Normal Labour

Question 1

A lady comes in with rupture of membranes at 38 weeks. Discuss the management of the 3 stages of labour.

Answer 1

Impression
Sounds like normal progression of labour.

Would take into consideration History of pregnancy, risk factors for labour, maternal preferences and requests around birth planning and findings from ongoing assessment in the active management of normal labour.

Question 2

Normal labour - stages and their definitions, 5P’s

Answer 2

Stages

1st: Onset to full dilation of cervix
- latent (0-3/4cm)
- active (4-10cm)
2nd: full dilation of cervix to delivery of the baby
3rd: delivery of baby to delivery of the placenta

5P's
power - uterus
passenger - fetus
passage - cephalopelvic proportions
position - maternal position/activity during labour
psyche - maternal mental state

Question 3

Normal labour - 1st stage Mx

Answer 3

1st stage
Main concerns
- failure to progress

Assessment

• check modified bishop score
• assess rate of dilation
• normal antenatal assessments
• CTG if higher risk pregnancy (GDM, etc)

Management

• Women labour better if they stay at home for latent phase of 1st stage of labour
• supportive: analgesia as requested and preferences by the mother
• if there is failure to progress, consider starting a syntocinon infusion to facilitate membrane rupture and uterine contractions

Question 4

Normal labour - 2nd stage Mx

Answer 4

2nd stage
Stages
- descent
- flexion
- internal rotation
- extension
- restitution
- lateral flexion + expulsion

Concerns

• fetal condition (bradycardia
• failure to progress
• shoulder dystocia

Management

• midwife support
• analgesia
• regular monitoring and obs
• crowning: small expulsion efforts, perineal pressure, consider episiotomy if there is risk of tear
• shoulder dystocia manoeuvres if it occurs
• instrumentation (forceps, vontousse)

Question 5

Normal Labour - 3rd stage Mx

Answer 5

3rd stage - delivery of placenta
Active management is recommended in ALL patients to reduce the risk of PPH and retained products.

Active

• Oxytocin/syntocinon or Syntometrine to supplement uterine contractions
• fundal massage to assist in uterine contractions
• Assisted delivery of the placenta; sustained downward traction on the placenta
• examine the placenta for completeness + the umbilical cord for any abnormalities