Normal Labour

Question 1

What are some of the key physiological changes which must occur to allow for the expulsion of the fetus?

Answer 1

Cervix softens
Myometrial tone changes to allow for coordinated contractions
Progesterone decreases whilst oxytocin and prostaglandins increase

Question 2

When is the first stage of labour complete?

Answer 2

When the cervix is fully dilated

Question 3

What happens in the second stage of labour?

Answer 3

Labour goes from full cervical dilatation to the birth of the baby

Question 4

What happens in the third stage of labour?

Answer 4

Expulsion of the placenta and membranes

Question 5

How is the position of the baby described?

Answer 5

In relation to the occiput (posterior fontanelle)

Question 6

What are the 8 steps in the mechanism of labour?

Answer 6

1. Descent
2. Flexion
3. Internal rotation of the head
4. Crowning and extension of the head
5. Restitution
6. Internal rotation of the shoulders
7. External rotation of the head
8. Lateral flexion

Question 7

What are the different types of analgesia available in labour?

Answer 7

Breathing, massage, TENS, paracetamol, dihydrocodeine
Water
Entonox
Opioids
Remifentanil PCA
Epidural
Consider maternal position and mobility as means of reducing pain and facilitating progress in labour

Question 8

What is involved in active management of the third stage of labour?

Answer 8

Routine use of uterotonic drugs, optimal cord clamping, controlled cord traction

Question 9

What is involved in physiological management of the third stage of labour?

Answer 9

No routine use of uterotonics, no cord clamping until pulsation has stopped, delivery of placenta by maternal effort

Question 10

When is a diagnosis of prolonged third stage of labour given?

Answer 10

If it is not completed within 30 mins of the birth with active management or within 60 minutes of the birth with physiological management