Normal Labour

Question 1

First Stage of Labour

Answer 1

Regular Contractions until the cervix is fully dilated

Question 2

What is a partogram?

Answer 2

A partogram - graphic record of observations and events during labour - should be used. Monitor heart rate hourly, vital signs 4-hourly, urinary frequency and frequency of contractions every half hour.

Question 3

First labour - how long does it usually last?

Answer 3

First labour: an average of around 8 hours may be expected, rarely would it last longer than 18 hours.

Question 4

Subsequent labour: may last how long?

Answer 4

Around 5 hours on average and rarely longer than 12 hours.

Question 5

The second stage of labour runs from the point of complete cervical dilation to …

Answer 5

The second stage of labour runs from the point of complete cervical dilation to the birth of the baby.

Question 6

Intermittent auscultation of the foetal heart rate should be conducted after a contraction for 1 minute and at least every … minutes. Palpate the women’s pulse every 15 minutes.

Answer 6

Intermittent auscultation of the foetal heart rate should be conducted after a contraction for 1 minute and at least every 5 minutes. Palpate the women’s pulse every 15 minutes.

Question 7

The third stage runs from the birth of the baby to the …

Answer 7

The third stage runs from the birth of the baby to the expulsion of the placenta and membranes.

Question 8

Active management of 3rd stage of labour

Answer 8

Use of uterotonic drugs to encourage the expulsion of the placenta and membranes.
Deferred cutting and clamping of the cord.
Careful and controlled traction of the cord once signs of separation of the placenta.

Question 9

Physiological management of third stage of labour

Answer 9

Uterotonic drugs not routinely used.
Cord not clamped until pulsation has stopped.
Placenta delivered by maternal effort.

Question 10

The third stage is delayed if not complete within … minutes when receiving active management and … minutes when receiving physiological management.

Answer 10

The third stage is delayed if not complete within 30 minutes when receiving active management and 60 minutes when receiving physiological management.

Question 11

Delay of third stage of labour and haemorrhage

Answer 11

Transfer patients to an obstetric unit and organise obstetrician review if there is any delay. If postpartum haemorrhage occurs or other concerns develop urgently transfer, consider major obstetric haemorrhage call or ambulance transfer depending on location.

Question 12

There are three stages of labour: describe each

Answer 12

The first stage is from the onset of labour (true contractions) until 10cm cervical dilatation.
The second stage is from 10cm cervical dilatation to delivery of the baby.
The third stage is from delivery of the baby to delivery of the placenta.

Question 13

What are Braxton-Hicks Contractions?

Answer 13

Braxton-Hicks contractions are occasional irregular contractions of the uterus. They are usually felt during the second and third trimester. Women can experience temporary and irregular tightening or mild cramping in the abdomen. These are not true contractions, and they do not indicate the onset of labour. They do not progress or become regular. Staying hydrated and relaxing can help reduce Braxton-Hicks contractions.

Question 14

The first stage of labour has three phases:

Answer 14

Latent phase: From 0 to 3cm dilation of the cervix. This progresses at around 0.5cm per hour. There are irregular contractions.
Active phase: From 3cm to 7cm dilation of the cervix. This progresses at around 1cm per hour, and there are regular contractions.
Transition phase: From 7cm to 10cm dilation of the cervix. This progresses at around 1cm per hour, and there are strong and regular contractions.

Question 15

The second stage of labour lasts from 10cm dilatation of the cervix to delivery of the baby. The success of the second stage depends on “the three Ps”: power, passenger and passage.

Answer 15

Power: the strength of the uterine contractions.

Passenger: the four descriptive qualities of the fetus:

Size: particularly the size of the head as this is the largest part.
Attitude: the posture of the fetus. For example, how the back is rounded and how the head and limbs are flexed.
Lie: the position of the fetus in relation to the mother’s body:
Longitudinal lie – the fetus is straight up and down.
Transverse lie – the fetus is straight side to side.
Oblique lie – the fetus is at an angle.
Presentation: the part of the fetus closest to the cervix:
Cephalic presentation – the head is first.
Shoulder presentation – the shoulder is first.
Breech presentation – the legs are first. This can be:
Complete breech – with hips and knees flexed (like doing a cannonball jump into a pool)
Frank breech – with hips flexed and knees extended, bottom first
Footling breech – with a foot hanging through the cervix
Passage: the size and shape of the passageway, mainly the pelvis.

Question 16

Presentation: the part of the fetus closest to the cervix:
What are the possible presentations?

Answer 16

Cephalic presentation – the head is first.
Shoulder presentation – the shoulder is first.
Breech presentation – the legs are first. This can be:
Complete breech – with hips and knees flexed (like doing a cannonball jump into a pool)
Frank breech – with hips flexed and knees extended, bottom first
Footling breech – with a foot hanging through the cervix

Question 17

There are seven cardinal movements of labour:

Answer 17

Engagement
Descent
Flexion
Internal Rotation
Extension
Restitution and external rotation
Expulsion

Question 18

Obstetricians describe the position of the baby’s head in relation to the mother’s ischial spines during the descent phase. Descent is measured in centimetres, from:

Answer 18

-5: when the baby is high up at around the pelvic inlet
0: when the head is at the ischial spines (this is when the head is “engaged”)
+5: when the fetal head has descended further out

Question 19

Active management - third stage

Answer 19

Active management involves giving a dose of intramuscular oxytocin to help the uterus contract and expel the placenta. Careful traction is applied to the umbilical cord to guide the placenta out of the uterus and vagina.