Normal Labour

Question 1

What is labour?

Answer 1

The process in which the fetus, placenta and membranes are expelled via the birth canal characterised by cervical changes and contractions

Question 2

How many weeks is term?

Answer 2

37-42

Question 3

How long should labour typically last?

Answer 3

12-18 hours for first time pregnancy (can be half for subsequent pregnancies), but can vary

Question 4

What changes occur for the initatation of labour?

Answer 4

Cervix softens: Contractions pull on cervix causing it to thin and dilate, allowing fetus to leave

Myometrial tone changes to allow for coordinated contractions

Progesterone decreases whilst oxytocin and prostaglandins increase to allow labour to initiate

Question 5

What is the latent first stage of labour?

Answer 5

period during which there are intermittent, often irregular, painful contractions which bring about some cervical effacement and dilatation up to 4cm

Question 6

When is stage 1 of labour complete?

Answer 6

When cervix is fully dilated (10cm)

Question 7

How long does stage 1 of labour last?

Answer 7

8 hours (unlikely to last longer than 18 hours) for a primagravida

For a multigravida this stage lasts on average 5 hours (unlikely to last over 12 hours)

Question 8

How long should 3rd stage of labour last?

Answer 8

Within 30 minutes of the birth with active management or within 60 minutes of the birth with physiological management.

Question 9

What is the established first stage of labour?

Answer 9

Regular, painful contractions that result in progressive effacement and cervical dilatation from 4cm

Question 10

What is the passive second stage of labour?

Answer 10

The finding of full dilatation of the cervix before or in the absence of involuntary expulsive contractions. Plan to allow one hour of passive second stage to allow for further fetal descent.

Question 11

What is the active second stage of labour?

Answer 11

Expulsive contractions with a finding of full dilatation of the cervix.

Question 12

How long does passive second stage of labour last?

Answer 12

1 hour to allow fetal descent

Question 13

How long does active second stage of labour last?

Answer 13

In a primagravida birth would be expected within two hours of active second stage commencing.

For a multigravida birth would be expected within one hour of active second stage commencing.

Question 14

What is the 3rd stage of labour?

Answer 14

The third stage of labour is the time from the birth of the baby to the expulsion of the placenta and membranes.

Question 15

What does active management of the 3rd stage of labour involve?

Answer 15

routine use of uterotonic drugs: Drugs that stimulate contraction of the myometrium (oxytocins or prostaglandins)

deferred clamping and cutting of the cord

controlled cord traction after signs of separation of the placenta: Pressure applied until placenta is delivered

Question 16

What does physiological management of the 3rd stage of labour involve?

Answer 16

No routine use of uterotonic drugs

No clamping of the cord until pulsation has stopped

delivery of the placenta by maternal effort

Question 17

Describe false labour

Answer 17

Contractions felt in the lower abdomen

The contractions are irregular and occur every 20 minutes

Progressive cervical changes are absent.

Question 18

When does false labour occur?

Answer 18

Last 4 weeks of pregnancy

Question 19

What are the two types of C section?

Answer 19

Lower segment caesarean section

Classic caesarean section, involving longitudinal incision in the upper segment of the uterus

Question 20

What is a category 1 C section?

Answer 20

Immediate caesarean section, performed where there is evidence or clinical suspicion of acute foetal compromise

Question 21

What is a contraindication for vaginal delivery after C section?

Answer 21

Previous uterine rupture

Classical C section scar

Question 22

Give the requirements for instrumental delivery

Answer 22

Fully dilated cervix generally the second stage of labour must have been reached

OA position preferably OP delivery is possible with Keillands forceps and ventouse. The position of the head must be known as incorrect placement of forceps or ventouse could lead to maternal or fetal trauma and failure

Ruptured Membranes

Cephalic presentation

Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally

Pain relief

Sphincter (bladder) empty this will usually require catheterization

Question 23

Describe the stages of analgesia during labour

Answer 23

Non pharmacological methods

Nitrous oxide (gas and air)

Simple analgesia, such as paracetamol

Opiate analgesia, such as IV diamorphine or oral coedine

Epidural analgesia

Pudendal nerve block