Normal Labour

Question 1

Define normal labour?

Answer 1

Spontaneous labour at term (37-42 weeks) with fetus in vertex position resulting in a Spontaneous Vaginal Birth (SVD)

Question 2

What physiological changes must occur for labour to initiate?

Answer 2

• Cervix softens
• Myometrial tone changes to allow for coordinated contractions
• Progesterone decrease/ Oxytocin & Prostaglandins increase

Question 3

How many stages of labour are there?

Answer 3

3

Question 4

What are the parts of Stage 1 of labour?

Answer 4

Latent first stage

Established first stage

Question 5

What occurs during the latent first stage of labour?

Answer 5

Intermittent painful contractions leading to up to 4cm of dilatation

Question 6

What occurs during the Established first stage of labour?

Answer 6

Regular Painful contraction producing progressive cervical effacement and 10cm dilatation

Question 7

How long does the first stage last?

Answer 7

Established first stage lasts an average 8 hours primagravida and 5 multigravida

Progresses at 0.5-1cm per hour

Question 8

What occurs during stage 2 of labour?

Answer 8

Phase from full cervical dilation to birth of baby

Question 9

What occurs in the Passive 2nd stage of labour?

Answer 9

This is the stage after your fully dilated but before Involuntary Expulsive Contractions occur

Allow 1 hour for the fetus to descend

Question 10

What occurs in the Active Second stage of Labour?

Answer 10

Expulsive contractions with full dilatation = Active 2nd stage

The presenting part of fetus is visible and active maternal effort is required

Question 11

How long does the Active second stage of labour take?

Answer 11

Average 2 hours for primagravida and 1 for multigravida

Question 12

What occurs during the 3rd stage of labour?

Answer 12

Expulsion of the placenta and membranes

Question 13

What are the different ways we can handle the 3rd stage of labour?

Answer 13

• Active Management

- Physiological management

Question 14

Whats involved in Active management of the 3rd stage?

Answer 14

• Uterotonic drugs
• Deferrend clamping and cutting of cord
• Controlled cord traction

Physiological means no drugs, don’t clamp till it stops pulsating and deliver placenta by maternal effort alone

Question 15

How long does the 3rd stage take?

Answer 15

Prolonged Third Stage is a diagnosis made after 30 minutes of active management or 60 minutes of physiological management

Question 16

We use a partogram once established labour has been confirmed to monitor the labours progress.
What tests/measurments would this include?

Answer 16

• Abdominal Palpation
• Vaginal Exam
• Monitoring colour, smell & volume of liquor
• Fetal Heart rate
• Palpate Uterine muscle contractions
• External signs
• BP/Pulse/Temp/RR/O2Sat/Urine output/Urinalysis

Question 17

What does abdominal palpation tell us about the labour?

Answer 17

Fetal Lie
Presentation
Attitude
Denominator
Position
Engagement

Question 18

Define Fetal Lie

Answer 18

Axis of foetus to mother.
Either Longitudinal (same axis as mom) or transverse (lying sideways) or Oblique

Question 19

Define Fetal Presentation

Answer 19

The part of the foetus that is foremost in the birth canal

Question 20

Define Fetal Attitude

Answer 20

Foetus’s posture

i.e. back concave, straight or convex and head tilted forward or back

Question 21

Define Fetal Position

Answer 21

orientation of the foetus. Determined by which way the occiput (post fontanelle is facing)

1) anterior vs posterior vs transverse
2) and left vs right

Question 22

Define foetal Engagement

Answer 22

Degree to which the baby’s presenting part (head in vertex) has entered the pelvic inlet

Question 23

What can be found on vaginal exam?

Answer 23

Fotal presentation, engagement and position

Cervical effacement and dilatation

Presence/absence of membranes

Question 24

How do we auscultate the foetal heart?

Answer 24

Intermittently with Hand held doppler or pinard

OR Continuously with Cardiotocograph (CTG)

Question 25

How often should be auscultate the foetal heart if doing it intermittently?

Answer 25

Every 15 minutes in first stage and 5 minutes in 2nd stage

Question 26

How often/long do you hope for when palpating uterine muscle contractions?

Answer 26

3-4 every 10 minutes lasting 40-60seconds each

And moderate to strong not weak

Question 27

What are some external signs of labour?

Answer 27

Rhomboid of Michaelis

Anal Cleft line

Question 28

What are the parts of the actual mechanism of labour?

Answer 28

Descent
Flexion (of head)
Internal rotation of head (so facing downward)
Crowning & extension of head
Shoulders rotate internally
Head gets out and rotates to face sideways (restitution)
External rotation of the head
Lateral flexion to deliver shoulders (Ant first then Post)
Expulsion

Question 29

What forms of analgesia can women get during labour?

Answer 29

• Entonox
• Opioids
• Epidural
• Breathing & massage
• TENS
• Paracetamol and Dihydrocodeine
• Remifentanil Patient controlled Analgesia

Question 30

What is entonox?

Answer 30

Inhalation Nitrous Oxide and oxygen

Aka gas and air

Question 31

Mnemonic for mechanism of labour

Answer 31

Every damn fool in Egypt enticingly  Eats Raw Low fat  eggs. 
Engagement 
Descent 
Flexion 
Internal rotation of head 
Extension and crowning 
Restitution 
Internal rotation of shoulders 
External Rotation of head 
Lateral flexion of shoulder 
Expulsion