Normal Labour

Question 1

4 main fetal lie’s

Answer 1

cephalic / breech / transverse / shoulder

Question 2

what is caput?

Answer 2

oedema of the fetal scalp

Question 3

3 stages of labour?

Answer 3

1st stage: (split latent and active)

• Latent = onset contraction to 3cm dilation
• Active = 3cm to fully dilated

2nd : full dilation until delivery of child
3rd : delivery of child until placenta delivered

Question 4

signs of placental delivery

Answer 4

rush of blood / lengthening of cord / relaxation of uterus

Question 5

length of each stage (prim and parous)

Answer 5

1st: prim = 12 hours/ parous = 7.5
2nd: 45-120 mins / 15-45 mins
3rd: similar

Question 6

managment of stages

Answer 6

1 + 2 = assess progress every 2-4 hours via Partogram graph (time / cerv dilation + vital signs) as well as abdomen and Vag exam –> effacement, dilation, station, position

also maternal health = contractions, pulse, BP, temp as well as urine (if ketotic give IV dextrose)

3 = oxytocin(syntometrine) / early cord clamping (only if baby asphixiated) / controlled cord traction/ monitor for PPH signs

Question 7

why use oxytocin? effects?

Answer 7

promotes continuation of contractions

decrease PPH / decrease time taken for 3rd stage // can increase MI risk

Question 8

CI to giving oxytocin

Answer 8

pre-eclampsia, hypertension, liver or renal impairment

Question 9

process of delivery

Answer 9

descent and flexion of head
internal rotation
extension of head and delivery
restitution
external rotation and deliver shoulders

Question 10

induction of pregnancy - ? / how many in uk? / indications

Answer 10

artifically rupturing the membranes / 20% of pregs /

DM / prev stillbirht / abruption / twins / fetal death in utero / placental insuff

Question 11

contra-ind of induction

Answer 11

fetal distress, placenta praevia, pelvic tumor, cord presentation, intra0uterine growth retardation

Question 12

dangers of induction

Answer 12

infection, bleeding, cord prolapse, c-section/forceps increase risk

Question 13

methods of induction

Answer 13

Membrane Sweep (releases prostaglandings/ best done 40+ weeks
Vaginal PGE2 = prostin
ARM(amniotomy) = must be done before oxytocin given
Oxytocin (syntocinon) = infusion per regime

Question 14

pain relief in labour options

Answer 14

• entonox (N2O and O2) started before pain does
• systemic opiates (IM diamorph/pethidine) given in 1st stage labour/not given if delivery imminent
• epidural (bupivicaine/ fentanyl) generally anaesthatising nerves T11 to S5. Given once labour establised (>3cm) but wait >12 hours after LMWH dose.
• combined spinal epidural
• local anaesthesia - given for episiotomy (perineal nerve) or forceps (pudendal nerve)
• Gen Anaesthetic - emergency only

Question 15

effects of epidural + why combined spinal epidural best?

Answer 15

hypotension (give hartmanns to prevent) / paralysis / urine retention

must be assessed every 15 mins and topped up every 2 hours

combined is better as: quicker / less motor blockade / pt dose controlled