Normal Labour

Question 1

What is labour?

Answer 1

Onset of regular and painful contractions with cervical dilation and descent of the presenting part

Question 2

Signs of labour?

Answer 2

• regular and painful uterine contractions
• a show (shedding of mucous plug)
• rupture of the membranes (not always)
• shortening and dilation of the cervix

Question 3

What are the 3 stages of labour?

Answer 3

• stage 1: from the onset of true labour to when the cervix is fully dilated
• stage 2: from full dilation to delivery of the fetus
• stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered

Question 4

What monitoring is done in labour?

Answer 4

• FHR monitored every 15min (or continuously via CTG)
• Contractions assessed every 30min
• Maternal pulse rate assessed every 60min
• Maternal BP and temp should be checked every 4 hours
• VE should be offered every 4 hours to check progression of labour
• Maternal urine should be checked for ketones and protein every 4 hours

Question 5

What is stage 1 of labour? what happens?

Answer 5

Stage 1 - from the onset of true labour to when the cervix is fully dilated. In a primigravida lasts typical 10-16 hours
•latent phase = 0-3 cm dilation, normally takes 6 hours
•active phase = 3-10 cm dilation, normally 1cm/hr

Question 6

What is stage 2 of labour? what happens?

Answer 6

from full dilation to delivery of the fetus
•’passive second stage’ refers to the 2nd stage but in the absence of pushing (normal)
•active second stage’ refers to the active process of maternal pushing
•less painful than 1st (pushing masks pain)
•lasts approximately 1 hours
•if longer than 1 hour (can be left longer if epidural) consider Ventouse extraction, forceps delivery or caesarean section
•episiotomy may be necessary following crowning
•associated with transient fetal bradycardia

Question 7

What is CTG?

Answer 7

Records pressure changes in the uterus using internal or external pressure transducers

Question 8

Normal fetal HR?

Answer 8

100/110-160

Question 9

Causes of a baseline brady?

Answer 9

Increased fetal vagal tone, maternal beta-blocker use

Question 10

Increased baseline Hr on ctg?

Answer 10

Maternal pyrexia, chorioamnionitis, hypoxia, prematurity

Question 11

What can cause a loss of baseline variability?

Answer 11

Prematurity, hypoxia

Question 12

What casuese early decelerations?

Answer 12

Usually an innocuous feature and indicates head compression

Question 13

What casues latedecelerations?

Answer 13

Indicates fetal distress e.g. asphyxia or placental insufficiency

Question 14

Variable decelerations?

Answer 14

Cord compression