Labour

Question 1

What is the clinical definition of Labour?

When is one diagnosed to be in Labour?

What do the contractions lead to?

Answer 1

• Process of Uterine contractions and Cervical dilatation that enables delivery of viable Foetus (>24 weeks), Placenta and Membranes
• Diagnosed when there are regular and increasingly painful uterine contractions (5 MINUTES APART)
• Progressive Cervical effacement/dilatation

Question 2

STAGES OF LABOUR:
1st Stage:
What occurs here?

What’s the first phase here? What occurs?

How does the first phase time duration differ between nulliparous and multiparous women?

What stimulates this first phase?

What’s the second phase here? What occurs?

2nd Stage:
What occurs here?

How does the time duration differ between nulliparous and multiparous women?

3rd Stage:
What occurs here?

Answer 2

• Onset of regular painful Uterine contractions → Full Cervical dilatation
• • Latent phase - Duration for the Cervix to become Effaced (3cm to <0.5cm long) and Dilated to 3cm wide
• • 6-8 hours (Nulliparous)
  • 4-6 hours (Multiparous)
• Prostaglandins
• • Active phase - Duration for the Cervix to become Fully dilated (3cm to 10cm); about 1cm/hr

• Delivery of the Foetus
• • 1 hour (Nulliparous)
  • 30 minutes (Multiparous)

• Delivery of Placenta and Membranes

Question 3

What is used to record the progress of Labour?

What does it measure?

What are the 2 lines drawn on the graph?

When does the graph indicate the need for intervention?

Answer 3

• Partograms
• Rate of Dilatation, Descent of the head, Contraction frequency and duration, Foetal HR, Colour/Quantity of amniotic fluid, Caput and Moulding of head, Maternal Pulse/BP/Temperature and Urine analysis
• • Alert line - Line drawn at a rate of 1cm/hr from beginning of the active phase
  • Action line - Line drawn 4CM TO THE RIGHT of the alert line
• When labour progresses to the right of the ACTION LINE it’s deemed to be slow

Question 4

SECOND STAGE:
What changes are seen here?

How does the baby’s head orientation change as it moves through the pelvic fossa?

What occurs for the head to be pushed out? Why does the obstetrician hold the head and what does it prevent?

What position does the baby then go in once its head is fully out?

How is each shoulder then pulled out?

What is given after the anterior shoulder is delivered?

Answer 4

• Vulval bulging, Anal dilatation, Urge to push, Increased Resp. rate, Unable to sit still, “In the zone”/”Lost the plot”
• Passes through sideways before rotating downwards
• • Mother pushes until the crown of the head is out
  o Hand on head to allow it to gradually come out - Prevents a tear and baby being “spurted” out
• Turns its head back to the side, with both shoulders in a longitudinal plane
• • Anterior shoulder (behind pubic symphysis) is pulled out by pushing the baby downwards
  • Posterior shoulder pulled out by pushing the baby upwards
• IM Syntometrine (Combination of Oxytocin and Ergometrine)

Question 5

Dystocia:
What is it?

What are does it lead to?

What is Caput?

What is Moulding?

Answer 5

• Obstructed labour
• Failure of Cervix to dilate, Head to descend, Increased Caput and Moulding
• Oedema of the scalp due to tourniquet effect of Cervix during labour
• Reduction in Foetal head diameter due to overlapping sutures and compressible nature of bones and Fontanelles

Question 6

THIRD STAGE:
How is the placenta pulled out?

What are the 2 complications that occur here?

Answer 6

• Left hand placed above pubic symphysis to guard anterior wall of Uterus; Controlled cord traction until placenta is delivered
• • Retention of Placenta
  • Herniation of Uterus - uterus pulled out with placenta, which is why it’s important to ensure the placenta is fully detached before pulling