Normal Labor and Intrapartum

Question 1

Define labour?

Answer 1

Labour can be defined as the process by which regular painful contractions bring about effacement and dilatation of the cervix and descent of the presenting part, ultimately leading to expulsion of the fetus and placenta from the mother.

Question 2

Define Normal Labour?

Question 3

How long does labour last in multi and primigravida?

Answer 3

Primi:12-18hrs
Multigravida_6-9hrs

Question 4

Describe the pathophysiology of how contractions comes about ?

Question 5

How many and what are the stages of labour?

Answer 5

1st stage – Effacement and dilatiation of cervix with labour contractions
2nd stage – Expulsion of fetus
3rd stage – Expulsion of Placenta
4th stage- Monitoring

Question 6

What are the two phases of 1stage and describe them?

Answer 6

Latent phase; the period taken for the cervix to completely efface and dilate up to 3cm.
Active phase; from 4cm to full dilatation.

Question 7

How long does the latent and active phase in 1st stage usually last?

Answer 7

Latent phase-8-20hrs
Active phase-4-8hrs at a rate of 1cm/hour or more in normal pregnancy.

Question 8

How does the first stage begin?

Answer 8

Begin by the onset of regular contractions

Question 9

Describe the difference between False and true labor contractions?

Answer 9

Refer to handout.

Question 10

What happens in the second stage of labour? How long does it take?

Answer 10

Begins with a complete dilated cervix and ends with delivery of fetus.
Takes 1-2hrs

Question 11

Describe the 2 phases of the second stage of labour?

Answer 11

-Passive descent phase -no maternal urge to push and the fetal head is relatively high in the pelvis
-An active push phase- is characterized by maternal urge to push because the fetal head is low causing a reflex need to push

Question 12

Describe the 3rd stage of labour and how long does it usually last?

Answer 12

Starts from delivery of the baby to delivery of the placenta and membranes
Last for 30 minutes

Question 13

List the cardinal movements of 2ns stage of labour?

Answer 13

Engagement
Descent
Increased flexion
Internal rotation
Extension
Restitution
External rotation
Delivery of the shoulders and fetal body (expulsion)

Question 14

What is Engagement?

Answer 14

Is the passage of the widest transverse diameter of the presenting part(biparietal diameter) through the plane of the pelvic inlet

Question 14

When is Engagement said to have occured?

Answer 14

Engagement is said to have occurred when the widest part of the presenting part has passed successfully through the inlet

Question 15

What is descent and what causes it?

Answer 15

Passage of the fetal head down the pelvis
descent of the fetus is secondary to uterine action

Question 16

In which stages does Descent occur?

Answer 16

Occurs during the first stage and passive phase of the second stage of labour

Question 17

Why does cervical flexion occur?

Answer 17

As the head descends into the narrower mid-cavity it meets resistance which in turn causes a lever like motion of the head. Leading to cervical flexion

Question 18

How does cervical flexion make it an easier passage?

Answer 18

The cervical flexion brings the chin into more contact with the fetal thorax substituting the longer occipitofrontal diameter with shorter suboccipital bregmatic which helps in passage.

Question 19

At what level of the birth cala does internal rotation occur?

Answer 19

At the level of the ischial spine.

Question 20

Describe internal rotation?

Answer 20

Involves rotation of the position of the fetal head in the mid pelvis from transverse to anterior-posterior by 90° so that the sagittal suture now lies in the AP diameter of the pelvic outlet (widest diameter)

Question 21

When does extension occur?

Answer 21

Occurs after the fetus has descended to the level of the maternal vulva

Question 22

How does extension bring out the delivery of the head?

Answer 22

This action brings the base of the occiput into contact with the inferior margin of the symphysis pubis, where the birth canal curves upward

Question 23

Describe Restitution?

Answer 23

involves rotation of the head so that the occiput is in line with the fetal spine

Question 24

Describe External Rotation?

Answer 24

The anterior shoulder rotates 45° anteriorly as it meets the maternal pelvic floor.
This action is transmitted to the head which also rotates 45° placing the head in its original transverse position

Question 25

Describe Expulsion?

Answer 25

Occurs when the rest body is delivered. Anterior shoulder via downward traction and posterior shoulder via upward traction.

