Normal Labour

Question 1

Keeps uterus settled
Prevents formation of gap junctions
Hinders contractibility of mycoytes

Answer 1

Progesterone

Question 2

Makes the uterus contract

Promotes prostaglandin production

Answer 2

Oestrogen

oxytocin also promotes prostaglandin production

Question 3

How do you know when you’re in true labour?

Answer 3

Contractions are evenly spaced out

Question 4

What is important about the region of the tubal ostia?

Answer 4

This is the pacemaker for the contractions

Question 5

How many contractions do you usually get?

Answer 5

3-4 every ten mins

-usually last 10-15 seconds

Question 6

Normal baby head position

Answer 6

Occipito-anterior

-emerges transvers

Question 7

Which shoulder comes out first?

Answer 7

The anterior one

Question 8

What is crowning?

Answer 8

When the baby’s head is visible at the opening of the vagina

Question 9

This scale is the most commonly used method to assess the readiness of the cervix for labour

Answer 9

Bishops score

Question 10

What is lochia?

Answer 10

The vaginal discharge you get following delivers
1st = lochia rubra (red)
2nd = lochia serosa (brown)
3rd = lochia alba (yellow)

Question 11

What initiates lactation?

Answer 11

Placental expulsion

Question 12

1st degree perineal tear?

Answer 12

Tear within vaginal mucosa only

Question 13

2nd degree perineal tear?

Answer 13

Extends into subcutaneous tissue

Question 14

3rd degree perineal tear?

Answer 14

Laceration extends into the external anal sphincter

Question 15

4th degree perineal tear?

Answer 15

Laceration extends through external anal sphincter into rectal mucosa

Question 16

Risks associated with obstetric choelstasis?

Answer 16

Increased risk of premature birth

Question 17

Predominant estrogen during reproductive years

Answer 17

Estradiol (most potent oestrogen)

Question 18

Predominant estrogen during pregnancy?

Answer 18

Estriol (most abundant but weakest oestrogen)

Question 19

Predominant estrogen during menopause?

Answer 19

Estrone

Question 20

Fetal cortisol levels increase around labour, what does this cause?

Answer 20

Causes increase in maternal estriol

Question 21

What happens when oxytocin receptors become activated?

Answer 21

Results in increased phospholipase C activity and more calcium enters the cells cytoplasm

This results in increased uterine contractility

Question 22

When would you consider labour to be prolonger?

Answer 22

In nulliparous women:
prolonged if longer than 3 hours (with analgesia)
Or longer than 2 hours (without analgesia)

In multiparous women:
prolonged if longer than 2 hours (with analgesia)
or longer than 1 hour (without analgesia)

Question 23

How long does the third stage of labour usually take?

Answer 23

10 minutes on average

Question 24

If the 3rd stage of labour takes longer than an hour, what should you do?

Answer 24

Prepare for removal under GA

Question 25

Why is active management for the 3rd stage preferred?

Answer 25

Lowers the risk of PPH

Question 26

How does the cervix become softer?

Answer 26

Increases in hyaluronic acid gives increase in molecules among collagen fibres
The decrease in bridging among collagen fibres gives decrease in firmness of the cervix

Question 27

How do you describe a real contraction?

Answer 27

The feeling is like a wave
The pain starts low, rises until it peaks and finally ebbs away
If you touch the mother’s abdomen it will feel hard during a contraction

Question 28

How can you make braxton-hicks contractions resolve?

Answer 28

Often resolve with change of position (unlike true contractions)

Question 29

How long is a contraction?

Answer 29

Initially 10-15 seconds

Max 45 seconds, slowly builds up

Question 30

In this part of labour, the mum may feel a burning and stinging feeling?

What position may be required in this part of labour and why?

Answer 30

Crowning

Episiotomy may be required to prevent trauma to anal sphincters

Question 31

3 classic signs that indicate placental separation?

Answer 31

• Uterus hardens and contracts
• Umbilical cord lengthens permanently
• Gush of blood (variable in amount)

Question 32

How long does it take for tissues to return to normal non-pregnant state?

Answer 32

6 weeks

Question 33

What initiates lactation?

Answer 33

Placental expulsion