Normal Labour

Question 1

definition

Answer 1

normal physiological process during which the foetus, membranes, umbilical cord and placenta get expelled fromt the uterus

• this usually occurs spontaneously between 37-42weeks

Question 2

how long is labour for prims and multips?

Answer 2

prims - 1st pregnancy - usually lasts between 12-18hours

Multips- had a previous pregnancy- usually lasts between 6-8hours

• uterus and muscles become more efficient with a prior pregnancy

Question 3

what is causes contractions to start?

Answer 3

progesterone ↓ and oxytocin and prostaglandins ↑

• they cause release of free intracellular Ca which stimulates contractions

Question 4

what 2 physiological changes must occur to allow for expansion of the foetus?

Answer 4

• cervix softens
• myometrial tone changes to allow for co-ordinated contractions

Question 5

identify and describe the stages of labour

Answer 5

1- begins with initiation of contractions and ends at full cervical dilatation

2-begins at full cervical dilatation and ends with delivery of foetus

3- period between delivery of foetus and expulsion of placenta and membranes

Question 6

describe the 1st stage of labour

Answer 6

• latent & active phase
  
  • latent - until cervix reaches 4cm
  • active (established) - from 4-10cm
• in established 1st stage
  
  • regular, painful contractions which result in progressive effacement (baby’s head opens cervix) and cervical dilatation
  • complete when cervix dilated to 10cm

Question 7

what are initial obs done in 1st stage of labour?

Answer 7

• Obs
• Urinalysis
• Colour of liquor
• Membranes

Question 8

describe the 2nd stage of labour

Answer 8

• active + passive
  
  • passive: full dilatation of cervix without contractions (no urge to push)
  • active: full dilatation of cervix with contractions
• delivery of baby is by
  
  • extension
  • restitution
  • delivery of shoulders

Question 9

describe the 3rd stage of labour

Answer 9

• may be physiological or active
• controlled cord clamping
  
  • when pulsation stopped

Question 10

how may you assess the progress and monitor labour?

Answer 10

• Obs
  
  • BP
  • pulse
  • o2
  • temperature
  • RR
  • urine output
  • urinalysis
• abdominal palpation
• vaginal examination
• auscultation of foetal heart
• palpation of uterine muscle contractions
• monitoring of liquor (colour, smell, volume)

Question 11

analgesia used in labour?

Answer 11

• Breathing, massage, TENS, paractamol and diihydrocodeine
• Entonax (inhalational nitrous oxide and oxygen)
• Opioids –> morphine, diamorphine, pethidine
• Remifentanil patient controlled analgesia
• epidural