Normal Labour

Question 1

how many weeks is average pregnancy?

Answer 1

37-42

Question 2

Define labour

Answer 2

Normal physiologic process during which the fetus, membranes, umbilical cord and placenta are expelled from the uterus after 24 weeks– most women experience without complications.

Question 3

how long does labour last for?

Answer 3

12-18 prims, 6-8 multips

Question 4

what is braxton hicks contractions

Answer 4

irregular contractions which do not increase in frequency or intensity

Question 5

what is show labour?

Answer 5

bloody mucous from the cervix

Question 6

what brings about contractions?

Answer 6

Increase in intracellular free calcium brings about contractions. Prostaglandins and oxytocin increase intracellular free calcium and hence stimulate uterine contraction

Question 7

Key physiological changes must occur to allow for expulsion of the fetus:

Answer 7

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

Question 8

what is assessed during th evaginal examination during labour?

Answer 8

effacement, dilaiton and consistency of the cervix. Weather the membranes are intact, colour of the amniotic fluid, presentation of the head, size the pelvic outlet.

Question 9

What is the 1st stage of Labour?

Answer 9

begins with regular contractions and ends at full dilatation.

Question 10

What is the 2nd stage of Labour?

Answer 10

starts with full cervical dilatation and ends with delivery of fetus

Question 11

What is the 3rd stage of Labour?

Answer 11

period between delivery of fetus and delivery of placenta and fetal membranes

Question 12

what is defined as full dilation?

Answer 12

10cm

Question 13

what needs to be acessed at stage 1?

Answer 13

FHR, cervix is acessed for shortening, dilation and the posiiton of the head, colour of the membrane too. There is a latent and active phase. There will be 3-4 strong contractions every 10 mins, you should auscultate every 15 mins

Question 14

how should the babies head descend?

Answer 14

the smallest diameter first with neck flexed and head tucked in, visible Occiput

Question 15

what needs to be acessed at stage 2?

Answer 15

first there is restitution and external rotation then expulsion and delivery of the shoulders. Passive and active (passive is when the mother is fully dilated and not pushing).

Question 16

what is seen in the 3rd stage of labour?

Answer 16

separation of the placenta and its descent to the lower segment and its expulsion with the membranes. There is a gush of blood, cord lengthening and a rising fundus, along with controlled cord traction. There is a release of oxytocin too

Question 17

what analgesia is given for labour? Specify 2/3?

Answer 17

Breathing, massage, TENS, paracetamol and dihydrocodeine, Water immersion,

Entonox (inhalational nitrous oxide and oxygen),

Opioids (morphine, diamorphine, pethidine injecitons),

Remifentanil patient controlled analgesia,

Epidural and spinal anaesthetic.

Question 18

when does active mx need to be used?

Answer 18

after 60 mins, Prolonged third stage of labour if it is not completed within 30 minutes of the birth with active management or within 60 minutes of the birth with physiological management.

Question 19

mechanisms of labour?

Answer 19

Descent
Flexion
Internal rotation of the head
Crowning and extension of the head
Restitution
Internal rotation of the shoulders
External rotation of the head
Lateral flexion
then Expulsion

Question 20

how long after the baby does the placena need to be expelled?

Answer 20

30 mins

Question 21

maternal complications with epidurals

Answer 21

abcess, hypotension, urinary retention, delayed 2nd stage of labour, nausea and vomiting, heacache.

Question 22

difference between epidural and spinal anaesthetic

Answer 22

anatomical location of insertion, epidural is inserted in the space between the dura mater and periosteum, spinal anaesthesia is induced by injecting small amounts of local anaesthetic into the CSF after having peirced the dura mater.

Question 23

Contraindications to an epidural?

Answer 23

abnormal bleeding, skin infeciton, hypovolaemia, cvs disease, neurological disorders, patient refusal, anatomical abnormalitites, lack of adequately trained staff.