Intrapartum Care

Question 1

Duration of labour

Answer 1

• varies
• sometimes a few days
• from active labour (~ 8 hours to 18 hours)

Question 2

Variables of labour

Answer 2

1. Power
2. Passenger
3. Passage
4. Psyche of a mother

Question 3

What is Power?

Answer 3

• force generated during a uterine contraction
• more power, more successful outcome
• assessment: observation of the mother and palpation of the fundus of the uterus or using external tocodynamometry
• 3-5 contractions in 10 min, lasting 50-60 seconds

Question 4

What is passenger?

Answer 4

• refers to fetus
• fetal size ~2.8-3.5kg
• lie: longitudinal, transverse or oblique
• presentation (leading fetal part in pelvic): vertex or breech
• attitude (degree of flexion of the fetal head)
• position (relationship between presenting part to a specific quadrant of woman’s pelvis e.g. right occipital anterior)
• station (degree of decent of leading part): -2, -1, 0

Question 5

What is passage?

Answer 5

• refers to pelvis
• consists of bony pelvis + soft tissues (cervix, pelvic floor musculature)

Question 6

What is psyche of the mother?

Answer 6

• mother’s willpower to push the baby

Question 7

What are the 3 stages of labour?

Answer 7

1st stage- time from onset of labour to full cervical dilation (10cm)
2nd stage- time from 10cm to delivery of baby
3rd stage- time from delivery of baby to expulsion of placenta

(4th stage- immediately after baby birth: newborn & postpartum care)

Question 8

1st stage (time from onset of labour to full cervical dilation- 10cm)
- divided into 2 phases: latent phase & active phase

Answer 8

• focus on coping with pain
• uterus begins rhythmic contractions which steadily increase in strength and frequency
• uterine contractions dilate the cervical & push the fetus through the birth canal

Question 9

Latent phase of 1st stage of labour (<3cm)

Answer 9

• slow cervical dilation

Question 10

Active phase of 1st stage of labour (>3cm)

Answer 10

• contractions are stronger, last longer and more regular
• faster rate of cervical dilation (~1cm per hour)

Question 11

Side effects of pethidine (opioid, IM injection)

Answer 11

Maternal: nausea, vomiting and sedation
Fetal: respiratory depression, cross placenta, fetus peak (~2-3 hours), baby should deliver <1/>4 hours

Question 12

Side effects of epidural analgesia

Answer 12

Frequent: hypotension, itching, nausea and vomiting, spinal headache, fever

Infrequent: fits, breathing difficulties, nerve damage, death

Question 13

Side effects of epidural analgesia

Answer 13

Frequent: hypotension, itching, nausea and vomiting, spinal headache, fever

Infrequent: fits, breathing difficulties, nerve damage, death

Question 14

7 Cardinal movements

Answer 14

1. Descent
2. Engagement
3. Flexion
4. Internal rotation
5. Extension
6. External rotation/ Restitution
7. Expulsion

Question 15

Signs of placenta expulsion

Answer 15

1. Gush of blood
2. Lengthening of umbilical cord
3. Uterine fundus becomes firmer and globular