Complications of Labour

Question 1

What three key factors does normal labour depend on?

Answer 1

The Passenger
The Passages
The Powers

Question 2

What two phases consist the first stage of labour?

Answer 2

Latent (0-3cm cervical dilatation) and active phase (3-10cm cervical dilatation)

Question 3

What rate does the first stage of labour progress in primigravida and multigravida?

Answer 3

1-3cm/hr

3-6cm/hr

Question 4

What two phases consist the second stage of labour?

Answer 4

Propulsive phase - from full dilatation to presenting part reaching pelvic floor
Expulsive phase - from reaching pelvic phase to delivery of baby

Question 5

How does the second stage of labour last in primigravida and multigravida?

Answer 5

40 minutes

20 minutes

Question 6

What is the third stage of labour?

Answer 6

From delivery of baby to expulsion of placenta

Question 7

How long does the third stage labour last?

Answer 7

20-30 minutes

Question 8

What problems may there be with ‘passenger’? (3)

Answer 8

Size (e.g. macrosomia), Number (e.g. mulitple pregnancy), Lie (e.g. breech, transverse)
Presentation & Position
Anatomical Abnormalities

Question 9

How much does a foetus weight at 22 weeks?

What about at 40 weeks?

Answer 9

500 grams

3300 grams

Question 10

What does macrosomia mean?

Answer 10

Increased foetal size

Question 11

What is associated with macrosomia? (4)

Answer 11

Maternal diabetes
Maternal obesity
Previous large babies
Prolonged pregnancy

Question 12

What is the incidence of twins?

What about quads?

Answer 12

1 in 80

1 in 512 000

Question 13

Monozygotic twinning is a chance event, but what are the risk factors of dizygotic twinning? (4)

Answer 13

Racial predisposition
Fertility treatments
Older ages
Parity > 5 (number of times a women has given birth)

Question 14

What are potential complications of a multiple pregnancy? (7)

Answer 14

Anaemia
Pre-eclampsia
Congenital anomalies
IUGR
Polyhydramnios
Malpresentation
Miscarriage and preterm labour

Question 15

How is the foetus turned if they present in the wrong position?

Answer 15

External Cephalic Version

Question 16

What problems may there be with ‘passage’? (4)

Answer 16

Contracted pelvis
Placenta praevia
Soft tissue tumours (e.g. fibroids)
Pendulous abdomen

Question 17

What is the favourable female pelvis shape?

Answer 17

Gynaecoid

Question 18

What problems may there be with ‘powers’? (4)

Answer 18

Uterine inertia
Inco-ordinate contractions
Hypertonic contractions
Uterine Rupture

Question 19

What are signs of a ‘poor fit’?

Answer 19

Failure of progressive cervical dilatation
Failure of descent of the presenting part
Moulding
Caput

‘Cephalopelvic disproportion’ (CPD) or ‘Fetopelvic disproportion’ (FPD)

Question 20

How is uterine inertia treated in pregnancy?

Answer 20

Syntocinon

Question 21

How is malpresentation resolved? (4)

Answer 21

ECV
Rotational forceps
Ventouse
C-section

Question 22

Contracted pelvis and rigid cervix - what should be done?

Answer 22

C-section

Question 23

What are signs of foetal distress?

Answer 23

Meconium-stained liquor

Fetal heart rate abnormalities - bradycardia, tachycardia, <5/mt baseline variability, decelerations

Question 24

What are the problems that can occur in the third stage of labour? (4)

Answer 24

Retained placenta
Uterine atony
Soft tissue lacerations
Uterine inversion

Question 25

What can the problems that can occur in the third stage of labour cause?

Answer 25

Post-partum haemorrhage and maternal shock