Labour and delivery

Question 1

When do labour and delivery normally occur?

Answer 1

-between 37 and 42 weeks gestation

Question 2

What are the three stages of labour?

Answer 2

• first stage
• second stage
• third stage

Question 3

When does the first stage begin and end?

Answer 3

-form onset of labour(true contractions) until 10 cm cervical dilatation

Question 4

When does the second stage begin and end?

Answer 4

-from 10cm cervical dilatation until delivery of the baby

Question 5

When does the third stage begin?

Answer 5

-from delivery of the baby until delivery of the placenta

Question 6

What are the three phases of the first stage?

Answer 6

• latent phase
• active phase
• transition phase

Question 7

What is the latent phase of the first stage of labour?

Answer 7

• from 0 to 3cm dilation of the cervix
• this progresses around 0.5cm per hour
• there are irregular contractions

Question 8

What is the active phase of the first stage of labour?

Answer 8

• from 3cm to 7cm dilation of the cervix
• progresses around 1cm per hour
• regular contractions

Question 9

What is the transition phase of the first stage of labour?

Answer 9

• from 7cm to 10cm dilation of the cervix
• progresses at around 1cm per hour
• strong and regular contractions

Question 10

What are braxton-hicks contractions?

Answer 10

• braxton-hicks contractions are occasional irregular contractions of the uterus
• usually felt during the second or third trimester
• these are not true indications and do not indicate the onset of labour
• staying hydrated and relaxed can reduced these

Question 11

What are the signs to look for when diagnosing the onset of labour?

Answer 11

• Show (mucus plug from cervix)
• rupture of membranes
• regular, painful contractions
• dilating cervix on examination

Question 12

What does rupture of membranes (ROM) refer to?

Answer 12

-amniotic sac has ruptured

Question 13

What does rupture of prelabour membranes (PROM) refer to?

Answer 13

-amniotic sac has ruptured before the onset of labour

Question 14

What does preterm prelabour rupture of membranes refer to (P-PROM)?

Answer 14

amniotic sac has ruptured before the onset of labour and before 37 weeks gestation

Question 15

What does preterm Prolonged rupture of membranes (also PROM)refer to?

Answer 15

amniotic sac ruptured more than 18 hours before delivery

Question 16

What is classed as a premature birth?

Answer 16

-birth before 37 weeks gestation

Question 17

What babies are considered non-viable?

Answer 17

• those below 23 weeks gestation
• resuscitation is not considered in these babies that do not show signs of life
• they have a 10% chance of survival
• from 24 weeks onwards there is increased chance of survival and resusciation is offered

Question 18

What gestation is classified as extreme preterm?

Answer 18

-under 28 weeks

Question 19

What gestation is classified as very preterm?

Answer 19

28-32 weeks

Question 20

What gestation is classified as moderate to late preterm?

Answer 20

32-37 weeks

Question 21

What options are there for prophylaxis of preterm labour?

Answer 21

• vaginal progesterone

- cervical cerclage

Question 22

How does vaginal progesterone work as prophylaxis for preterm labour?

Answer 22

• maintains pregnancy and prevents labour by decreasing myometrium activity and preventing cervix remodelling
• offered to women with cervical length <25mm on US between 16 and 24 weeks gestation

Question 23

How does cervical cerclage work as prophylaxis for preterm labour?

Answer 23

• involves putting stitch in cervix to add support and keep it closed
• stitch is removed when women goes into labour or reaches term
• offered to women with cervical length <25mm on US between 16 and 24 weeks gestation, who have had previous preterm birth or cervical trauma

Question 24

How can rupture of membranes be diagnosed?

Answer 24

• by speculum exam which reveals pooling of amniotic fluid in the vagina
• if doubt about diagnosis, can test for IGFBP-1 and PAMG-1