Normal labour and puerperium

Question 1

What is labour

Answer 1

physiological process during which the foetus, placenta, umbilical cords and membranes are expelled from the uterus

Question 2

Where can a woman give birth

Answer 2

Consultant led unit - abnormal labour/pregnancy
Midwife led unit - normal labour/pregnancy
Homebirth

Question 3

What are the biological and physiological changes that initiate labour

Answer 3

Decrease in progesterone 
Increase in oestrogen 
Increase in oxytocin 
Mechanical stretching of the cervix 
stretching of myometrium 
Stripping of foetal membranes 
Fergusons (positive feedback) reflex

Question 4

When can membranes rupture

Answer 4

Pre term 
Pre labour 
1st stage 
2nd stage 
not at all - born in a caul

Question 5

What cervical changes occur in labour

Answer 5

Cervical softening
increase in hyaluronic acid
decreased strength of collagen fibres

Question 6

What is Bishops score

Answer 6

method to determine if it is safe to induce labour

score>5 is favourable

Question 7

What components are measure in Bishops score

Answer 7

Cervical: 
Dilatation 
Effacement 
Station 
Firmness / consistency
Position
"Pregnancy Can Enlarge Dainty Stomachs"

Question 8

How many stages of labour are there

Answer 8

3

Question 9

What happens in the 1st stage of labour

what phases make it up

Answer 9

Cervical dilatation

Latent phase - mild irregular uterine contractions, cervix shortens and softens
Active phase - 4cm to full dilatation, contractions become more rhythmic and stronger, painful stage

Question 10

What defines the 2nd stage of labour

Answer 10

full dilatation of the cervix (10cm) to delivery of baby

Question 11

What defines the 3rd stage of labour

Answer 11

period from delivery of baby to expulsion of placenta and foetal membranes

Question 12

What is the average time the placenta is expelled

Answer 12

10 minutes after delivery

Question 13

If the placenta is not expelled after ??, it should be removed under GA

Answer 13

1 hour

Question 14

What is involved in active management of the 3rd stage of labour

Answer 14

oxytocin infusions

Question 15

What are Braxton Hicks contractions

Answer 15

Pretend contractions 
Irregular tightenings of uterus 
don't increase in frequency or strength 
painless 
can occur from 6/40 but are most common in 3rd trimester

Question 16

What are true labour contractions

Answer 16

painful contractions that increase in frequency and strength and duration
ie get longer and closer together

Question 17

What hormone influences true labour contractions

Answer 17

Oxytocin

Question 18

Where do true labour contractions start

Answer 18

in the fundus of the uterus and spread down symmetrically

Question 19

name the 3 key factors in labour

Answer 19

Power
Passage/Pelvis
Passenger

Question 20

What is responsible for “power” in labour

Answer 20

uterine contractions

Question 21

What features are important in “passage” in labour

Answer 21

pelvis - anthropoid vs gynaecoid

cervix - Bishops score parameters

Question 22

How should the “passenger” be positioned in labour

Answer 22

Ideally lying longitudinally, cephalic position, occipitoanterior

Question 23

What analgesia can be used in childbirth

Answer 23

paracetamol/co-codamol 
TENS machine 
Entonox gas mixture 
Diamorphine 
Epidural 
Remifentanyl 
combined spinal/epidural

Question 24

What are the 7 cardinal movements in labour

Answer 24

1. Engagement of foetal head - measured in 1/5ths
2. Descent of the foetal head into the pelvis
3. Flexion of foetal cervical neck
4. Internal rotation to adopt OA position
5. Crowning and extension
6. Restitution and external rotation
7. Expulsion of the rest of the foetal body

Question 25

What is delayed cord clamping and why is it better than immediately clamping the cord

Answer 25

keeping cord in tact for 1 minute to increase blood flow to the foetus - multiple benefits
only immediately clamp the cord if baby needs to have immediate resuscitation

Question 26

How long should skin-skin contact be for after delivery

Answer 26

1 hour uninterrupted

Question 27

What is the puerperium period

Answer 27

6 weeks after delivery

Period of repair and recovery