Intrapartum Care

Question 1

What is the definition of labour?

Answer 1

the onset of painful uterine contractions accompanied by any one of:
rupture of membranes (ROM); bloody show; and
cervical dilatation and/or effacement

Question 2

What is the description of first stage of labour?

Answer 2

Starts from the onset of true labour pains
and ends with complete dilatation of cervix

Question 3

What are the characteristics of first stage of labour?

Answer 3

It can be divided into:
• Latent phase: Slow and gradual cervical
effacement and dilatation (up to 3 cm)
• Active phase: Active cervical dilatation
(3–10 cm) and foetal descent.
It comprises of:
– Acceleration phase
– Phase of maximum slope
– Deceleration phase

Question 4

What is the definition of second stage of labour?

Answer 4

Stage II
Starts from full dilatation of cervix and ends
with expulsion of the foetus from birth canal

Question 5

What is the definition of 3rd stage of labour?

Answer 5

Stage III
Begins after expulsion of the foetus and is associated with expulsion of placenta and membranes

Question 6

What is the definition of fourth stage of labour?

Answer 6

Stage IV
Stage of observation which lasts for at least
1hour after the expulsion of afterbirths

Question 7

What are the characteristics of latent phase ?

Answer 7

begins with onset of regular contractions, with contractions occurring after every 15–20 minutes, lasting 20–30 seconds
The cervix shortens from 3 cm in length to less than 0.5 cm
This phase ends when cervix becomes about 3–5 cm dilated

Question 8

What is the duration of latent phase?

Answer 8

8–9 hours in the primi
less than 6 hours in multigravida.

Question 9

What is prolonged latent phase?

Answer 9

greater than 20 hours in primigravida and greater than 14 hours in the multigravida.

Question 10

What are the characteristics of active phase?

Answer 10

begins when the cervix is about 4 cm dilated and ends when it becomes fully dilated.

Question 11

What does active phase consist of?

Answer 11

1. Phase of acceleration:
2. Phase of maximum slope: there is linear dilatation with time. According to Friedman, during this phase the minimum rate of progression is at least 1 cm/h.
3. Phase of deceleration: This phase occurs at the end of active phase prior to complete dilatation.

Question 12

What are the Symptoms indicating the onset of labour ?

Answer 12

1- Lightening
2- Bloody show
3- Increased frequency and strength of Braxton Hicks
4- Rupture of membranes

Question 13

What is the definition of Foetal presentation ?

Answer 13

foetal body part which occupies the lower pole of the uterus and thereby first enters the pelvic passage.

Question 14

What are the three types of foetal lie ?

Answer 14

(1) cephalic,
(2) podalic (breech),
(3) shoulder

Question 15

What are the elements of Abdominal examination in labour ?

Answer 15

1- Uterine height
2- Foetal lie
3- Obstetric grips [Leopold’s manoeuvres ]
4- Uterine contractions
5 - Assessing the engagement of foetal presenting part
6- Auscultation of foetal heart.

Question 16

What is the definition of Foetal position ?

Answer 16

the relationship of the denominator of the foetal presenting part with the fixed points of
maternal pelvis.

Question 17

What is the denominator?

Answer 17

the most definable point of the foetal presenting part.
*for
vertex presentation is occiput;
*for breech presentation is sacrum;
*acromion for shoulder presentation;
*mentum
for face presentation.

Question 18

What are the The fixed points of the maternal pelvis ?

Answer 18

symphysis pubis anteriorly and the sacrum posteriorly

Question 19

What to estimate during vaginal examination in labour?

Answer 19

1-Cervical dilatation
2-Cervical consistency and effacement
3-Foetal presentation and position
4-Assessment of foetal membranes and amount of liquor.
5-Foetal descent [station of foetal head
6-Moulding of foetal skull
7-Pelvic assessment

Question 20

How to estimate the Foetal descent ?

Answer 20

• must be defined vaginally only after an abdominal examination has been done.
  Vaginally: the relationship to the ischial spine in centimetres above and below this landmark.
  Abdominally : as the number of fifths of foetal head palpable per abdomen( important in case of moulding of foetal head)

Question 21

How to determine the degree of moulding of foetal head ?

Answer 21

1- 0 (normal)
: Normal separation of the bones with open sutures
2- 1+ (mild moulding)
: Bones touching each other
3- 2+ (moderate moulding)
:Bones overlapping, but can be separated with gentle digital pressure
4- 3+ (severe moulding)
:Bones overlapping, but cannot be separated with gentle digital pressure

Question 22

What is Caput succedaneum ?

Answer 22

type of foetal head swelling, is a reflection of scalp oedema.
usually indicative of prolonged labour, it may sometimes be even present in normal cases and therefore may not be useful in planning the management.

Question 23

What are the investigations that should be done in labour?

Answer 23

1-Haematocrit + (CBC)
2-Urine for proteins (dipstick examination)
3-Blood typing (ABO and Rh)
4-Blood typing and screening (in case caesarean section is
anticipated)
5-VDRL, TORCH, HIV, (HBsAg)
(in case they have not been done in the antenatal period).

Question 24

How to monitor the pregnant woman during labour?

Answer 24

*BP and pulse :should be recorded every hour during the first stage &
every 10 minutes during the second stage
*FHR should be recorded immediately after a contraction
at least every 30 minutes during the active phase of the
first stage & at least every 15 minutes during the second stage

Question 25

Is partograph necessary in normal labour?

Answer 25

Normal labour should be plotted graphically on a partograph

Question 26

What is the alert line on partogram ?

Answer 26

starts at the end of latent phase and ends with the full dilation of the cervix (10 cm) within 7 hours (at the rate of 1 cm/h)

Question 27

What is the relationship between alert line & active line on partogram?

Answer 27

The action line is drawn 4 hours to the right of the alert line

Question 28

How to read the partogram according to the alert line & the action line?

Answer 28

Labour is abnormal: when the cervicograph crosses the alert line
and falls on zone II
intervention is required when it crosses the action line and falls in zone III.

Question 29

What is the manoeuvre applied to deliver the fetal head ?

Answer 29

Ritgen manoeuvre.
controlled delivery of the head so that the head is delivered with its smallest diameter