Normal labour

Question 1

What are the three key factors contributing to normal labour?

Answer 1

Power
Passage
Passenger

Question 2

What do estrogen and progesterone do to the uterus?

Answer 2

Estrogen: contracts uterus
Progesterone: relaxes uterus

Question 3

Which hormone initiates and sustains contractions?

Answer 3

Oxytocin

Question 4

What happens to the number of oxytocin receptors towards the end of pregnancy?

Answer 4

Increases

Question 5

Where is oxytocin produced?

Answer 5

Decidual and extraembryonic fetal tissues and in the placenta

Question 6

What is the first stage of labour?

Answer 6

Latent phase: up to 3-4 cm dilatation

Active stage: 4-10cm (full) dilatation

Question 7

What is the second stage of labour?

Answer 7

Full dilatation - delivery of baby

Question 8

What is the third stage of labour?

Answer 8

Delivery of baby - delivery of placenta and membranes

Question 9

What happens during the latent first stage of labour?

Answer 9

Mild, irregular uterine contractions
Cervix shortens and softens
May last a few days

Question 10

What happens during active first stage of labour?

Answer 10

Slow descent of presenting part (usually head)

Contractions become rhythmic and stronger

Question 11

How long should the second stage of labour last in nulliparous women?

Answer 11

In nulliparous women considered prolonged if it exceeds 3 hours if there is regional analgesia, or 2 hours without

Question 12

How long should the second stage of labour last in multiparous women?

Answer 12

In multiparous women, the second stage considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without

Question 13

How long should the third stage of labour last?

Answer 13

10 minutes but can take 30+

Question 14

When does removal of placenta under general anesthetic become necessary?

Answer 14

Duration of 3rd stage of labour >1 hour

Question 15

What options are there for active management of the 3rd stage of labour?

Answer 15

Includes prophylactic administration of oxytocin 10 units
Ergometrine 1ml
Cord clamping and cutting,
Controlled cord traction
Bladder emptying
Injection of oxytocin directly into the cord

Question 16

What are the properties of Braxton-Hicks contractions?

Answer 16

Irregular
Do not increase in frequency or intensity
Resolve with walking or change in activity
Relatively painless
Do not lead to delivery

Question 17

What are the properties of true labour contractions?

Answer 17

Contractions are evenly spaced
Time between contractions gets shorter
Contractions increase in intensity and pain
The pain starts low, rises until it peaks, and finally ebbs away
Mothers abdomen will feel hard during a contraction

Question 18

What cervical changes accompany increasing frequency of contractions?

Answer 18

There is cervical softening, effacement and dilatation

Question 19

What is an anthropoid pelvis?

Answer 19

There is an oval shaped inlet with large anterio-posterior diameter and comparatively smaller transverse diameter

Question 20

What is an android pelvis?

Answer 20

Android shaped pelvis has triangular or heart-shaped inlet and is narrower from the front
African-Caribbean women are more at risk of having an android shaped pelvis

Question 21

What is the most suitable pelvis type for delivery?

Answer 21

Gynaecoid pelvis

Question 22

What is the normal fetal position for delivery?

Answer 22

Longitudinal lie
Cephalic presentation
Vertex is presenting part

Question 23

What position should the fetal head engage in?

Answer 23

Occipito-transverse

Question 24

What position should the baby’s head be when delivered?

Answer 24

Occipito-anterior

Question 25

Should the baby’s head be flexed or extended when delivered?

Answer 25

Flexed

Question 26

What scoring system is widely used to assess whether it is safe to induce labour?

Answer 26

Bishop’s score

Question 27

What is a normal volume of blood loss for labour?

Question 28

What is the most common method of placental separation?

Answer 28

Matthew Duncan - separations from the margins first

Question 29

What is the more uncommon type of placental separation?

Answer 29

Schulz - separation from the central aspect

Question 30

What are the three main signs that the placenta is separating?

Answer 30

Uterus contracts, hardens and rises
Umbilical cord lengthens permanently
Gush of blood variable in amount

Question 31

How is haemostasis achieved after the placenta has separated from the uterine wall?

Answer 31

Tonic contraction: lattice pattern of uterine muscle strangulate the blood vessels
Thrombosis of the torn vessel ends: pregnancy is a hyper-coaguable state
Myo-tamponade-opposition of the anterior/posterior walls

Question 32

What is puerperium?

Answer 32

Recovery and return of tissues to non-pregnant state

Question 33

How long does puerperium last?

Answer 33

Up to 6 weeks

Question 34

What is lochia?

Answer 34

Vaginal discharge containing blood, mucus and endometrial castings

Question 35

What colour might lochia be?

Answer 35

Rubra (fresh red)
Serosa (brownish-red, watery)
Alba (yellow)

Question 36

What is effacement?

Answer 36

Shortening and thinning of the cervix

Question 37

When should women be encouraged to push during labour?

Answer 37

When the head is visible or urge is uncontrollable

Question 38

When should active pushing be stopped in labour?

Answer 38

As the head is crowning - small pants instead

Question 39

When is the head crowning?

Answer 39

When the widest part of the head is passing through the vulva

Question 40

Why is the woman encouraged to stop pushing actively when the head is crowning?

Answer 40

To reduce the chance of tearing