Normal Labour And Delivery

Question 1

What is the process of normal labour?

Answer 1

Stage 1 - has latent first stage eg irregular contractions, uncomfortable but not painful. then established first stage eg regular contractions, painful. Completed when cervix is fully dilated. Dilation progress usually 0.5-1cm/hour

Stage 2 - passive second stage eg no need to push, to active second stage eg needs to push. Birth expected within two hour for primagravida, one hour for multi

Mechanism
Descent> Flexion (head tucks towards chest) > internal rotation of head > crowning and extension of the head > restitution > internal rotation of shoulders > external rotation of head > lateral flexion

Stage 3 - time between birth of baby and expulsion of placenta and membranes. Can be actively managed eg give oxytocic injection or physiologically managed

Question 2

What problems are associated with normal labour?

Answer 2

X

Question 3

What methods can be used to assess progress in labour?

Answer 3

Maternal observations
Abdominal palpation
Vaginal examination
Monitoring of liquor
Auscultation of foetal heart eg CTG monitioring
Palpation of uterine muscle contractions
External signs

Question 4

What methods of anaesthesia and analgesia are used during labour, and what are their advantages and disadvantages?

Answer 4

Breathing, massage, TENS, paracetamol, dihydrocodeine - minimal, non invasive
Water bath
Etonox (inhaled)
Opioids eg diamorphine - possibly slows labour
Remifentanil
Epidural