Normal Labour

Question 1

Definition of normal labour?

Answer 1

Regular, painful contractions with cervical effacement and dilatation

Question 2

Definition of first, second and third stages of labour? In which stage is mortality the highest?

Answer 2

First - onset of labour to full dilatation of cervix
Second - full dilatation to delivery of baby
Third - delivery of baby to delivery of placenta; highest mortality!

Question 3

What are the 2 phases of the first stage of labour?

Answer 3

Latent - slow progress until 3cm dilated

Active - fast progress until 10cm dilated

Question 4

Definition of spurious labour?

Answer 4

Regular, painful contractions w/o effacement/dilatation

Question 5

Name 2 indications for AROM

Answer 5

Speed up progress of labour

Check colour/amount of amniotic fluid

Question 6

What does the colour/amount of amniotic fluid tell you about the foetus?

Answer 6

If it’s hypoxic - hypoxic foetus releases meconium (turns colour brown), and oligohydramnios indicates the foetus is centralising blood supply

Question 7

What are the 3 components to successful contractions?

Answer 7

Strong, long and frequent (usually 3-5/10 minutes)

Question 8

Definition of foetal lie, presentation, attitude, position, and station

Answer 8

Lie - what way is the longest axis of the foetus relative to mother (transverse vs longitudinal)
Presentation - what part of foetus is presenting (vertex vs face vs breech)
Attitude - Degree of flexion/extension of foetus (usually flexed)
Position - Relationship of a part of foetus to the mother’s pelvis (in cephalic, defined as relation of foetal occiput to mother)
Station - how far above/below the ischial spines is the foetus (ischial spines chosen as landmark as this is usually where foetus becomes engaged)

Question 9

Name 4 things we have regular observations of the mother for

Answer 9

Infection
Pre-eclampsia - BP and urinanalysis
Bleeding
Emotional wellbeing (pain)

Question 10

Are we obliged to give analgesia to a mother during delivery? Why/why not?

Answer 10

No (depends on mother’s wishes) - there’s a perception that a certain amount of pain during childbirth is normal and desirable

Question 11

Name 4 non-pharmacological and 4 pharmacological analgesics during delivery

Answer 11

Non-pharm: Massage, relaxation/breathing techniques, environmental changes, hot and cold packs, TENS
Pharm: NO gas, oral or IV opioids, neuraxial block (epidural/spinal), local block (pudendal block)

Question 12

How often do we do foetal auscultation in the 1st and 2nd stages of labour?

Answer 12

1st - every 15 minutes in active phase

2nd - after every contraction

Question 13

Give indications for continuous foetal monitoring

Answer 13

Pre-natal complications - HT, PE, bleed, IUGR, DM

Intrapartum risk factors - meconium/blood stained liquor, abnormal HR on auscultation

Question 14

How quickly does the 1st stage of pregnancy usually take?

Answer 14

Roughly 1cm/hour, but can be more, especially if nullpara

Question 15

Name 5 elements of the admission history of a woman in labour

Answer 15

PMx
Past Obsx
Review this pregnancy for complications
Infection status (GBS, HIV/HBV/HCV)
Blood group

Labour Hx - duration, show, ROM, bleeding

Birth/analgesia plan, antenatal education

Question 16

Name 4 components of initial examination of a woman in labour

Answer 16

BP, urinanlysis (pre-eclampsia)
T (infection)
Signs of bleeding
Duration, frequency, intensity of contractions and pain control

Question 17

How often are women examined during the first stage of labour? Name 4 components of the examination

Answer 17

Abdo exam every hour, vaginal every 4 hours. Document uterine contractions (strength, freq, intensity), cervical effacement, dilatation and station of presenting part

Question 18

Name 1 SE of an epidural

Answer 18

Can prolong length of second stage of labour

Question 19

How long does the second stage of labour usually take for a nullpara and multipara woman? What’s it called if it takes longer than this?

Answer 19

Nullpara - under 2 hours
Multipara - under 1 hour

Any longer = arrested descent

Question 20

What are the 3 ways the foetal head descends through the pelvis

Answer 20

Moulding, flexion and rotation

Question 21

Go through the normal movements of the foetal head (in cephalic presentation) and shoulders from beginning to end of delivery (including how to deliver the shoulders)

Answer 21

Head starts in OT position, as it allows the longest diameter of the head to match the longest diameter of the mum’s pelvic inlet (transverse)

Then internally rotates to become OA to navigate through ischial spines (longest diameter of ischial spines in AP direction)

Head extends to pass through vaginal canal

After head is out, it restitutes by externally rotating to become OT again, to allow shoulders to pass through pelvic inlet

Pull down on anterior shoulder, then elevate head to deliver posterior shoulder

Pull on shoulders for rest of body to deliver

Question 22

What is the shortest diameter of the foetal head? How long is it?

Answer 22

Suboccipitobregmatic distance (9.5cm)

Question 23

Name the 3 general things you should monitor during 2nd stage of labour

Answer 23

Mother - P, BP, T
Foetus - Auscultate after every contraction, amniotic fluid colour
Progress of labour

Question 24

How long does stage 3 usually take?

Answer 24

5 - 10 minutes

Question 25

Name 3 signs of placental separation in stage 3

Answer 25

Fresh show of blood
Lengthening of umbilical cord
Firm uterus

Question 26

What are the 3 elements of active management of the third stage?

Answer 26

Prophylactic oxytocics
Controlled cord traction
Early cord clamping

Question 27

Name 3 oxytocics commonly used (in order of strength). What is a C/I for using the strongest one?

Answer 27

Syntocinon - least strong
Syntometrine
Ergometrine - strongest; C/I if HT

Question 28

What’s the definition of early cord clamping? 1 good and 1 bad thing about it?

Answer 28

Cord clamping between 30-60 seconds. Good - reduces risk of PPH. Bad - might reduce amount of blood going to baby = more likely to become iron deficient

Question 29

What are the recommendations for food and fluid in the first stage of labour?

Answer 29

If at risk of C/S or GA, IV line and NBM. Otherwise, light diet early, clear fluids in late labour

Question 30

Name 3 indications for antibiotics in 1st stage of labour

Answer 30

GBS +ve
Chorioamnionitis
Prolonged ROM
Endocarditis prophylaxis