Labour management/normal childbirth lecture:

Question 1

What weeks of gestation is it normal to deliver between?

Answer 1

37-42 complete weeks

Question 2

What is effacement?

Answer 2

Thinning of the cervix. Occurs before dilation of the cervix begins

Question 3

List the 5 parameters used to assess the progression of labour:

Answer 3

• Presentation
• Lie
• Attitude (presenting part flexed or deflexed)
• Engagement widest part of the presenting part has passed through the brim of the pelvis)
• Station

Question 4

At what part of labour does oxytocin have effects in?

Answer 4

Active labour:

• 4cm dilated
• Regular, frequent contractions
• progressive

Question 5

What 4 factors affect woman satisfaction in labour?

Answer 5

• Personal expectations
• Amount of support from caregivers
• Quality of caregiver-patient relationship
• Involvement in decision making

Question 6

List 4 methods of dealing with pain:

Answer 6

• Psychological methods
• Sensory methods
• Birth environment
• Complementary (massage, acupuncture, reflexology etc.)

Question 7

List 3 types of pain relief used during labour and 2 disadvantage for each:

Answer 7

1) Entonox (Nitric oxide)
- Nausea and vomiting

2) Opiates (morphine) -
- Foetal respiratory depression
- Diminished breast seeking
- Prolonged 1st and 2nd stages of labour

3) Epidural (most effective) -
- Need for more oxytocin
- Foetal tachycardia due to maternal temperature

Question 8

What is delayed active phase of second stage of labour defined as?

Answer 8

Primigravid - >2hrs

Multiparous - >1hr

Question 9

List 3 beneficial actions and 3 non-beneficial actions during labour:

Answer 9

Beneficial:
- Upright posture
- Spontaneous pushing
- Privacy/dignity
Non-beneficial:
- Directed pushing
- Sustained bearing down
- Breath-holding

Question 10

List the 8 stages/mechanisms of labour:

Answer 10

1) Descent
2) Flexion
3) Internal rotation
4) Crowning
5) Extension
6) Restitution
7) Internal restitution of shoulders
8) Lateral flexion

Question 11

What are the benefits of delay cord clamping?

Answer 11

Improved irons status and reduced prevalence of iron deficiency at 4 months

Question 12

What nerve roots do nerve pains derive from during the 1st and second stages of labour?

Answer 12

1st stage - uterine contraction, cervical effacement and dilatation:

• T10 - L1
• S2-S4

2nd stage - stretching vaginal and perineum, extrauterine pelvic structures:

• S2 - 4 (pudendal)
• L5 - S1

Question 13

Why do opioids cross the placenta easily?

Answer 13

They are lipid soluble

Question 14

What opioid should be avoided in epileptics?

Answer 14

Pethidine - metabolites can cause seizures

Question 15

What does PCA mean?

Answer 15

Patient controlled analgesia (PCA)

Question 16

List 2 types of PCA opioids:

Answer 16

• Fentanyl

- Alfentanil

Question 17

Where is an epidural inserted?

Answer 17

L3/4

Question 18

Indications for epidural:

Answer 18

• Maternal request
• Cardiac/other medical disease
• Augmented labour
• Instrumental/operative delivery is likely

Question 19

List 2 contraindications to epidural:

Answer 19

• Local infection

- Allergy to LA

Question 20

What are the effects of regional techniques (epidural and spinal)?

Answer 20

• Vasodilation (= reduced MAP)
• Analgesia
• Motor blockade
• Fever

Question 21

List 4 SE of epidurals:

Answer 21

• Lengthen labour
• Triple risk of severe perineal tear
• Increase risk of CS by 2.5 times
• Increase induction with synthetic oxytocin (Pitocin)

Question 22

What do regional techniques not cause?

Answer 22

• Increase in CS rate
• Associated back pain
• Effect on neonatal APGAR score

Question 23

List 2 advantages and 2 disadvantages of regional anaesthesia:

Answer 23

(+ves):
- Safer
- Can see baby immediately
(-ves):
- Hypotension
- Headache