Normal labour

Question 1

When does “normal labour” occur?

Answer 1

37-42 weeks

Question 2

What initiates labour?

Answer 2

Paracrine and autocrine signals generated by fatal, maternal and placental factors

Question 3

What are the key physiological changes in the initiation of labour?

Answer 3

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

Question 4

What are the 2 parts of stage 1 labour?

Answer 4

Latent

Established

Question 5

What happens in latent first stage labour?

Answer 5

Intermittent, often irregular, painful contractions which bring about some cervocal effacement and dilation up to 4cm

Question 6

What happens in established firs stage?

Answer 6

Regular painful contractions that result in progressive effacement and cervical dilation from 4-10cm

Question 7

How long does stage 1 labour take in primigravida?

Answer 7

Average 8 hours

Should be No more than 18

Question 8

How long does stage 1 labour take in multigravida?

Answer 8

Average 5 hours

Should be no more than 12 hours

Question 9

What is the anticipated progress in stage 1 labour?

Answer 9

0.5-1cm per hour

Question 10

What is stage 2 labour?

Answer 10

From full cervical dilatation to birth

Question 11

What are the 2 stages of stage 2 labour?

Answer 11

Passive

Active

Question 12

When is the passive phase of stage 2?

Answer 12

Full cervical dilation but before expulsive contraction

Question 13

How long should passive stage 2 be allowed for?

Answer 13

About 1 hour

Question 14

What is the active phase of stage 2?

Answer 14

Presenting part of baby is visible

Expulsive contractions with fully dilated cervix

Question 15

How long does stage 2 last for in primigravida?

Answer 15

Birth expected within 2 hours f active stage commencing

Question 16

How long does stage 2 last for in multigravida?

Answer 16

Birth expected within 1 hour of active stage commencing

Question 17

What is stage 3?

Answer 17

From time baby is born until expulsion of placenta and membranes

Question 18

What are the 2 type of management of stage 3?

Answer 18

Active management

Physiological management

Question 19

When is active management of stage 3 used?

Answer 19

Long labour

Induced labour etc

Question 20

What does active management of stage 3 involve?

Answer 20

Routine use of uterotonic drugs
Deferred clamping and cutting of cord
Controlled cord traction after signs of separation of placenta

Question 21

What does physiological management of stage 3 involve?

Answer 21

Delivery of placenta by maternal effort

Question 22

How long does stage 3 take?

Answer 22

Up to 30 mins with active management or 60 mins with physiological management

Question 23

How is labour monitored?

Answer 23

MEWS
Abdo exam
Vaginal exam
Monitor liquor
Fetal heart
Palpation of uterine contractions
External signs

Question 24

What is monitored for MEWS?

Answer 24

BP
Pulse
Temp
Respirations
Oxygen saturation
Urine output
Urinalysis

Question 25

What is palpated for in abdomen?

Answer 25

``` Fetal lie Presentation Attitude Denominator Position Engagement ```

Question 26

What is the position of th foetus monitored in relation to?

Answer 26

Occiput- posterior fontanelle

Question 27

What is monitored via vaginal exam?

Answer 27

``` Presentation Engagement and station Position Cervical effacement and dilation Presence/absecnce of membranes ```

Question 28

What is monitored in liquor?

Answer 28

Colour Smell Volume

Question 29

What is the normal colour of amniotic fluid?

Answer 29

Clear to very light straw colour

Question 30

What can be present in the amniotic fluid?

Answer 30

Blood | Foetal faeces

Question 31

How often is foetal heart rate monitored?

Answer 31

Every 15 mins in first stage | Every 5 mins in second stage

Question 32

What are "normal" uterine contractions?

Answer 32

3-4 per 10 mins | Lasting approx 40-60 seconds each

Question 33

What are external signs we look for?

Answer 33

Rhomboid of Michaelis | Anal cleft line

Question 34

What analgesia in used in labour?

Answer 34

``` Breating, massage, water TENS Paracetemol, dihrdrocodeine Entenox Opiods- morphine, dimorphic, pethidine Remifentani patient controlled analgesia Epidural ```