Labour

Question 1

What are the three stages of labour?

Answer 1

1st - onset of regular contractions to full dilatation of the cervix

2nd - from full dilation of the cervix to the birth of the baby

3rd - birth of the baby to delivery of the placenta and membranes, and control of associated bleeding

Question 2

Presentation of the foetus

Answer 2

Part of the foetus which lies at the pelvic brim or lower pole of the uterus

Question 3

What are the five common presentations of the foetus?

Answer 3

Vertex

Breech (more common in preterm)

Brow (head is de-flexed)

Face (complete extension of the head)

Shoulder (twins, placenta praevia)

Question 4

Induction of labour

Answer 4

Process of artificially starting labour.

Has an impact on the birth experiece of women. May be less efficient and usually more painful than spontaneous labour. Epidural and analgesia more likely to be required.

Question 5

In what situations may induced labour be indicated?

Answer 5

Post-term

Foetal compromise

Maternal compromise (pre-eclampsia)

Poor obstetic history

Stillbirth

Prematue rupture of membranes with no contractions.

When the foetus and/or mother will benefit from a healthier outcome than if the birth is delayed. Only considered when vaginal delivery is appropriate

Question 6

What are the main methods of induction?

Answer 6

Membrane sweep

Prostglandins given vaginally

Artifical rupture of membranes

Oxytocin infusion

Question 7

What are the three cephalic presentations in labour?

Answer 7

Vertex

Face

Brow

Question 8

How can the state of the foetus be monitored in labour?

Answer 8

Foetal heart rate (should be increasing)

Presence of meconium (indicated distress)

Question 9

What are the two main types of foetal monitoring?

Answer 9

Intermittent foetal monitoring

Continuous foetal monitoring

Question 10

What is the normal foetal heart rate?

Answer 10

110-160 bpm

Question 11

What is the normal colour of liquor?

Answer 11

straw-coloured and clear

Question 12

What interventions to facilitate birth?

Answer 12

Social:
Environment (dim lighting)
Trust
Social support
Nutrition
Mobility

Medical:
Forceps
Analgesia
C-section
Position

Question 13

Factors which increase risk of pelvic floor dysfunction

Answer 13

Smoking,
ageing,
female gender,
childbirth,
obstetric risks ( lacerations etc),
overweight,
chronic constipation,
some occupations

Question 14

Events of the first stage of labour

Answer 14

Increased prostaglandin release stimulates and an increase in oxytocin, producing more forceful contractions.

As contractions increase the stretch receptors in the cervix send fibres to the hypothalamus and increases OT. Makes contractions more foreceful and frequent (Ferguson reflex)

Muscle fibres shorten but do not relax fully, the fundus shortens.

This pushes the presenting part of the foetus towards the birth canal and dilates the cervix.

Stage ends when cervix is 10cm

Question 15

Events of the 2nd stage of labour

Answer 15

The descending head flexes as it meets the pelvic floow reducing the diameter of presentation.

There is then internal rotation to bring the shoulders through the bones of the pelvis.

The flexed head descends through the vulva, stretching the vagina and perineum and the head is delivered. Risk of tearing may be reduced by an episiotomy

The shoulders then rotate are delivered, rapidly followed by the rest of the foetus.

Stage ends when the baby is fully delivered.

Question 16

Events of the third stage of labour

Answer 16

Following delivery of the baby there is powerful uterine contractions, which separate the placenta and it moves to the upper part of the vagina/lowe uterus.

Placenta and membanes are also expelled within 10-20mins.

Contraction of the uterus compresses spiral arteries and endometrial vessels to reduce bleeding. Process can be enhanced by administering oxytoxin.

Completes third stage of labour.