Labour and Delivery

Question 1

What are the stages of normal labour?

Answer 1

First Stage [cervical stage] - latent (contactions > Q5m, up to 3-4 cm dilation) and active (contractions Q2-5m, 3-10cm dilation) – some divide last 3 cm cerv dilation to transistion phase
Second Stage [fetal expulsion] - Complete effacement to delivery
Third stage [placental expulsion] - Post delivery of baby to delivery of placenta
Fourth - 1st hour after delivery of placenta, when PPH most likely to occur.

Question 2

What is normal fetal / cervical progression for the first stage of labour?

Answer 2

Cerivcal - nullip 1 cm/hr, multip 1.5 cm/hr

Fetal station - nullip 1 cm/hr descent, multip 2 cm/hr

Question 3

What are risk factors for preterm labour? (16)

Answer 3

1] Psychosocial:

• age extremes > 40, teens
• cocaine use
• smoking / tobacco
• low SES
• prolonged standing occupation
• psychosocial stressors

2] Gyne:

• prior preterm
• multiple gestation
• anatomic endometrial anomalies
• cervical incompetence
• low pregnancy weight gain
• diethylstilbestrol exposure
• first trim PVB
• placenta prev/abruption

3] Surgical:

• previous gyne surgery
• previous paraendometrial surgery (e.g. appy)

4] Infectious:

• UTI
• systemic infection
• GU infetions (e..g. C/G BV)

Question 4

When to suspect premature labour? (3)

Answer 4

Uterine contractions (best differentiated from false contractions by electronic monitoring)   +
Cervical changes   +
gest < 37 wk or wgt < 2500 g

Question 5

What is management of premature labour? (4) What are contraindications to these? (12)

Answer 5

TOCOLYTICS (in conjunction of gyne):

• MgSO4 - 4-6 IV over 20min, then 2-4 gr/hr infusion (measure/trend Mg)
• terbutraline