Normal labour

Question 1

What is the 1st stage of labour?

Answer 1

Latent/early phase - cervical effacement and dilation up to 4cm

Active/established phase - dilation from 4cm to fully dilated (10cm), painful regular contractions

Question 2

What rate of dilation is acceptable for active 1st stage?

Answer 2

0.5cm/h (2cm every 4h)

Question 3

Frequency of contractions during active/established 1st stage should be what?

Answer 3

3-4/10 mins, lasting up to 1 min

Question 4

What is the 2nd stage of labour?

Answer 4

full cervical dilation to delivery of baby

• passive stage - seen particularly in epidural (1-2h passive stage recommended)
• active stage - maternal pushing

Question 5

What is the 3rd stage of labour?

Answer 5

delivery of placenta and membranes

Question 6

How long should a physiological 3rd stage take?

Answer 6

up to 1 hour

Question 7

When are uterotonics for active 3rd stage used?

Answer 7

as anterior shoulder is born

Question 8

Which uterotonics should be used for active management of the 3rd stage?

Answer 8

• syntometrine (oxytocin + ergometrine maleate IM) if not CI

- syntocinon (oxytocin) IM - NICE recommend this, fewer SEs and CIs

Question 9

What are the CIs to syntometrine and why?

Answer 9

Can precipitate MI

• pre-eclampsia
• severe HTN
• severe liver or renal impairment
• severe heart disease

Question 10

What are early decelerations?

Answer 10

• downward spike of >15bpm for >15s
• mimic the shape of the contraction
• caused by head compression

Question 11

What are late decelerations?

Answer 11

• downward spike of >15bpm for >15s
• reach their lowest point after the peak of the contraction has passed
• sign of acidosis

Question 12

FBS pH ranges

Answer 12

Normal (repeat every hour if CTG remains abnormal): >/= 7.25
Borderline (repeat 30 mins if CTG remains abnormal): 7.20-7.25
Abnormal (immediate delivery): <7.20

Question 13

When to expect birth, suspect and diagnose delay in 2nd stage of labour

Answer 13

Nulliparous:

• expect birth within 3h of pushing
• suspect delay after 1h
• diagnose delay after 2h

Multiparous:

• expect birth within 2h of pushing
• suspect delay after 30mins
• diagnosed delay after 1h

Question 14

When is entonox used in labour?

Answer 14

throughout

Question 15

When is pudendal nerve block used in labour?

Answer 15

instrumental delivery (not sufficient for rotational forceps)

Question 16

When is local anaesthetic (lidocaine) used in labour?

Answer 16

before episiotomy at delivery, before suturing vaginal tears

Question 17

Monitoring after epidural insertion

Answer 17

• monitor BP every 5 mins for 20 mins

- CTG monitoring

Question 18

When is combined spinal epidural anaesthesia (CSE) used in labour?

Answer 18

• for quick pain relief (spinal) with option of prolonging anaesthesia (epidural)
• e.g. for C-section that might take longer than usual (e.g. prev. difficult surgery, placentae praevia)

Question 19

When is spinal anaesthesia used in labour?

Answer 19

for most LSCS