normal labour

Question 1

what is normal labour

Answer 1

process in which the fetus, placenta and membranes are expelled via the birth canal

it is spontaneous, 37-42wks gestation, fetus presenting by the vertex, results in a spontaneous vaginal birth (SVD)

Question 2

physiological changes that allow for expulsion of the fetus

Answer 2

cervix softens
myometrial tone changes to allow for coordinated contractions
progesterone decreases whilst oxytocin and prostaglandins increase to allow labour to initiate

Question 3

how many stages

Answer 3

3

Question 4

describe the 3 stages of labour

Answer 4

1st - early/latent, active 1st phase and transition
2nd - passive, active
3rd - active or physiological

Question 5

what are the stages of the first stage of labour

Answer 5

latent phase/early labour
active 1st stage

Question 6

describe the latent phase

Answer 6

can be the longest part of labour
irregular contractions
cervical changes and dilatation up to 4cm

Question 7

describe the active phase

Answer 7

length of active labour can vary from 8-12hrs
regular, painful contractions
cervix is 4-10cm

Question 8

describe the transition

Answer 8

cervix 8-10cm
may experience physical changes - vomiting, shaking, need to empty bowels
may express that they can no longer cope

Question 9

describe the 2nd stage of labour

Answer 9

can have a passive and active element
full dilatation to birth
length will vary between 2-3hrs depending on if woman is nulliparous or multiparous

Question 10

describe the 3rd stage of labour

Answer 10

from birth of the baby to the expulsion of the placenta and membranes
physiological and active management

Question 11

what are the 7 mechanisms of labour

Answer 11

engagement and descent
flexion
internal rotation of the head
crowning and extension of the head
restitution
internal rotation of the head and external rotation of the head
lateral flexion of shoulders

Question 12

what are the different types of fetal lie

Answer 12

cephalic

breech

transverse

Question 13

what are the different types of fetal presentation

Answer 13

face

brow

vertex

breech

shoulder

Question 14

what are the different fetal positions

Answer 14

right occipitoposterior

left occipitoposterior

left occipitotransverse

left occipitoanterior

right occipitoanterior

right occipitotransverse

Question 15

whis is it important to assess fetal wellbeing

Answer 15

stress is being exerted onto the fetus - in both spontaneous and augmented delivery

this can be intermittent or continous - depends on the woman’s risk assessment

Question 16

methods of assessing fetal wellbeing

Answer 16

Pinards stethoscope - intermittnet monitoring

hand held dopplar - intermittent monitoring

cardiotocograph (CTG) - continuous monitoring

Question 17

what is a normal fetal heart rate

Answer 17

110-160bpm

with good variability (>5bpm) and accelerations (15bpms)

Question 18

methods of monitoring labour

Answer 18

maternal observations

abdo palpation

vaginal examination

monitoring of liquor

palpation of contractions

external signs e.g. rhomboid of Michaelis and anal cleft line

Question 19

non-pharmacological and pharmacological support through labour

Answer 19

maternal position and mobility, breathing and hypnobirthing techniques, massage, aromatherapy , TENS, water

oral analgesia, entonox, opioids, Remifentanil PCA, epidural

Question 20

pros and cons of entonox

Answer 20

widely used, safe, patient in control, works and wears off quickly, patient mobile, can be used with other pain relief systems

dizzy, dry mouth, sick, doesn’t take pain away quickly, timing takes practice

Question 21

pros and cons of diamorphine

Answer 21

works in 40 mins, lasts 4 hours, relaxes patient, helps patient cope with pain better

sick, sleepy, slows breathing, similar effects on baby

Question 22

pros and cons of remifentanil PCA (patient controlled analgesia)

Answer 22

patient is in control, works and wears off quickly, strong pain relief

may slow breathing, extra oxygen and monitoring, drowsy, sick, itchy, can’t start if you have had diamorphine in the last 4hrs, not mobile once started

Question 23

pros and cons of an epidural

Answer 23

most effective pain relief during labour, unlikely to affect baby, you are in control and can be topped up if going for C section

can slow pushing phase of delivery, increased risk of forceps/suction cup, drop in BP, itching, fever, sore area on back, headache

Question 24

rare but serious complications of epidural

Answer 24

temporary nerve damage - numb area/weakness

nerve damage >6mths

epidural abscess

meningitis

epidural haematoma

accidental unconsciousness

severe injury