Labour

Question 1

What % women have IOL

Answer 1

15-20%

Question 2

A scoring system (Bishop’s score) is used to assess the readiness

Answer 2

Of the cervix. prior to commencing the IOL. It enables decisions to be made for the dose of medication and the method to be determined. A low score suggests that induction of labour is likely to take a longer time.

Question 3

What is used to ripen the cervix?

Answer 3

Vaginal prostin

Question 4

In situations where the risk of hyperstimulation of the uterus incurred with prostaglandin gel should be avoided, what is used?

Answer 4

balloon catheter passed through the cervix is used e.g. if a woman has had a previous Caesarean section, or the fetus is severely growth restricted.

Question 5

What is included in bishops score?

Answer 5

Position, consistency, length, dilatation, station. (score 6 –> IOL)

Question 6

Phase 1 of first stage labour.

Answer 6

latent stage with cervical effacement < 3cm dilation of the cervix and some descent of the head. This phase can be up to 10-12 hours in a nulliparous woman, the contractions may or may not be painful but most healthy women have this stage at home

Question 7

Phase 2 of first stage labour

Answer 7

acceleratory phase from 3 cm dilation during which time uterine activity increases and the head descends. The cervix continues to dilate about 0.5cm/hour in a nulliparous woman but quicker for multiparous (1cm/hour).

Question 8

Phase 3 of first stage labour

Answer 8

transition phase. Increasing activity and the onset of the expulsion of the head of the baby.

Question 9

The second stage of labour is

Answer 9

from full dilatation until birth of the baby. There may be a passive second stage in which further descent is awaited (especially if an epidural is used), followed by the active second stage where maternal effort (eg by Valsalva manoeuvre) is used to push the baby out through the pelvic outlet. The baby is said to be “crowning” as the head distends the vulva and perineum and the ‘crown’ of the head is easily visible.

Question 10

In second stage labour what fetal attitude (position) should baby be in

Answer 10

Flexed with chin to neck, round back, flexed arms and legs(subocciptobregmatic diameter - smaller diameter) fits through the pelvic inlet.

Question 11

Longitiudinal lie

Answer 11

long axis (spine) lies along mums long axis (spine)

Question 12

Fetal presentation

Answer 12

First part to descent into pelvis (cephalic vertex - with flexion of head). Can also be shoulder or breech.

Question 13

Cardinal movements of labour

Answer 13

Descent - downward movement of fotus (called metal station) Relationship of fetal presenting part to mums ischial spine. Pelvic inlet -5 to isical spine 0 = engagement.

Then flexion - fetal chin against chest (resistance from pelvic floor)

Internal rotation - widest part shoulders inline with widest part pelvic inlet.

After fetal head passes under symphysis pubis (+4) there is extension

Extension +5 - delivery from vagina

Resistution - head externally rotates so shoulders can pass through pelvic outlet and under symphysis pubis.

Expulsion - anterior shoulder followed by posterior shoulder –> rest of body

Question 14

The third stage is from birth of the baby until delivery of the placenta.

Answer 14

his 3rd stage can happen by itself or can be actively managed by clamping the cord, giving an embolic

Question 15

What is the widest part of the fetal head

Answer 15

biparetal diameter

Question 16

Rising maternal temperature might indicate what

Answer 16

Obstructed labour.