Management of labour

Question 1

what is labour?

Answer 1

The process of uterine contractions and cervical dilatation that allows the uterus to deliever a viable foetus

Question 2

How often do you want the contractions to be before they come on the labour ward?

Answer 2

At least every five minutes

Question 3

what are theories for the initiaiton of labour?

Answer 3

• progesterone withdrawal

- neuronal stimulation from cervical pressure

Question 4

why could progesterone drop cause labour?

Answer 4

progesterone is a strong smooth muscle relaxant

Question 5

what is the first stage of labour?

Answer 5

The period between onset of regular painful contractions to full cervical dilatation

Question 6

what is the second stage o flabour?

Answer 6

From full cervical dilatation to delivery of a foetus

Question 7

what is the third stage of labour?

Answer 7

From delivery of the foetus to delivery of the placenta and membranes

Question 8

how long is the second stage of labour normally in a nulliparous women?

Answer 8

one hour

Question 9

how long is the second stage of labour normally in a multiparous lady?

Answer 9

half an hour

Question 10

how big do you want the cervix by the end of the first stage of labour?

Answer 10

10cm

Question 11

what is the normal progress in the second stage of labour?

Answer 11

1cm an hour

Question 12

what stage of labour is considered the most dangerous?

Answer 12

third

Question 13

what is the first stage of labour split into?

Answer 13

latent phase

active phase

Question 14

what is the latent stage?

Answer 14

the duration for the cervic to be effaced at 3cm long.

Question 15

how long is the latent stage of labour?

Answer 15

nullipara: 6-8 hours
multipara: 4-6 hours

Question 16

why does the cervix become soft in the latent stage?

Answer 16

Prostaglandin release act as vasodilators allowing water in

There is also actviation of MMP’s which break down collagen

Question 17

what is the normal rate of progress in the active phase?

Answer 17

1cm/hr

Question 18

what events are reported on a partogram?

Answer 18

• rate of cervical dilatation
• descent of the head
• contraction frequency and duration
• foetal heart rate and colour
• caput and moulding
• maternal pulse, BP, temp, UO

Question 19

what is the alert line on a partogram?

Answer 19

Drawn at a rate of 1cm/hour from admission cervical dilatation in the active phase.

Question 20

what is the action line?

Answer 20

A line drawn 2 or 3 cm to the right and parallel to the alerty line

Question 21

If labour is to the right of the normal line how can it be augmented?

Answer 21

• rupture the amniotic membranes if they haven’t already as this helps the head descent and releases PG’s
• consider using oxytocin

Question 22

what are the 3 P’s of causes of slow labour?

Answer 22

P- passage
P-passenger
P-power

Question 23

why can ‘passage’ be a cause of slow labour?

Answer 23

• inadequate pelvis to fit for example short, previous injury or trauma

Question 24

why can ‘passenger’ be a cause of slow labour?

Answer 24

• large foetus

- abnormal prseentation

Question 25

why can 'power' be a cause of slow labour?

Answer 25

- inadequate uterine contractions

Question 26

what is the most common cause of slow labour?

Answer 26

Not enough power: inadequate uterine contractions

Question 27

what is the standard management for active phase?

Answer 27

- reassurance by giving one to one support - hydration - pain relief

Question 28

what extra management can be added to the standard care in a slow active phase?

Answer 28

- artificial membrane rupture - use of oxytocin - foetal surveillance - monitoring labour progress and mothers conditions

Question 29

how do staff check the mothers hydration through out the active phase?

Answer 29

checking the urine for ketones as a marker

Question 30

what is an eppsiotomy?

Answer 30

A cut to prevent tears in the 8 o clock direction

Question 31

why do you not do an epsiotomy straight down?

Answer 31

damage to the anal sphincter

Question 32

what is seen in the mother in the second stage of labour?

Answer 32

vulval bulging anal dilatation increased resp rate can't sit still

Question 33

what is the ferguson reflex and when is it present?

Answer 33

In the second stage of labour and is the urge to push

Question 34

what positions do you want the baby?

Answer 34

1. as it passes through the pelvic inlet which it's face to the side and chin tucked in 2. after passing the pelvis moves it's head forward through the vagina facing the bed

Question 35

what is given to help the third stage of labour?

Answer 35

IM syntometrine

Question 36

when is IM syntometrine given for the third stage of labour?

Answer 36

once the anterior shoulder has been delievered

Question 37

As the doctor where do you want your hands in the third stage of labour?

Answer 37

Left on the pubis synphisis to guard the anterior wall of uterus

Question 38

how should you deliver the third stage of labour?

Answer 38

wait to see cord lengthening then gently pull to see if the placenta has detached

Question 39

what should be done after the placenta has been delivered?

Answer 39

it should be checked for completeness

Question 40

what dose of oxytocin should be given in labour?

Answer 40

2-4MU//min and then slowly increase

Question 41

what are risks of using oxytocin throughout labour?

Answer 41

- hyperstimulation - foetal distress - uterine rupture - ADH effect and water intoxication

Question 42

what are complications of a slow labour?

Answer 42

- maternal dehydration and exhaustion - maternal and foetal infection - foetal distress - operative delivery - uterine rupture - postpartum haemorrhage - increased morbidity - fistula

Question 43

what are indications of dystocia?

Answer 43

- failure of the cervix to dilate - failure of the head to descend - increased caput andmoulding.

Question 44

what help can be given in a prolonged second stage?

Answer 44

- forceps = ventous = analgesia

Question 45

what is given for the 3rd stage at the point the anterior shoulder is delievered?

Answer 45

IM syntometrine

Question 46

what are possible complications of the third stage of labour?

Answer 46

- retained placenta - postpartum haemorrhage - perineal trauma via tears - perineal haematoma - uterine inversion