normal labour

Question 1

what is labour?

Answer 1

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

Question 2

when does normal labour usually occur

Answer 2

spontaneously at term (37-42 weeks gestation)

Question 3

how is labour triggered?

Answer 3

paracrine and autocrine signals

generated by maternal, foetal and placental factors

Question 4

what are the key physiological changes which must occur before expulsion of the foetus will occur?

Answer 4

• cervix softens
• myometrial tone changes
• progesterone decreases, oxytocin and prostaglandins increase

Question 5

what is the latent first stage of labour?

Answer 5

• longest part
• intermittent, often irregular painful contractions
• which bring about some cervical effacement and dilatation up to 4cm

Question 6

what is the active first stage of labour?

Answer 6

• regular, painful contractions

- result in progressive effacement and cervical dilatation from 4cm - 10 cm

Question 7

when is the first stage of labour complete?

Answer 7

When the cervix is fully dilated (10cm)

Question 8

how does the cervix thin and dilate?

Answer 8

uterine contractions

• start at the fundus and move down and across
• exert pressure on fetal pole
• encourages flexion
• pressure on the cervix to thin and dilate

Question 9

what does stage 2 of labour encompass?

Answer 9

from full cervical dilatation to the birth of the baby

Question 10

what is the passive second stage of labour

Answer 10

full dilatation of cervix

Question 11

what is the active second stage of labour?

Answer 11

expulsive contractions with a finding of full dilatation of the cervix

Question 12

how long should the second stage of labour last?

Answer 12

2 - 3 hours

Question 13

what is the third stage of labour?

Answer 13

birth of the baby to the expulsion of the placenta and membranes

Question 14

how should progress be monitored during labour?

Answer 14

maternal observations

abdominal palpation

vaginal examination

monitoring of liquor

palpation of the uterine muscle contractions

external signs: Rhomboid of Michaelis and anal cleft line

Question 15

how is the foetal heart auscultated

Answer 15

• handheld dopplar
• Pinards stethoscope
• cardiotocograph (CTG)

Question 16

Where should information be recorded during labour?

Answer 16

Partogram

Question 17

give examples of foetal lie

Answer 17

cephalic

breech

transverse

Question 18

Give examples of foetal presentation.

Answer 18

face

brow

vertex

breech

shoulder

Question 19

what is position of foetus determined in relation to?

Answer 19

occipitut (posterior fontanelle)

Question 20

what is the mechanism of labour?

Answer 20

extension
descent
flexion
internal rotation of the head
crowning 
extension of the head
restitution
external rotation of the head

Question 21

what types of analgesia can be used in labour?

Answer 21

non pharmacological

• maternal position and mobility
• breathing & hypnobirthing techniques
• massage
• aromatherapy
• TENS

pharmacological

• oral analgesia
• water
• entonox
• opioids (morphine, diamorphine, pethidine)
• remifentanil patient controlled analgesia
• epidural