Normal and abnormal labour and delivery

Question 1

Common reasons for abnormal labour

Answer 1

• Delay during labour 1 or 2
• Meconium staining
• Retained placenta
• Abnormal foetal heart rate
• Neonatal concerns

Question 2

Causes of high risk birth

Answer 2

Cardiac/hypertensive disease
Asthma/CF
Hyperthyroidism/diabetes
Hep B/HIV/TB

Question 3

NICE guidelines for abnormal labour

Answer 3

Raised BP/pulse + protein
Fever
Membrane rupturing etc
Presentation/lie of baby

Question 4

Reassuring trace

Answer 4

Baseline 110-150 bpm with variations of 5-25 bpm

No concerning decelerations

Question 5

Non-reassuring trace

Answer 5

<110 or >160 bpm with a lot of variability

There are variable decelerations

Question 6

Abnormal trace

Answer 6

Below 100 or above 180 bpm with considerable variation

Decelerations lasting over half an hour

Question 7

Stage 1 labour

Answer 7

True contractions 
Latent (<4cm) and active (4-10)
Cervix effaces and dilates 
Cervix will become 10cm dilated 
Up to 18hr

Question 8

Stage 2 labour

Answer 8

Descent in birth canal
Pushing
Baby born
3 hours

Question 9

3rd stage of labour

Answer 9

Delivery of placenta

30 mins

Question 10

PROM

Answer 10

Normally membranes break in the first stage of labour
PROM is where they break more than an hour before labour begins
<37 weeks is pre-term prom
Babies should be delivered within 96hours

Question 11

Meconium risks

Answer 11

Aspiration pneumonia

Increased c-section and ICU risk - continuous CTG needed

Question 12

Normal labour length for first baby

Answer 12

8-18 is normal

Question 13

Normal labour length for second baby or more

Answer 13

5-12 hours

Question 14

What causes limited progress in labour?

Answer 14

P = power of contractions (dysfunctional uterus)

P = passage through uterus/cervix/pelvis (obstructed labour)

P = passenger size/presentation/position (malpresentation)

Question 15

Dysfunctional uterine activity

Answer 15

• Inertia
• Weak/infrequent/short contractions <4 in 10 mins
• Most common reason for first baby
• Vaginal exam needed every 2h
• Artificial rupture of membranes + oxytocin infusion → c-section after 4/6h
• Secondary inertia: at full dilation, contractions become weak

Question 16

Obstructed labour causes

Answer 16

Mass, baby-pelvis disproportion, malpresentation, foetal abnormalities

Question 17

Maternal impacts of obstructed labour

Answer 17

PPH and rupture

Question 18

Brow presentation of baby

Answer 18

On VE can palpate brow, orbit, anterior fontanelle - delivery by c-section

Question 19

Face presentation of baby

Answer 19

On VE can palpate chin

Question 20

Foetal impacts and risk factors for shoulder dystocia

Answer 20

Effects: hypoxia, death, fractured arm/clavicle, Erb’s

Risk factors: macrosomia, post-term baby

Question 21

Maternal effects and risk factors for shoulder dystocia

Answer 21

Bleeding, perineal trauma

R/f: diabetes, short stature, obesity

Question 22

Difference between induction and augmentation

Answer 22

• Induction: stimulate uterus to begin labour

- Augmentation: stimulating uterus during labour to increase frequency and strength

Question 23

What is Bishop’s score?

Answer 23

Success related to the cervix at the start of induction
Favourable if soft, short and dilated
More than 8 indicates a successful induction is likely

Question 24

What prostaglandin is found in pessaries?

Answer 24

PGE2

Question 25

What is a healthy rate of contractions?

Answer 25

> 2cm/4h

Question 26

Primary PPH

Answer 26

> 500ml within 24h of delivery

Question 27

Secondary PPH

Answer 27

> 500ml from 24h to 12 weeks

Question 28

Minor PPH

Answer 28

500-1000ml

Question 29

Major PPH

Answer 29

> 1000ml

Question 30

Reasons for PPH

Answer 30

Tone (uterine atopy), Tissue (retained placenta), Trauma (injury during delivery), Thrombin (clotting disorder)

Question 31

Sx PPH

Answer 31

tachycardia, low BP, N and V, syncope, pallor, slow CRT