Question 26

What are the pertinent areas to cover of the management of Stage 1 of Labour?

Answer 26

History taking
General examination
Abdominal examination
Vaginal examination
Fetal assessment
The partogram
Monitor progress of labour and fetal well being with timely intervention if anything becomes abnormal
Adequate and appropriate pain relief
Adequate hydration to prevent ketosis

Question 27

What are the important areas to ask in History Taking for management of 1st Stage of labour?

Answer 27

Details of previous births and the size of previous babies
The frequency, duration and perception of strength of the contractions and when they began
Whether the membranes have ruptured and, if so, the color and amount of amniotic fluid lost
The presence of abnormal vaginal discharge or bleeding
The recent activity of the fetus
Any medical issues of note that may influence the labour and delivery e.g. pregnancy-induced hypertension, fetal growth restriction

Question 28

What are the things looked out for during a general exam of patient in stage 1 of labor?

Answer 28

Vital signs are measured
Head and neck checking for pallor, cyanosis, dry mucous membranes
Chest examination, listening for heart and lung sounds
Extremities looking for pallor, pulses whether regular and strong or not, cynosis
Things that may complicate the management of labour are also looked into, for instance raised body mass index

Question 29

What are the things assessed in the abdominal exam of a patient in their 1st stage of labor?

Answer 29

Obstetric Examination is key
Lie and the nature of the presentation of the fetus
The degree of engagement if it’s a cephalic presentation
Assessment of contractions ;the frequency, duration and intensity
Examination of the fetal heart
Site, rhythm and rate

Question 30

What is assessed in the vaginal exam during the 1st stage of labor?

Answer 30

The cervix is assessed for dilatation and effacement
Condition of membranes, if ruptured color and amount of fluid drained should be noted
The fetal presenting part in terms of presentation, position, degree of flexion, station, moulding and caput

Question 31

How is the fetus assessed in a 1st stage of labor?

Answer 31

Observation of the color of the liquor – fresh meconium staining and heavy bleeding are markers of potential fetal compromise
intermittent auscultation of the fetal heart using a Pinard fetoscope or a hand-held Doppler ultrasound
continuous external fetal monitoring using cardiotocograph

Question 32

What are the important things to note in the management of a patient in 2nd stage of labor?

Answer 32

Lithotomy position
Clean vulva and perineum with antiseptic
Encourage organized pushing down with every contraction
Frequent monitoring of the uterine contractions and fetal heart rate
Do an episiotomy if necessary

Question 33

What are the two ways of delivery a placenta?

Answer 33

Conventional and Active

Question 34

Describe the conventional way of delivering the placenta?

Answer 34

Conventional involves
Allowing the Placenta and membranes to separate without interference
Awaiting the signs of placental separation
No oxytocin is given
The placenta is delivered by maternal effort alone

Question 35

What is the disadvantage of the conventional way of placenta delivery?

Answer 35

Takes longer time and there is a risk of postpartum hemorrhage

Question 36

What are the signs of placental separation?

Answer 36

Gush of blood
Lengthening of umbilical cord protruding the vulva
Globular shaped uterine fundus on palpation compared to a broad softer fundus prior to separation

Question 37

Describe the Active management of the placenta?

Answer 37

Uterine stimulants are given to produce strong uterine contractions and thus rapid placental separation.

Oxytocin administered after cutting the umbilical cord
Controlled cord traction while allowing the placenta to separate spontaneously (Brandt-Andrews maneuver)

Question 38

What is the advantage of Active management of the placenta?

Answer 38

1.significantly reduces the risk of postpartum hemorrhage
2.third stage of labor is shortened 3.Less requirement for blood transfusion

Question 39

What is the management of stage 4 of labor?

Answer 39

Suture episiotomy or any laceration
Estimate blood loss, count cotton swabs, take cord blood for; HB, blood group.
Monitor vital signs and intervene accordingly
Check uterine muscle tone
Encourage nursing
Care of the baby

Question 40

What are the complications of labor?

Answer 40

Pain
Perineal tear
Uterine inversion
Retained placenta
Excessive bleeding

Question 41

What are things looked for on the placenta?