Normal labour and delivery

Question 1

Gestation of normal (not premature) delivery

Answer 1

37-42 weeks

Question 2

Exact definition of labour

Answer 2

Painful contractions leading to effacement and dilation of cervix

Question 3

What to ask in taking history of woman who thinks she is in labour

Answer 3

• CONTRACTIONS: frequency, duration, onset

- MEMBRANES: ruptured or intact

Question 4

What to examine in woman who thinks she is in labour

Answer 4

• Maternal obs
• Urine
• Abdominal palpation
• Foetal movements
• May auscultate heart
• +/- vaginal exam to diagnose onset of labour

Question 5

Role of prostaglandins in labour

Answer 5

• reduces cervical resistance

- increases release of oxytocin from posterior pituitary gland

Question 6

3 mechanical factors of labour

Answer 6

1. powers
2. passage
3. passenger

Question 7

Describe the 3 stages of labour

Answer 7

1. Initiation -> full cervical dilation
2. full cervical dilation -> foetal delivery
3. foetal delivery -> delivery of placenta

Question 8

How long should the 1st stage of labour take on average

Answer 8

12h in nulliparous

7.5h in multiparous

Question 9

What is considered adequate level of contractions

Answer 9

4-5 contractions every 10min

Question 10

Most common presenting part of foetus (>95% of cases)

Answer 10

Most common presenting part of foetus (>95% of cases)

Question 11

Where is the vertex of the foetus

Answer 11

Diamond shaped area between anterior and posterior fontanelles, between parietal eminences

Question 12

How long should the active part of the 2nd stage take on average

Answer 12

40min in nulliparous

20min in multiparous

Question 13

What is a normal level of bleed loss in the 3rd stage

Answer 13

500ml

Question 14

How often should foetal monitoring be carried out during 1st stage of labour

Answer 14

Every 15min

Question 15

How often should foetal monitoring be carried out during 2nd stage of labour

Answer 15

Every 5min

Question 16

Non-pharmacological analgesia during labour

Answer 16

Hypnosis
TENS
Water birth
Acupuncture

Question 17

Pharmacological analgesia during labour

Answer 17

Paracetamol 
Dihydrocodeine 
Entonox (NO + O2)
Diamorphine + metoclopramide
Epidural

Question 18

Components of Bishop score

Answer 18

• Cervix dilation
• Cervix consistency: firm to soft
• Length of cervix
• Cervix position: posterior/ central/ anterior
• Station of presenting part (cm above ischial spin)

the higher the score, the more likely labour will commence soon

Question 19

Components of APGAR score

Answer 19

Appearance
Pulse
Grimace
Activity (floppy or normal muscle tone)
Respiration

Question 20

In foetal scalp blood sampling, what levels of pH and lactate would require intervention

Answer 20

o Scalp blood pH<7.2

o Lactate >4.8

Question 21

Difference between foetal distress and foetal compromise

Answer 21

Distress = acute situation (eg hypoxia); diagnosed with foetal scalp blood

Compromise = chronic suboptimal growth conditions (eg placental dysfunction)

Question 22

Absolute contraindications to vaginal birth

Answer 22

1. Placenta previa
2. Abnormal foetal lie
3. Previous classical C section
4. Active genital herpes
5. HIV (if high viral load)

Question 23

Who is VBAC suitable for

Answer 23

1. Single baby
2. Cephalic at 37 weeks
3. Previous LSCS