease in the MOTHER

Question 4

Describe the ONSET of Labor

Answer 4

• Contractions occur every 10-15 mins, increasing in intensity + frequency
• EFFACEMENT of Cervix
• RUPTURE of Amniotic Membrane

Question 5

What are the 3 Stages of Delivery?

Answer 5

STAGE 1 = EFFACEMENT + DILATION of Cervix

STAGE 2 = Fetal EXPULSION

STAGE 3 = PLACENTAL DELIVERY + SEPARATION

Question 6

Describe STAGE 1 of Delivery

Answer 6

STAGE 1 = EFFACEMENT (thinning + shortening) + DILATION of Cervix - showing bloody mucus plug

• (a) LATENT Phase = Onset Labour —- DILATES TO 4cm
• (b) ACTIVE Phase = Dilation from 4cm TO 10cm
• FULL DILATION = 6 -10cm
• Nulliparous (NEW) = 12h; Multiparous = 6h
• Effacement / Dilation to be checked EVERY 2h; Mother’s HR, BP EVERY 2-4h

Question 7

Describe STAGE 2 of Delivery

Answer 7

STAGE 2 = Fetal EXPULSION

• Where Cervix is FULLY Dilated
• There’s REGULAR Uterine Contractions
• CROWNING of Foetal HEAD
• Nulliparous (NEW) = 1 - 2h; Multiparous = 30 mins
• Labor MUST BE ENDED IF = Foetal HR is LESS than 120bpm ; MORE than 180bpm
• EPISIOTOMY = In case of Shoulder DYSTOCIA (Shoulder is stuck behind Pelvic Bone), therefore surgical cut is made at opening of vagina

Question 8

Describe STAGE 3 of Delivery

Answer 8

STAGE 3 = PLACENTAL DELIVERY + SEPARATION

• Happens IMMEDIATELY AFTER Fetus is delivered
• Usually takes around 5 - 15 / 30 mins
• SIGNS = Cord lengthening; GUSH of blood; Uterine Fundal REBOUND; when signs appear Dr must pull cord with gentle traction

Question 9

What are the 2 Types of Foetal Positions?

Answer 9

1) Occiput ANTERIOR Presentation = Occiput points TOWARDS Maternal SYMPHYSIS; facing downwards - either be Left, or Right

2) Occiput POSTERIOR Presentation = Occiput points TOWARDS Maternal SACRAL; facing upwards - TO THE Pubic Symphysis

Question 10

What are the 7 Cardinal Movements of Labor?

Answer 10

“Every Decent Firefighter Is Extremely Ready & Efficient”

• E - Engagement (fetal head enters pelvic inlet)
• D - Descent (presenting part starts descending)
• F - Flexion (head flexes more, chin to chest)
• I - Internal rotation (head rotates 90 degrees)
• E - Extension (head extends, moves past pubic symphysis)
• R - Restitution (head rotates 45 degrees to align)
• E - External rotation (anterior shoulder rotates)
• E - Expulsion (shoulders and body come out)