Labour

Question 1

outline the three stages of labour

Answer 1

first - from nothing to full dilatation
second - delivery of the baby
third - delivery of the placenta

Question 2

outline the latent and active phases of the first stage of labour

Answer 2

latent - from 0-4cm dilation, slow dilatation

active - from 4-10cm, faster usually 1cm per hour

Question 3

what are the changes in contractions and the cervix during the first stage of labour

Answer 3

cervix shortens and softens

contractions become stronger, more frequent and regular

Question 4

the first phase of labour should be no more than __ hours

Answer 4

18 in nulliparous women

Question 5

what is the second phase of labour

Answer 5

from full dilation to delivery of the baby

Question 6

how long should the second phase of labour last in nulliparous women

Answer 6

<2 hours if no analgesia

<3 hours if analgesia

Question 7

how long should the second phase of labour last in multiparous women

Answer 7

<1 hour if no analgesia

<2 hours if no analgesia

Question 8

describe the passive stage of second phase of labour

Answer 8

woman if fully dilated and feels head reaching the pelvic floor, feels desire to push

Question 9

describe the active stage of second phase of labour

Answer 9

baby is visible, persistent involuntary contractions and active maternal effort in time with contractions

Question 10

what is the third stage of labour

Answer 10

from the delivery of the foetus to the expulsion of the placenta and membranes

Question 11

how long should the third stage of labour last

Answer 11

usually lasts around 10 minutes but should be no more than 30 minutes

Question 12

if the third stage of labour exceeds 30 minutes, what are the next steps in management

Answer 12

give IM syntocinon and observe for further 30 minutes - 1 hour in total

Question 13

what are the indications to switch from physiological to active management of the third stage of labour

Answer 13

active bleeding
failure to deliver placenta in 1 hour
patient desire

Question 14

list some indications that the placenta may have separated from the uterus

Answer 14

uterus contracts, hardens and rises
umbilical cord lengthens permanently
gush of blood
placenta visible at introitus

Question 15

list the 7 cardinal movements of the foetus in preparation for labour

Answer 15

engagement 
descent 
flexion
internal rotation
extension 
external rotation 
expulsion

Question 16

list some causes of malpresentation

Answer 16

breech
transverse lie
shoulder
brow/face presentation

Question 17

what is the correct presentation of a foetus in labour

Answer 17

cephalic presentation, longitudinal lie
presenting part = vertex
occipito-anterior

Question 18

outline some causes of failure to progress during labour (3Ps)

Answer 18

power - inadequate or infrequent contractions
passages - abnormally shaped pelvis, trauma
passengers - big baby, malposition, cephalic-pelvic disproportion

Question 19

what are some risk factors for foetal hypoxia

Answer 19

small for dates
preterm 
antepartum haemorrhage 
pre-eclampsia at term
diabetes 
epidural analgesia 
sepsis 
induction of labour

Question 20

what are the two methods of assisted delivery

Answer 20

forceps delivery

ventouse/vacuum assisted

Question 21

what is the aim of assisted delivery

Answer 21

use of instrument to facilitate same cardinal movements before birth

Question 22

for forceps delivery, what features must be present

Answer 22

fully dilated 
OAP
ruptured membranes 
cephalic presentation 
engaged presenting part

Question 23

amniotic fluid embolism is one of the immediate complications of labour, how does it present

Answer 23

respiratory distress
hypoxia
hypotension
usually occurs within 30 mins of delivery

Question 24

what are the indications of induction of labour

Answer 24

prolonged pregnancy >42 weeks 
pre-eclampsia at term 
diabetes in pregnancy 
IUGR
but NOT macrosomia alone

Question 25

what are the three methods of induction of labour

Answer 25

vaginal prostaglandins
amniotomy
membrane sweep

Question 26

what are the options for anaesthesia in labour

Answer 26

spinal anaesthesia
epidural
pudendal anaesthesia