Normal Labour and Puerperium

Question 1

What are the 3 “P”s in Labour

Answer 1

Power: Uterine Contractions

Passage: Maternal Pelvis

Passenger: Foetus

Question 2

Desrcibe the Ferguson reflex

Answer 2

positive feedback loop

oxytocin release is initiated by pressure on cervix and vagina.

Oxytocin causes uterine contractions which pushes the baby further down and causes an increased pressure on the cervix and vagina

Question 3

describe the 3 stages of labour

Answer 3

• First Stage
• Latent phase up to 3-4cms dilatation
• Active stage 4cms -10cms (full dilatation)
• Second Stage
• Full dilatation –delivery of baby
• Third Stage
• Delivery of baby –expulsion of placenta and membranes

Question 4

when is the second stage considered prolonged in nulliparous and multiparous ladies?

Answer 4

• In nulliparous women considered prolonged if it exceeds 3 hours if there is regional analgesia, or 2 hours without
• In Multiparous women, the second stage considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without

Question 5

how long does the third stage usually last for?

At what point would you carry out active management?

What would active management consist of?

Answer 5

• Average duration 10 minutes but can be 3 minutes or longer
• After 1 hour preparation made for removal under GA

Includes prophylactic administration of oxytocin 10 units

Ergometrine 1ml

Cord clamping and cutting,

Controlled cord traction

Bladder emptying

Injection of oxytocin directly into the cord

Question 6

what is the difference between braxton hicks and true labour contractions?

Answer 6

Braxton Hicks

• Irregular, do not increase in frequency or intensity
• Resolve with ambulation or change in activity
• Relatively painless

Question 7

how long would you expect contractions to last for?

Answer 7

• Initially 10-15 seconds
• Max 45 seconds, slowly builds up

Question 8

list the different types of pelvis shape.

Answer 8

Android- Heart shaped

Anthropoid- large anerio-posterior diameter

Gynaecoid- normal

Question 9

describe the different fetal positions in the pelvis

Answer 9

Question 10

describe the fontanelles and suttures of the foetal skull

Answer 10

Question 11

give the definition of abdominal 5ths in labour

Answer 11

Question 12

what is the bishops score?

Answer 12

Bishops score is used to determine whether or not it is safe to induce labour

Question 13

what anaesthesia should be considered?

Answer 13

• Paracetamol/ Co-codamol
• TENS
• Entonox
• Diamorphine
• Epidural
• Remifentanyl
• Combined spinal/epidural

Question 14

what are normal and abnormal levels of blood loss in labour?

Answer 14

• Normal:
• Volume of less than 500mls
• Abnormal
• Volume greater than 500mls
• More significance if greater than 1,500mls
• Any blood loss prior to delivery apart from “show” is abnormal and requires referral to consultant unit

Question 15

during third stage what are three classical signs of separation?

Answer 15

• Uterus contracts, hardens and rises
• Umbilical cord lengthens permanently
• Gush of blood variable in amount

Question 16

where is the plane of placental separation?

Answer 16

Plane of separation: Spongy layer of decidua basalis

Question 17

what are the two methods of separation?

Answer 17

• Method of separation: Matthew Duncan, marginal most common type of separation
• Schultz, separation from central aspect

Question 18

what is the duration of pureurperium?

what is the name of the Vaginal discharge containing blood, mucus and endometrial castings?

Answer 18

6 weeks

Lochia:

Rubra (fresh red)

Serosa (brownish-red, watery)

Alba (yellow)