Labour

Question 1

What is the role of progesterone in labour?

Answer 1

Inhibits contractions

Prevents formation of gap junctions

Question 2

What is the role of oestrogen in labour?

Answer 2

Makes uterus contract

Promotes prostaglandin production

Question 3

What is the role of oxytocin in labour?

Answer 3

Initiates & sustains contractions

Promotes prostaglanidn release

Question 4

What are the 2 phases of the first stage of labour?

Answer 4

Latent phase (up to 3-4cm dilated) 
Active phase (4cm onwards)

Question 5

When is the second phase of labour prolonged in a nulliparous woman?

Answer 5

> 3 hours (or >2 hours without analgesia)

Question 6

When is the second phase of labour prolonged in a multiparous woman?

Answer 6

> 2 hour (>1 hour without analgesia)

Question 7

What is the average duration of the third stage of labour?

Answer 7

10 mins

Question 8

What can be used to lower the risk of PPH in the third stage of labour?

Answer 8

Oxytocic drugs & cord traction

Question 9

What changes happen to the cervix in labour?

Answer 9

Softening (increased hyaluronic acid)

Ripening (decreased collagen allignment & increase in cervical decorin)

Question 10

What are Braxton-Hicks contractions?

Answer 10

Non-painful ‘practice’ contractions (>30 weeks)

Question 11

What is the normal progression of true contractions?

Answer 11

Get longer
More frequent
More intense

Question 12

Where does the placenta separate?

Answer 12

Spongy layer of decidua basalis

Question 13

What is considered a normal time for placental expulsion?

Answer 13

< 30 mins

Question 14

How long does it normally take for the fundal height to return to within the pelvis?

Answer 14

2 weeks

Question 15

What are the hormonal changes post labour?

Answer 15

Decrease in oestrogen
Decrease in progesterone
Prolactin is maintained

Question 16

When does diuresis commence post delivery?

Answer 16

2-3 days

Question 17

When is failure to progress suspected in the first stage of labour?

Answer 17

<2cm in 4 hours

Question 18

What 3 factors can cause failure to progress?

Answer 18

Power
Passages
Passenger

Question 19

What does a foetal partogram assess?

Answer 19

Foetal heart
Amnioticfluid 
Cervicaldilation 
Descent 
Contractions 
Obstruction (moulding) 
Maternal observations

Question 20

How is foetal distress assessed?

Answer 20

Doppler auscultation of foetal heart

Question 21

How do you interpret a CTG?

Answer 21

D - Determine
R - Risk 
C - Contractions 
Bra - Baseline Rate (120-160)
V - Variability 
A - Accelerations 
D - Deccelerations
O - Overall Impression

Question 22

What are accelerations?

Answer 22

Increase of >15 bpm in 15 seconds

Normal = at least 2 every 15 mins

Question 23

What are decceleration?

Answer 23

Decrease of >15bpm in 15 second
Early = normal
Variable = potential cord compression (change position)
Late (start at peak of contraction) = insufficient blood flow

Question 24

What should be done if there is late decelerations?

Answer 24

Foetal blood sampling for pH(if acidic = significant foetal hypoxia and need for emergency c section)

Question 25

What does a sinusiodal pattern of CTG indicate?

Answer 25

Severe foetal hypoxia
Severe foetal anaemia
Foetal/maternal haemorrhage
EMERGENCY!!!!!!

Question 26

What manouvere is recommended in shoulder dystocia?

Answer 26

Hyperflex legs & apply suprapubic pressure

McRobert’smanouvere