Labour

Question 1

Definition of labour.

Answer 1

The process of expulsion of the fetus from intrauterine to extrauterine life.

Question 2

Diagnosis of labour.

Answer 2

Intermittent abdominal pain corresponding to intermittent contractions with show and/or dribbling.
Dilation of the cervix.

Question 3

Definitions of the stages of labour and their respective phases.

Answer 3

Stage 1 = onset of labour to complete cervical dilation
-latent = 8-15hrs slow until 4cm
-active = 6hrs, 1cm/hr rate

Stage 2 = from full dilation of the cervix to the expulsion of the fetus.
-passive = descent of the fetus
-active = pushing and delivery (primi 2hrs, multi 1hr w/o epidural)

Stage 3= expulsion of the placenta and membranes
-active
-passive

Stage 4 = first 2hrs post-partum

Question 4

Pearls of pharmacological analgesia

Answer 4

-if epidural was used, stage 2 of labour is prolonged (primi 3hrs, multi 2hrs)
-if opioids (eg pethidine) was used, the baby should be delivered within 4hrs. If not, it will cross the placenta and cause respiratory depression.

Question 5

Frequency of checking FHR.

Answer 5

Stage 1 = 30 minutes
Stage 2 = 15 minutes
Stage 3 = 10 minutes then 5 minutes during bearing down

Question 6

Intrapartum interventions to reduce perineal trauma.

Answer 6

Perineal massage, perineal support with hands during deliver, episiotomy

Question 7

Active management of stage 3 of labour.

Answer 7

Syntocin bolus administration (IM 10IU, IV 5IU)
Controlled cord traction
Delayed cord clamping

Question 8

Process of delayed cord clamping.

Answer 8

Wait for minimum of 2 minutes or until cord pulsation stops. Or employ milking towards the baby.

Question 9

Steps in labour mechanism.

Answer 9

Engagement
Descent
Flexion
Internal rotation/Restitution
Extension
External rotation/Vestitution
Expulsion