Normal labour

Question 1

Stage 1 of labour?

Answer 1

= onset until cervix is fully dilated

Question 2

Latent stage of labour

Answer 2

Part of stage 1
Onset until cervix = 4 cm dilated
Involves effacement of the cervix (internal Os is incorporated into the uterus)
In PG

Question 3

Active stage of labour

Answer 3

Part off stage 1
4 cm until fully dilated
Should dilate at 1.2 cm/hr in PG and 1.5 cm/hr in MG

Question 4

Stage 2

Answer 4

Full dilation until delivery

should last

Question 5

Propulsive phase

Answer 5

Stage 2a
Baby propelled by uterine contractions
Full dilation till the head hits the pelvic floor

Question 6

Expulsive phase

Answer 6

Stage 2b
Baby expelled by pelvic floor muscles
Irresistible urge to push (caused by floor stretching) till delivery

Question 7

Stage 3

Answer 7

The afterbirth

Expulsion of placenta and membranes

Question 8

Operculum?

Answer 8

a.k.a a show
Blood stained mucus discharge, occurs in 2/3rd during early stages of labour as there is a discharge of a plug of mucous within the cervical canal

Question 9

Engagement

Answer 9

Descent of the biparietal diameter through the pelvic brim, clinically defined as 2/5th or less palpable per abdomen

Question 10

Lie

Answer 10

Relation of the long axis of the foetus to the mother
Longitudinal (normal)
Oblique
Transverse

Question 11

Presentation

Answer 11

Part of the foetus in the lower pole of the uterus
Cephalic - head
Vertex - in transverse lie
Breech - bottom/feet

Question 12

Position

Answer 12

Relationship of presenting part of baby to pelvis
LOL - left occipito lateral
DOA - direct occipito anterior (chin to chest)
DOP - direct occipito posterior (face to pubes)
If in breech then use sacrum instead of occipito

Question 13

Attitude

Answer 13

Degree of flexion/extension of the foetal head

Question 14

Station

Answer 14

Relation of head to the ischeal spines
-3 = 3cm above
0 = level
+4 = 4cm below and out

Question 15

Oxytocin

Answer 15

Secreted by pituitary

Important for effacement and stimulation of uterine contraction

Question 16

Syntocinon

Answer 16

Synthetic oxytocin
Used for inefficient uterine contraction - PG only, and in post partum haemorrhage (induces strong contractions to aid clotting)

Question 17

When should syntocinon be used with caution?

Answer 17

Previous C-section - risk of rupture

If mother has a high BP as can increase it further

Question 18

Ergometrine uses

Answer 18

Used in postpartum haemorrhage
Induces tetonic contraction - prolonged spasm
Lasts up to 30mins
Clamps down uterus to aid clotting

Question 19

Cautions with Ergometrine

Answer 19

HIgh BP, can increase further

Question 20

Syntometrine

Answer 20

Syntocinon + Ergometrine combined

Quick acting and longer lasting

Question 21

Dinoprostone

Answer 21

Prostaglandin E2 Analogues
Ripens and effaces the cervix
Used to induce labour
Inserted vaginally

Question 22

What are the 3 reasons for failure to progress?

Answer 22

The 3 Ps
1 - Powers = Pushing - forces generated by uterine contraction
2 - Passenger - foetal size, presentation, position, attitude
3 - Passage - bony pelvis size/shape and soft tissue resistance. Normally = gynecoid but can be platypoid, anthropoid, android

Question 23

What are the common causes of failure to progress?

Answer 23

IUA - inefficient uterine contraction (PGs), give syntocinon
OP presentation ~10%
CPD - cephalo-pelvic disproportion ~1/250 births

Question 24

Risk screening for Down’s syndrome

Answer 24

Triple test between 15-20wks tests hormone levels , maternal age and gestational age (NHS)

Nucchal Traslucency, 11-14 wks, inc NT suggests heart failure and chromosomal abnormalities

Integrated test, 11-14 wks = triple test + NT to increase sensitivity and specificity

Question 25

Diagnostic tests for Down’s syndrome

Answer 25

Amniocentesis. 12-18 wks, >99% accuracy, 1% risk miscarriage

Chronic Villus Sampling, 11-13 wks, ~97% accuracy andd 1% risk of miscarriage