Normal labour

Question 1

What is labour?

Answer 1

A physiological process during which the fetus, membranes, umbilical cord and placenta are expelled from the uterus.

Question 2

Three key factors in quality of labour?

Answer 2

Power
Passage
Passenger

3 P’s

Question 3

Action of progesterone during labour?

Answer 3

Keeps uterus settled

Prevents formation of gap junctions

Question 4

Oestrogen?

Answer 4

Makes uterus contract

Promotes prostaglandins

Question 5

Oxytocin?

Answer 5

Oxytocin initiates and sustains contractions

Acts on decidual cells to release PGs

Question 6

Where is oxytocin synthesised?

Answer 6

Decidual and extraembryonic fetal tissues and placenta

Question 7

What is Fergusons reflex?

Answer 7

Cycle of uterine contractions initiated by pressure at the cervix or vaginal walls. + Fedback

Question 8

First stage of labour?

Answer 8

Latent and active

Latent- mild irregular uterine contractions

Active- slow descent of presenting part

Question 9

Second stage of labour?

Answer 9

Complete dilatation of cervix to delivery of baby

Question 10

Third stage of labour?

Answer 10

Delivery of abby to expulsion of placenta and fetal membranes

Question 11

Active management of third stage

Answer 11

Prophylactic syntometrine

Cord clamping
Controlled cord traction
Bladder emptying

Question 12

What causes cervical softening?

Answer 12

Increase in hyaluronic acid decreases bridging amongst collagen fibres

Question 13

What are braxton-Hicks contractions?

Answer 13

“False labour”

Irregular relatively painless contractions

Question 14

What are real labour contractions?

Answer 14

Evenly spaced, painful contraction

Time between gets shorter and shorter

Question 15

Pacemaker of contractions?

Answer 15

Region of tuba ostia

Question 16

What is an anthropoid pelvis?

Answer 16

Oval shaped inlet with large AP diameter and smaller transverse diameter

Question 17

What is an android pelvis?

Answer 17

Triangular or heart shaped inlet and is narrower from the front

Question 18

How often should vaginal exams be carried out during labour?

Answer 18

Approx every 4 hours

Question 19

5 parameters used to assess the cervix?

Answer 19

Effacement
Dilatation
Firmness
Position
Level of presenting part

Question 20

What is Bishops score?

Answer 20

A pre labour scoring system used to assess whether induction of labour will be required

Question 21

Analgesia options?

Answer 21

Para/Co codamol
TENS
Entonox
Diamorphine
Epidural
Remifentanyl
Combined spinal/epidural

Question 22

What is considered normal blood loss during labour?

Answer 22

500ml or less, any more is abnormal

Question 23

The 3 classic signs that indicate placental separation?

Answer 23

Uterus contract, hardens and rises

Umbilical cord lengthens permanantly

Gush of blood

Question 24

How is haemostasis achieved after the baby is delivered?

Answer 24

Tonic contraction: Lattice pattern of uterine muscle strangulates blood vessels

Thrombosis of torn vessel ends

Question 25

What is Peurperium?

Answer 25

Period of repair and recovery ~ 6 weeks

Question 26

What is lochia?

Answer 26

Vaginal discharge containing blood, mucous and endometrial castings

Question 27

Hormonal changes in puerperium?

Answer 27

Decrease in oestrogen
Decrease in progesterone
Prolactin maintained