Labour and abnormal labour.

Question 1

Define normal labour.

Answer 1

Painful, regular contractions with cervical change.

Question 2

Stage I normal labour.

Answer 2

Mucousy show.
Cervix goes from 3cm-10cm.
Latent phase–> Active phase (6cm).
Involves softening, effacement, dilation, position.

Question 3

Stage II normal labour.

Answer 3

10cm to baby delivery.
Passive descent (couple hours).
Active pushing (~1 hour).

Episiotomy may be performed.

Question 4

Episiotomy.

Answer 4

Surgical incision between vagina and anus to prevent perineal tear due to delivery.

Question 5

Stage III normal labour.

Answer 5

Baby delivery to delivery of the placenta.

<30 minutes.

Question 6

How is baby’s movement through the pelvis measured.

Answer 6

By ‘foetal station’ based on the ischial spines.
–5 = within uterus.
0 = level of the ischial spines.
+5 = at vaginal opening.

Question 7

Active management of delivery of the placenta.

Answer 7

Give oxytocin.

Suprapubic massage + continuous gentle traction on the umbilical cord.

Question 8

Baby movement through the pelvis.

Answer 8

Enters at pelvic inlet in transverse position (occipito-transverse).
Rotates mid cavity.
Occipito-anterior position, 90º.
Clears the birth canal.
Restitution (external rotation realigning with shoulders).

Question 9

Causes of non-progress in labour.

Answer 9

Power
Passenger
Pelvis

Question 10

First stage problems of non-progress and how to manage.

Answer 10

Power – give oxytocin or perform amniotomy to rupture membranes.
Passenger + pelvis – C-section.

Question 11

Second stage problems of non-progress and how to manage.

Answer 11

Power – encouragement, instrument delivery, C-section.
Passenger– instrument delivery, C-section.
Pelvis – C-section.

Question 12

Define non-progress of labour in second stage.

Answer 12

> 1h pushing without delivery.

Question 13

Third stage problems of non-progress and how to manage.

Answer 13

Delay = high risk of haemorrhage.
Suprapubic massage + cord traction + ergometrine.
Surgery.

Question 14

Instruments used for delivery.

Answer 14

Forceps.

Ventouse.

Question 15

When can instruments be used for delivery.

Answer 15

When baby’s head is at station 0 (level of ischial spines)

Question 16

Risks of instrument delivery.

Answer 16

Trauma to mother.
Trauma to baby’s head.
Haemorrhage/infection.
Shoulder dystopia.

Question 17

What is foetal hypoxia?

Answer 17

Serious complication of labour where there is poor gas exchange between mother and foetus.

Causes: hypercapnia, acidaemia, hypoxaemia, increased lactate production –> tissue ischaemia, acidosis, death.

Question 18

Degrees of perineal tear.

Answer 18

1 – fourchette and vaginal mucosa damaged, muscles exposed but not affected.
2 – posterior vaginal walls and perineal muscles.
3 – anal sphincter torn.
4 – anal canal opened, rectal mucosa torn.

Question 19

What is shoulder dystocia?

Answer 19

When the baby’s head is outside the pelvic rim but the shoulders are stuck in the anterioposterior position. Baby can breathe through it’s mouth, but it’s chest cannot expand.

Causes rapid hypoxia and death if not delivered.

Question 20

What is McRobert’s manoeuvre?

Answer 20

1st manoeuvre to deliver baby in shoulder dystocia.

Involves mother hyperflexing and abducting hips.

Question 21

What are Wood’s Screw and Rubin’s manoeuvre’s?

Answer 21

2nd line attempts to deliver a baby in shoulder dystocia.