LABOUR

Question 1

When is prolonged labour diagnosed ? (failure to progress)

Answer 1

cervical dilatation is <2cm in 4 hrs

Question 2

what is the first stage of labour divided into ?

Answer 2

early latent phase and active phase

Question 3

describe the early latent phase and the active phase of labour

Answer 3

early latent - cervix effaced, shortens and dilates to 4cm

active phase - cervix dilates from 4cm to full dilatation (10cm)

Question 4

what is the second stage of labour

Answer 4

full dilation to delivery

Question 5

what is stage 3 of labour? how long after stage 2 does it occur

Answer 5

time between delivery of foetus and delivery of placenta around 5-10 mins up till 30 is norm .

Question 6

what is the second stag of labour divided into and describe

Answer 6

passive second stage - full dilation prior to or in absence of persistent contractions
active second stage - baby visible , or persistent contractions

Question 7

when is a delay in 2nd stage of labour ( active part) diagnosed in nulliparous women and multiparous women. what should you do in a diagnosis of delayed 2nd stage

Answer 7

nulliparous - after 2 hrs of active second stage
multiparous - after 1 hr of active second stage
refer in both cases
NB: epidural adds an hour onto each

Question 8

what are the two different ways of managing the 3rd stage of labour

Answer 8

physiological and active management

Question 9

when is the cord clamped in physiological management of stage 3 of labour

Answer 9

after pulsations ceased

Question 10

when would changing from a physiological to active management of stage 3 of labour be indicated ?

Answer 10

excessive bleeding or haemorrhage occurs, failure to deliver placenta in an hour, patient desire

Question 11

after how many hours is a rupture of membranes termed a pre-labour rupture of membranes (PROM) if no contractions

Answer 11

4 hours

Question 12

what are the 7 cardinal movements of labour

Answer 12

1. engagement
2. descent
3. flexion
4. int. rotation
5. extension
6. ext. rotation (restitution)
7. expulsion

Question 13

why might failure to progress occur?

Answer 13

3P’s
Powers ( inadequate contractions)
Passages ( trauma, shape)
Passenger ( big baby, malposition)

Question 14

indications for outlet forceps (wrigleys)

Answer 14

foetal scalp visible without seperating labia, sagittal suture in AP diameter or right/left occiput anterior

Question 15

indications for mid cavity /low cavity forceps (neville barnes, andersons, simpsons

Answer 15

foetal head 1/5th palpable abdominally, leading point of skull above station +2 but not above ischial spine
rotation of 45 degrees or less

Question 16

indications for rotational forceps (kiellands)

Answer 16

in theatre with effective analgesia

Question 17

soft puffy swelling that looks bruised and crosses suture lines. present at birth

Answer 17

caput succedaneum

Question 18

firm swelling with distinct margins that doesnt cross suture lines and appears several hours after birth

Answer 18

cephalohaematoma

Question 19

crosses suture lines present at delivery caused by sevreing of emissery veins. may progress rapidly

Answer 19

subgaleal haemorrhage

Question 20

a bishops score of greater than what is storngly predicitive of labour following induction? a score of less than what is indicitive of cervical ripening

Answer 20

> 6 strongly indicative of labour

<5 indicates need for cervical ripening

Question 21

requirements to use forceps

Answer 21

F - fully dilated 
O - occiput ant 
R - ruptured membranes 
C - cephalic presentation 
E - engaged presenting part - below ischial spine 
P - pain relief 
S - spinchter empty (catheterise )

Question 22

indications for operative delivery

Answer 22

failure to progress in stage 2
foetal distress
maternal exhaustion