Normal labour

Question 1

Labour

Answer 1

Process in which the fetus, placenta and membranes are expelled via the placenta

Question 2

When does labour occur?

Answer 2

spontaneously at term (37-42weeks) with fetus presenting vertex

Question 3

SVD

Answer 3

spontaneous vaginal birth

Question 4

2 key physiological changes for labour

Answer 4

cervix softens - changing from support to the birth canal

myometrial tone changes to allow coordinated contractions

Question 5

Hormonal changes that occur for labour

Answer 5

progesterone down

oxytocin and prostaglandins up to allow labour to initiate

Question 6

Latent first stage of labour

Answer 6

intermittent, irregular, painful contractions

cervical effacement and dilation up to 4cm

Question 7

established first stage of labour

Answer 7

regular, painful contractions that result in cervical effacement and dilation from 4cm

Question 8

When is the 1st stage of labour complete?

Answer 8

cervix fully dilated - 10cm

Question 9

1st stage length for primigravida

Answer 9

about 8 hours but no more than 18

Question 10

1st stage length for multigravida

Answer 10

about 5 hours but no more than 12

Question 11

Anticipated progress for the first stage of labour

Answer 11

0.5-1cm/hour

Question 12

What is the 2nd stage of labour?

Answer 12

from full cervical dilation to the birth of the baby

Question 13

passive second stage

Answer 13

full cervix dilation before/in absence of involuntary expulsive contractions

Question 14

Plan of passive second stage

Answer 14

1 hour of passive 2nd stage to allow further fetal descent

Question 15

Active 2nd stage

Answer 15

presenting part is visible
expulsive contractions - full cervix dilation
active maternal effort - full dilation but no expulsive contractions

Question 16

2nd stage for primigravida

Answer 16

birth within 2 hours

Question 17

2nd stage for multigravida

Answer 17

birth within 1 hour

Question 18

What is stage 3?

Answer 18

time from birth of baby to the expulsion of placenta and membranes

Question 19

3 points for active management of stage 3

Answer 19

uterotonic drugs
deferred clamping and cutting of cord
controlled cord traction after signs of separation of placenta

Question 20

3 points for physiological management of stage 3

Answer 20

no routine use of uterotonic drugs
no clamping of cord until pulsation stops
placental delivery by maternal effort

Question 21

When to diagnose a prolonged stage 3?

Answer 21

30 mins - active

60 mins - physiological

Question 22

obs taken for progress and monitoring

Answer 22

blood pressure, temp, RR, pulse, O2 sats, urine output and urinalysis

Question 23

Abdominal exam findings

Answer 23

fetal lie, presentation, attitude, position, engagement

Question 24

Vagina exam findings

Answer 24

presentation, engagement, position, cervical effacement and dilation, membranes

Question 25

Liquor findings

Answer 25

colour, volume and smell - after spontaneous or artificial rupture of membranes

Question 26

How to auscultate fetal heart

Answer 26

intermittent - doppler or pinards | continuous - CTG

Question 27

CTG

Answer 27

cardiotocograph

Question 28

Intermittent fetal heart auscultation times in 1st and 2nd stage

Answer 28

1st - every 15 mins | 2nd - every 5 mins

Question 29

When palpating uterine muscle contractions what is expected?

Answer 29

3-4 every 10 minutes | lasting 40-60s and moderate to strong

Question 30

External signs which may be seen

Answer 30

rhomboid michaelis or anal cleft line

Question 31

What would you document your findings of monitoring in labour on? When?

Answer 31

partogram | when established labour confirmed

Question 32

3 fetal lie

Answer 32

oblique - transverse - longitudinal

Question 33

5 presentations

Answer 33

face-brow-breech-vertex-shoulder

Question 34

How is the position of the fetus determined?

Answer 34

in relation to posterior fontanelle

Question 35

mechanism of labour (explain video)

Answer 35

``` descent flexion internal rotation of head crowning and extension of head restitution internal rotation of shoulders external rotation of head lateral flexion ```

Question 36

Analgesia in labour

Answer 36

water - birthing pool and equipment breathing, TENS, massage, paracetamol, dihydrocodeine Entonox - Inhaled NO and O2 opiods eg morphine epidural maternal position and mobility remifentanil patient controlled analgesia