Labour, normal and abnormal

Question 1

1. Define Labour
2. What are the three options for birth locations?
3. What is a ‘Birth Plan’?

Answer 1

1. Labour is a physiological process during which the fetus, membranes, umbilical cord and placenta are expelled from the uterus.
2. Consultant led unit, midwife led unit, homebirth.
3. A record of what a woman would like to happen during her labour and after the birth.

Question 2

1. In short what is the role of progesterone, oestrogen and oxytocin in the onset of pregnancy
2. What is the name given to the fluid that exits the vagina during rupture of membranes (breaking of waters)

Answer 2

1. Progesterone keeps the uterus settled. Oestrogen causes uterine contraction. Oxytocin initiates and maintains uterine contractions.
2. Liquor (effectively amniotic fluid)

Question 3

1. What cervical changes occur with labour?

2. What is the Bishop’s score?

Answer 3

1. Cervical softening and ripening.
2. A score used to determine if it is safe to induce labour
   3.

Question 4

The first stage of labour consists of a ______ and _______ phase. The ________ phase consists of the initial mild uterine contractions, cervical ______ and lasts a variable amount of time. The following _______ phase cervical _______ begins until full dilatation. The uterine contractions slowly become stronger and more rhythmic. Normal progress is considered ________ an hour.

Answer 4

Latent, active, latent, softening, active, ripening, 1-2cm an hour

Question 5

The second stage of labour starts with maximum _______ of the cervix (10cm diameter). Finishes with _________ of the baby. In __________ women it is considered prolonged if exceeds 3 hours with regional analgesia or 2hrs without. In __________ women it is considered prolonged if exceeds 2hrs with regional analgesia or 1hr without

Answer 5

dilatation, delivery, nulliparous, multiparous.

Question 6

The third stage labour begins with the delivery of the baby and ends with the expulsion of the _______ and the ____ ________. The average duration is ________. After _______ preparation for surgical management is considered.

Answer 6

Placenta, fetal membranes, 10 minutes, 1 hour.

Question 7

1. What are the three P’s that are important factors in labour?
2. Uterine contractions should increase in ________, _________ and _________.
3. Name three types of pelvis. Which is most suitable for childbirth?

Answer 7

1. Power (uterine contractions), Passage (Maternal Pelvis), Passenger (Unborn child)
2. Frequency, Duration and Intensity.
3. Gynaecoid, android, anthropoid. Best for childbearing is Gynaecoid.

Question 8

1. What is the ideal position of the vertex in childbirth?
2. What can be felt on the vertex to determine the fetal position?
3. What is a Partogram.

Answer 8

1. Occipito-anterior.
2. Fontanelles.
3. A graphic record to store key maternal and fetal information and assess the progress of labour.

Question 9

What are the seven cardinal movements of labour?

Answer 9

1. Engagement
2. Descent
3. Flexion
4. Internal Rotation
5. Crowning and Extension
6. Restitution and external rotation
7. Expulsion, anterior shoulder first

Question 10

1. Define engagement.
2. During descent how is the fetal head positioned?
3. What is meant by crowning?

Answer 10

1. 1st stage in mechanism of labour where 3/5 of fetal head has entered the brim of the pelvis
2. Occiput transverse position
3. Appearance of large part segment of fetal head at introitus.

Question 11

1. Why is umbilical cord clamping delayed?

2. Name two drugs which can be used in the active management of third stage of labour.

Answer 11

1. Immediate clamping can reduce the red blood cell count of the baby at birth.
2. Prophylactic administration of oxytocin or Synometerine

Question 12

1. What is the most common type of placental separation?
2. What is the Puerperium?
3. Lochia is the discharge of the following days. What are the three types?

Answer 12

1. Matthew Duncan Separation
2. Period of repair and recovery following delivery where female tissues return to normal state (takes 6 weeks).
3. Rubra, Serosa, Alba

Question 13

1. Define malpresentation

2. What is the ideal analgesia?

Answer 13

1. Presentations of the fetus other than vertex.

2. Regional anaesthesia

Question 14

1. How may the three P’s contribute to failure of progress?

Answer 14

1. Power- inadequate frequency/strength of uterine contractions
   Passage- Short stature, severe pelvic trauma, shape of pelvis
   Passenger- Big baby, malposition

Question 15

1. How is the fetal heart monitored?

2. What 4 factors should be assessed when reviewing a CTG?

Answer 15

1. Doppler auscultation of fetal heart, cardiotocograph, colour of amniotic fluid.
2. Baseline fetal heart rate, Baseline variability, presence or absence of decelerations, presence of accelerations.

Question 16

What is the pneumonic for CTG interpretation.

Answer 16

DR C BRAVADO
Determine 
Risk
Contractions
Baseline
R
Ate
Variability
Accelerations
Decelerations
Overall impressions

Question 17

1. What are the main indications for Caesarean sections?

Answer 17

1. previous CS, fetal distress, failure to progress in labour, breech presentation, maternal request