Labour

Question 1

What is the first stage of labour?

Answer 1

From the onset of labour to up to 10cm dilated

Question 2

What is the second stage of labour?

Answer 2

From 10cm cervical dilation up to the delivery of the baby

Question 3

What is the third stage of labour?

Answer 3

From delivery of the baby until delivery of the placenta

Question 4

What is the latent phase of the first stage of labour?

Answer 4

Up to 3cm cervical dilation
Irregular contraction
Progresses at 0.5cm per hour

Question 5

What is the active phase of the first stage of labour?

Answer 5

From 3cm to 7cm cervical dilation
Regular contractions
Progresses at 1cm per hour

Question 6

What is the transition phase of the first stage of labour?

Answer 6

From 7 to 10cm cervical dilation
Strong regular contractions
Progresses at 1cm per hour

Question 7

What are Braxton-Hicks contractions?

Answer 7

Occassional irregular contractions that can be felt during the second and third trimesters of pregnancy. They do not progress or become regular

Question 8

What are the signs of labour?

Answer 8

Mucus plug from the cervix
Rupture of membranes
Regular, painful contractions
Dilating cervix on examination

Question 9

What is rupture of membranes (ROM)?

Answer 9

When the amniotic sac has ruptured

Question 10

What is spontaneous ROM?

Answer 10

The amniotic sac has ruptured spontaneously

Question 11

What is pre-labour ROM?

Answer 11

The amniotic sac has ruptured before the onset of labour

Question 12

What is preterm pre-labour ROM?

Answer 12

The amniotic sac has ruptured before the onset of labour and before 37 weeks gestation

Question 13

What is prolonged ROM?

Answer 13

The amniotic sac ruptures more than 18 hours before delivery

Question 14

What is the definition of prematurity?

Answer 14

Delivery before 37 weeks gestation

Question 15

What is cardiotocography?

Answer 15

Used to measure fetal heart rate and contractions of the uterus

Question 16

How is CTG recorded?

Answer 16

Two doppler ultrasound transducers are placed on the abdomen:
- One above the fetal heart
- One above the fundus of the uterus

Question 17

What are the indications for continuous CTG monitoring?

Answer 17

Sepsis
Maternal tachycardia
Significant meconium
Pre-eclampsia
Fresh antepartum haemorrhage
Delay in labour
Use of oxytocin
Disproportionate maternal pain

Question 18

What are the 5 key features of CTG?

Answer 18

Contractions
Baseline fetal heart rate
Variability
Accelerations
Decelerations

Question 19

What is a reassuring baseline fetal heart rate?

Answer 19

110-160

Question 20

What is a non-reassuring baseline fetal heart rate?

Answer 20

100-109 or 161-180

Question 21

What is an abnormal fetal heart rate?

Answer 21

Below 100 or above 180

Question 22

What is normal variability of fetal heart rate?

Answer 22

5-25

Question 23

What is a non-reassuring variability of fetal heartrate?

Answer 23

Less than 5 for 30-50 minutes or more than 25 for 15-25 minutes

Question 24

What is an abnormal variability of fetal heartrate?

Answer 24

Less than 5 for over 50 minutes or more than 25 for over 25 minutes

Question 25

What are decelerations?

Answer 25

Fetal heartrate dropping in response to hypoxia

Question 26

What are early decelerations?

Answer 26

Dips and recoveries in heart rate that correspond with uterine contractions - they are normal

Question 27

What are late decelerations?

Answer 27

Gradual falls in heart rate that start after the contraction has began. They are caused by hypoxia in the fetus and are pathological

Question 28

What are variable decelerations?

Answer 28

Decelerations that may be unrelated to uterine contraction. They are related to compression of the umbilical cord

Question 29

What are prolonged decelerations?

Answer 29

A drop of more than 15bpm from baseline that lasts between 2 and 10 minutes

Question 30

What is progress in labour influenced by?

Answer 30

Power - uterine contractions Passenger - size, presentation and position of baby Passage - size and shape of pelvis

Question 31

What is failure to progress in the first stage of labour?

Answer 31

Less than 2cm of cervical dilation in 4 hours Slowing of progress in a multiparous woman

Question 32

What is a partogram?

Answer 32

Monitoring system during the first stage of labour

Question 33

What is the attitude of the fetus?

Answer 33

The posture of the fetus

Question 33

What is included in a partogram?

Answer 33

Cervical dilation Descent of fetal head Maternal pulse, BP, temp and urine output Fetal heart rate Frequency of contractions Status of the membranes Drugs and fluids that have been given

Question 33

What is failure to progress in the second stage of labour?

Answer 33

When the active (pushing) phase of the second stage lasts more than 2 hours in a nulliparous woman or 1 hour in a multiparous woman

Question 34

What is oblique lie?

Answer 34

The fetus is at an angle

Question 34

What is longitudinal lie?

Answer 34

The fetus is straight up and down

Question 35

What is cephalic presentation?

Answer 35

The head presents first

Question 35

What is transverse lie?

Answer 35

The fetus is straight side to side

Question 36

What is shoulder presentation?

Answer 36

The shoulder presents first

Question 37

What is a complete breech presentation?

Answer 37

Breech presentation (feet first) with hips and knees flexed

Question 38

What is a frank breech presentation?

Answer 38

A breech presentation with hips flexed and knees extended - bottom first

Question 39

What is a footling breech?

Answer 39

A breech presentation with a foot hanging through the cervix

Question 40

What is delay in the third stage of labour?

Answer 40

More than 30 minutes with active management More than 60 minutes with physiological management

Question 41

What is the management of failure to progress in labour?

Answer 41

ARM - artifical rupture of membranes Oxytocin infusion Instrumental delivery C-section

Question 42

What is active management of the third stage of labour?

Answer 42

When the doctor/midwife assists in the delivery of the baby

Question 43

How is the third stage of labour actively managed?

Answer 43

IM oxytocin after delivery of the baby