Labour

Question 1

definition of labour

Answer 1

LABOUR IS THE PROCESS OF UTERINE CONTRACTIONS AND CERVICAL DILATATION THAT ENABLES THE UTERUS TO DELIVER THE VIABLE FETUS (>24 WEEKS), PLACENTA AND MEMBRANES.

Question 2

diagnosis of labour

Answer 2

LABOUR IS DIAGNOSED WHEN THERE ARE REGULAR & INCREASING PAINFUL UTERINE CONTRACTIONS THAT BRINGS ABOUT PROGRESSIVE CERVICAL EFFACEMENT AND/OR DILATATION

Question 3

average length of the second stage of labour in nulliparous and multiparous women

Answer 3

nulliparous: 1hr
multiparous: 2hr

Question 4

what is the latent phase of the 1st stage of labour

Answer 4

THE DURATION FOR THE CERVIX TO BECOME EFFACED (FROM 3 CM LONG TO <0.5 CM) AND DILATED TO 3 CM.
CAN TAKE 6-8 HRS IN A NULLIPARA AND 4-6 HRS IN A MULTIPARA

Question 5

what is the active phase of the 1st stage of labour

Answer 5

THE DURATION FOR THE CERVIX TO DILATE FROM 3 TO 10 CM (FULLY DILATED).
THE RATE OF CERVICAL DILATATION IS ON THE AVERAGE ABOUT 0.5CM/HR (2cm every 4 hours)

Question 6

what is recorded on a partogram? (8)

Answer 6

RATE OF CERVICAL DILATATION 
DESCENT OF THE HEAD 
CONTRACTION FREQUENCY & DURATION
FETAL HEART RATE (FHR) 
COLOUR/QUANTITY OF LIQUOR 
CAPUT & MOULDING OF THE HEAD 
MATERNAL PARAMETERS OF PULSE, BP, TEMPERATURE
URINE OUTPUT AND URINANALYSIS

Question 7

what is engagement

Answer 7

Engagement occurs when the widest diameter of the fetal head descends into the pelvis.

Question 8

movements of foetus during delivery

Answer 8

ENTERS PELVIS OCCIPITO-TRANSVERSE
DESCENT WITH HEAD FLEXION
INTERNAL ROTATION
EXTENSION
RESTITUTION (EXTERNAL ROTATION)
DELIVERY ANTERIOR THEN POSTERIOR SHOULDER
A BABY!!

Question 9

Causes of slow labour

Answer 9

PASSAGE
-INADEQUATE PELVIS (SHORT STATURE, PREVIOUS INJURY TO THE PELVIS, SOFT OR BONY TUMOUR)

PASSENGER
-THE FETUS MAY BE LARGE OR MAY PRESENT WITH A SUB-OPTIMAL DIAMETER (AS WITH MALPOSITION OR BROW PRESENTATION)

POWER
-INADEQUATE UTERINE CONTRACTIONS (COMMONEST CAUSE)

Question 10

what is a secondary arrest in labour

Answer 10

Secondary arrest occurs when there is no change in cervical dilatation for more than 4 hours following a period of normal active phase dilatation.

Question 11

describe the use of oxytocin in labour

Answer 11

START WITH LOW DOSE OF 2 TO 4 MU/MIN AND INCREASE BY 2 TO 4 MU

MOST LABOURS RESPOND WELL WITH 8-12 MU/MIN

TARGET UTERINE ACTIVITY:

• 4 TO 5 CONTRACTIONS EVERY 10 MIN
• EACH LASTING FOR > 40 SECS

TOTAL DURATION OF OXYTOCIN: UNLIKELY TO BENEFIT IF UNSATISFACTORY PROGRESS WITH 6 TO 8 HRS OF OXYTOCIN INFUSION

Question 12

Consequences of long infusion of oxytocin

Answer 12

BEWARE OF HYPERSTIMULATION & IATROGENIC FETAL DISTRESS

UTERINE RUPTURE IS RARE BUT CARE EXERCISED IN MULTIPARAE

‘ADH’ EFFECT & WATER INTOXICATION WITH HIGH DOSE & PROLONGED USE

Question 13

complications of slow labour

Answer 13

Maternal dehydration/ exhaustion
Maternal and Fetal infection
Fetal distress
Operative delivery
Uterine rupture
Postpartum haemorrhage
Increased Maternal & Fetal morbidity
Vesicovaginal fistula

Question 14

pre-requisites for assisted delivery

Answer 14

HEAD 0/5’TH OR 1/5’TH PALPABLE
NOT A LARGE BABY
CERVIX FULLY DILATED
MEMBRANES RUPTURED
NOT EXCESSIVE CAPUT/MOULDING
SATISFACTORY FETAL CONDITION
EMPTY BLADDER
SUITABLE PRESENTATION/ POSITION
DESCENT WITH CONTRACTION & BEARING DOWN EFFORT

Question 15

things used in the active management of the 3rd stage

Answer 15

IM Syntometrine given with delivery of anterior shoulder.
Left hand placed above symphysis pubis to guard anterior wall of uterus
Controlled cord traction until placenta is delivered
Placenta and membranes checked for completeness
Estimate blood loss
Check for tears and suture under local anaesthetic if required

Question 16

complications of the 3rd stage of labour

Answer 16

Retained Placenta
Postpartum haemorrhage
Perineal trauma 
Second / third degree tear
Perineal / Pelvic haematoma
Uterine inversion