Normal Labour

Question 1

Enumerate results of internal increased head felxion during 2nd stage of labour?

Answer 1

Facilitate internal rotation
1. Head enters pelvis by SOB (9.5)
2. The occiput reaches pelvic muscles first
3. The part of head occupying plane of max dimensions becomes like a circle as SOB & BPD are both 9.5cm

Question 2

Mention factors contributing to internal rotation of head

Answer 2

1. Sloping character of pelvic floor (occiput meets it first firected downward forward and medially)
2. Riffling action of the bony pelvis: as the inlet is transverse oval while outlet AP oval

Question 3

Mention ccc of true labour pains

Answer 3

1. Suprapubic radiating to back
2. Spasmdic colicky
3. Regular inc in frequency and duration
4. Effective ass with cervical dit and eff
5. Contraction does not dec with sedation

Question 4

Mention criteria of Bishop score

Answer 4

Cervical diltation, effacement, consistency, position and station of the head

Question 5

Mention advatages of UB and rectum evacuation

Answer 5

Prevent uterine inertia, non-engagement, soiling of vulva and increased pain.

Question 6

Mention regular observation and examination during the 2nd stage of labour

Answer 6

Every 5 min after contractions: FHR
Every 30 min frequency of contractions documentation
Every hour: pulse BP, offer PV (assess progress)
Every 4 hrs: check temp
Check frequency of bladder emptying regularly

Question 7

What is Ritgen maneuver?

Answer 7

A maneuver done during 2nd stage of labour after crowning in normal labour, by controlled head extension in-between contractions without bearing down through sliding the perineum over the face, thus the head will distend the vulva by suboccipito-fronal diameter (10 cm)

Question 8

Mention signs of placental separation

Answer 8

Abdominally: inc fundal level, uterus becomes globular, hard and small, suprapubic bulge
Vaginally: gush of blood, elongation of cord, placenta is felt
To confirm: Strassman sign (no transmitted abdominal traction), Rathman sign (stopping cord pulsations), no shortening of cord following traction

Question 9

Mention croteria of Aogar score and its interpretation

Answer 9

Colour, grimace, muscle tone, pulse, respiraion
Score >7 no need for support
4-7:assissted ventilation
>4 cardiopulmonary support