Labour (1)

Question 1

What is labour?
→ When is it diagnosed?

What is used to monitor the progress of labour?
→ What are the aspects of this?
→ When would it indicate intervention is needed?

Answer 1

➊ Process of Uterine contractions and Cervical dilatation that enables delivery of viable foetus, placenta and membranes
→ When there are regular and increasingly painful uterine contractions (5 mins apart) that bring about progressive cervical effacement and/or dilatation

➋ Partogram
→ • Alert line - Line drawn at a rate of 1cm/hr from when cervix enters the active phase
• Action line - Parallel line drawn 4cm to the right of the alert line
→ If labour progresses to the right of the Action line as it’s deemed to be slow

Question 2

First Stage:
What is the overall outcome here?

What are the 2 phases that occur here?

What is the main substance at work here?

Answer 2

➊ Full Cervical dilatation

➋ (1) Latent phase - Cervix becomes fully effaced and slightly dilated
(2) Active phase - Cervix becomes fully dilated

➌ Prostaglandins

Question 3

Second Stage:
What is the overall outcome here?

What are the steps that occur here?

What is a major complication that can occur here?
→ What occurs here?
→ What is a risk factor for this?
→ What is Caput?
→ What is Moulding?

Answer 3

➊ Delivery of Foetus

➋ • Babies head passes through pelvic fossa sideways before rotating its head downwards
• Mother pushes until crown is out
‣ Hand on the head, holding it in place to prevent a tear and the baby being “spurted” out
• Once babies whole head is out, head then turns back to the side, with both shoulders in a longitudinal plane
‣ Anterior shoulder (behind pubic symphysis) is pulled out by pushing the baby downwards
‣ Posterior shoulder pulled out by pushing the baby upwards

➌ Labour Dystocia
→ Obstructed labour - Failure of cervix to dilate, and head to descend, with increased Caput and Moulding
→ Small pelvis
→ Oedema of the scalp due to tourniquet effect of Cervix during labour
→ Reduction in Foetal head diameter due to overlapping sutures and compressible nature of bones and Fontanelles

Question 4

Third Stage:
What is the overall outcome here?

What occurs here?

What is given to actively manage this stage?
→ When is this given?

What are the complications that can occur here?

What are some complications that can occur with giving Oxytocin?

Answer 4

➊ Delivery of Placenta and Membranes

➋ Left hand placed above pubic symphysis to guard anterior uterine wall - Controlled cord traction until placenta is delivered

➌ IM Syntometrine (Oxytocin + Ergometrine)
→ On delivery of ant. shoulder

➍ • Retention of placenta
• PPH
• Perineal tear
• Herniation of uterus - ensure placenta is fully detached before pulling

➎ • Hyperstimulation
• Iatrogenic foetal distress
• Uterine rupture
• ADH effect and Water intoxication with high dose and prolonged use

Question 5

Slow Labour:
What are the causes of this?

What are the complications that can occur with this?

Answer 5

➊ 3 P’s:
• Power - Inadequate uterine contractions (Most common cause)
• Passage - Inadequate pelvis (short stature, previous pelvic injury, tumour)
• Passenger - Foetus may be large or may present with a sub-optimal diameter

➋ • Maternal dehydration/exhaustion
• Maternal and Foetal infection
• Foetal distress
• Operative delivery
• Uterine rupture
• PPH
• Increased maternal and foetal morbidity
• Vesicovaginal fistula