Complications of Labour

Question 1

Stages of labour

Answer 1

1st stage
2nd stage
3rd stage

Question 2

1st Stage of Labour

Answer 2

Latent phase: 0-3cm cervical dilatation

Active phase: 3-10cm cervical dilatation

Question 3

2nd Stage of Labour

Answer 3

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

Question 4

1st Stage of Labour duration

Answer 4

Primigravida (1-3cm/hour)

Multigravida (3-6cm/hour)

Question 5

2nd Stage of Labour duration

Answer 5

Primigravida: 40 mins
Multigravida: 20 mins

Question 6

3rd Stage of Labour

Answer 6

From delivery of baby to expulsion of placenta

Question 7

3rd Stage of Labour duration

Answer 7

2-30 mins in both primigravida and multigravida

Question 8

Complicated labour

Answer 8

Passenger
Passages
Powers

Question 9

Complicated labour- PASSENGER

Answer 9

Size
Number
Lie
Presentation + position
Anatomical abnormalities

Question 10

Complicated labour- PASSAGES

Answer 10

Contracted pelvis- C section
Placenta praevia
Soft tissue tumours e.g. fibroids
Pendulous abdomen

Question 11

Complicated labour- POWERS

Answer 11

Uterine inertia
Incoordinate contractions
Hypertonic contractions
Uterine rupture

Question 12

Problems with Passenger- Size

Answer 12

Macrosomia (big baby)

RFs- maternal diabetes, maternal obesity, previous large babies, prolonged pregnancy

Question 13

Problems with passenger- Multiple Gestation

Answer 13

Twins 1 in 80
Triplets 1 in 6400
Quadruplets 1 in 512000

Question 14

Multiple Gestation Types

Answer 14

Monochorionic/Monoamniotic
Monochorionic/Diamniotic
Dichorionic/Diamniotic (fused placenta)
Dichorionic/Diamniotic (separate placenta)

Question 15

Multiple Gestation Complications

Answer 15

Anaemia, pre-eclampsia
Congenital abnormalities, IUGR
Polyhydramnios, malpresentation, miscarriage, preterm labour
Twin-to-twin transfusion

Question 16

Abnormal lie + presentation

Answer 16

Longitudinal lie- head first
Transverse lie- lying horizontally
Cephalic presentation- Head first birth
Breech presentation- Bum first birth

Question 17

Signs of foetal distress in labour

Answer 17

Meconium-stained liquor
Foetal HR abnormalities
-->Baseline rate: Bradycardia <110, Tachycardia >160
--> Reduced baseline variability <5
--> Decelerations- early, variable, late

Question 18

3rd Stage problems

Answer 18

Retained placenta
Uterine atony
Soft tissue lacerations
Uterine inversion

Question 19

Uterine atony

Answer 19

Loss of muscular tone in uterus
Usually, uterine muscles contract to constrict vessels, promoting clotting + stopping haemorrhage
If don’t contract, more likely for haemorrhage and excessive bleeding