Normal Labour

Question 1

How many stages of labour are there?

Answer 1

3 stages

Question 2

The first stage of labour is divided into…

Answer 2

Latent phase

Established phase

Question 3

Describe the latent phase of stage 1 labour

Answer 3

Painful, irregular contractions
Cervix effaces (shortens and softens)
Cervix dilates to 4cm
Days to hours

Question 4

Describe the established phase of stage 1 labour

Answer 4

Regular contractions 3 every 10 minutes
Cervix dilates from 4-10cm
A satisfactory rate from 4cm is 0.5cm per hour
Examine every 4 hours

Question 5

The second stage of labour is divided into…

Answer 5

Passive phase and active phase

Question 6

Describe the passive phase of the second stage of labour

Answer 6

Complete cervical dilatation but no pushing
Particularly seen in women with epidural anaesthesia (1-2 hours of passive stage is recommended to reduce instrumental delivery rate)

Question 7

Describe the active stage of stage 2 labour

Answer 7

Maternal pushing uses the abdominal muscles and valsalva manoeuvre until baby is born

Question 8

How long should stage 2 labour last?

Answer 8

4 hours if primip (3 hours midwife, 1 hour doctor) - can be 1 hour passive and 2 hours active or 2 passive and 2 active
3 hours if multip (2 hours midwife, 1 hour doctor) - 1 hour passive and 1 hour active

Question 9

What is a precipitate delivery?

Answer 9

Childbirth after an unusually rapid labour - combined first and second stage in under 2 hours and culminating in rapid, spontaneous expulsion of the infant

Question 10

What maternal risks are there with a precipitate delivery?

Answer 10

Lacerations of the cervix, vagina, perineum - can cause haemorrhage
Does not allow maternal tissues an adequate time to stretch and accommodate passage of infant
May be infection due to unsterile delivery
Uterine atony - due to unusually strong and rapid labour causing muscular exhaustion

Question 11

What neonatal risks are there with precipitate delivery?

Answer 11

Intracranial haemorrhage - suddenly change in pressure on fetal head during rapid expulsion
Infection due to unsterile delivery

Question 12

What is stage 3 labour?

Answer 12

Placental delivery

Question 13

Placental delivery can be physiological or active. Describe both

Answer 13

Physiological - not recommended in UK due to bleeding risk (uterus cannot contract properly if placenta still present)
Usually takes 1 hour
Active - given oxytocin IM/IV, takes approximately 30 minutes

Question 14

If the is an increased risk of PPH, what is given instead of just oxytocin at stage 3 of labour?

Answer 14

Syntometrine - oxytocin and ergometrine
Also decreases S3 time to around 5 minutes
Given as anterior shoulder born

Question 15

What contraindications are there to giving syntometrine?

Answer 15

Can precipitate MI
Pre-eclampsia
Severe HTN
Severe renal or liver impairment 
Severe heart disease 
If BP not measured in labour just give oxytocin

Question 16

What signs are there that the placenta has separated?

Answer 16

Cord lengthening
Gush of blood (due to retroplacental haemorrhage)
Uterus rises and contracts

Question 17

How long does the first stage of labour usually take?

Answer 17

8-18 hours in primip

5-12 hours in multip

Question 18

When should the oxytocin/syntometrine be given?

Answer 18

At anterior shoulder delivery

Question 19

What kind of monitoring should be done in the first stage of labour?

Answer 19

Maternal BP and temp 4 hourly
Pulse hourly
Assess contractions every 30 minutes - strength (should not be able to indent uterus with fingers during a contraction) and frequency (ideally 3/4 every 10 minutes lasting 1 minute)
Note frequency of bladder emptying
Offer vaginal examination every 4 hours - degree of dilatation, position and station of head (measured in cm above/below ischeal spines) and note degree of head moulding
Auscultate fetal HR if not continuously monitored, every 15 minutes, listen for 1 min after contraction

Question 20

What monitoring is required during second stage?

Answer 20

BP and pulse hourly
Temp 4 hourly
Assess contractions every 30 mins 
VE hourly 
Record urination during second stage 
If contractions wane, oxytocin may be needed