Methods to asses progress in labour and birth

Question 1

What 3 factors do effective uterine contractions include?

Answer 1

Intensity, synchronization and frequency of contractions.

Question 2

Where does each contraction start?

Answer 2

At the fundus near one of the cornua and spreads across downwards.

Question 2

What happens when the upper pole contracts?

Answer 2

The lower pole relaxes.

Question 3

Where is the peak of a contraction reached?

Answer 3

simultaneously over the whole uterus

Question 3

what happens with the uterine muscle on each contraction?

Answer 3

Shorten- instead of becoming relaxed.

Question 4

During labour, uterine contractions are initiated from…?

Answer 4

The cornua

Question 5

The forewaters are formed when…?

Answer 5

The chorion separates from the decidua.

Question 6

What are the forewaters formed from?

Answer 6

As the lower segment of the uterus is pulled upwards and the chorion (the external membrane) detaches from it.
The well flexed baby’s head fits into the cervix and blocks off the water in front of the head (forewaters) from the fluid behind (hind waters)

Question 7

What does the uterus from with contractions?

Answer 7

upper and lower segments.

Question 8

What is the difference between the upper and lower segments of the uterus?

Answer 8

The upper is thicker and muscular, the lower (the isthmus and cervix) prepares for distension and dilation.

Question 8

What are the stages of labour and birth associated with assessing physiological progress?

Answer 8

-Latent first stage of labour
-Active first stage of labour
-Second stage of labour
-Third stage of labour.

Question 9

What is the retraction ring?

Answer 9

A ridge that has developed between upper and lower segments and the upper segment contracts and retracts and the lower segment thins out.

Question 10

What are the observational external signs for methods of assessment?

Answer 10

Purple line
Rhombus of michaelis
Cold feet
Behavioural change

Question 11

What did sheperd et al find out about the purple line

Answer 11

Positive correlation between length of purple line and cervical dilation
Occurred in 76% of women

Question 12

What is the physiology of the purple line?

Answer 12

Possibly results from increasing intra-pelvic pressure due to descent of presenting part causing vaso-congestion in basinvertebral and intravertebral veins.

Question 13

What is the rhombus of machaelis?

Answer 13

Kite shapes area-includes the sacrum and three lower lumber verterbrae
Movement of the rhombus by up to 2cm

Question 14

What can cold feet indicate (Frye 2004)

Answer 14

Temperature change in the lower leg to indicate cervical dilation.

Question 15

What does the Friedman’s curve illustrate?

Answer 15

The traditionally expected rate of cervical dilation and duration of each stage of labour in a woman who has never given birth.

Question 16

What are challenges with observational methods?

Answer 16

-Subjective
-Considered ‘not evidence based’
-Is the lack of evidence a problem?
-Individual differences between women
-Art versus science

Question 17

What did Muliira et al (2013) find out about the frequency of VEs

Answer 17

Found that the frequency may suggest a distrust or fear in the patient’s ability to give birth unaided on the part of the healthcare professional.
Negative perceptions of VE’s by patients, concerns regarding inc risk of infection.

Question 18

What are some indications of a VE

Answer 18

Speculum examination
Induction of labour: membrane sweep or protoglandin administration
Assess onset and progress of labour
Confirming presenting part and position
Induction/Augmentation of labour: Artificial rupture of membranes
Apply fetal scalp electrode
Fetal blood sampling

Question 19

What are some contraindications for VE?

Answer 19

Placenta Previa
Pre-labour rupture of membranes
malposition
preterm labour
Antepartum haemorrhage

Question 20

When do the NICE (2023) guidelines say to offer a VE in labour?

Answer 20

• Offer in active first stage 4 hourly or if there is a concern about progress or in response to the woman’s wishes (after palpation and assessment of loss)
  -Offer a VE in active second stage or in response to woman’s wishes.

Question 21

What are the preparation points for a VE

Answer 21

Identify indication
Gain informed consent
Ensure maternal comfort
-empty bladder
-positioning
Ensure privacy and dignity
collect equipment
perform abdominal palpation
Wash hands and apply gloves

Question 22

What does the visual inspection of external genitalia/vagina include for a VE?

Answer 22

Presence of infection
Vulval varicosities
Oedema
Female genital mutilation (FGM)
Discharge/ bleeding/ amniotic fluid
Piercing

Question 23

What are you considering in locating the cervix in a VE procedure?

Answer 23

Position: Posterior, mid or anterior
consistency: soft or firm
Effacement: length of cervix measured in cm
Dilatation: cervical os measured in cm
Application of presenting part: well or loosely applied to the cervix.

Question 24

What is the part of a VE procedure which is the station of the presenting part

Answer 24

Identify presenting part
Position of the presenting part in relation to the ischial spines of the pelvis

Question 25

What is the part of the procedure which includes the position of the presenting part?

Answer 25

Determine the position of the fetus by palpating sutures and fontanelles of fetal skull.

Question 26

What is a caput succedaneum?

Answer 26

Soft swelling on the head of newborn
Usually on the portion of the head presenting first
May cross suture lines

Question 27

What should you do following the VE?

Answer 27

Auscultate the fetal heart
Assist the woman with comfort measures
Sensitively communicate findings to the woman
Documentation
Propose plan of care.