Normal labour/ delivery 1B

Question 1

definition?

Answer 1

onset of regular and painful contractions associated with cervical dilation and descent of thepresenting part

Question 2

• Signs of labour =

Answer 2

 Regular and painful uterine contractions
 “Bloody show” = shedding of mucous plug
 Rupture of the membrane (not always)
 Dilation and shortening of the cervix

Question 3

• Stages of labour =

Answer 3

 Stage 1 = from the onset of true labour to when the cervix is fully dilated
 Stage 2 = from full dilation to the delivery of the foetus
 Stage 3 = from delivery of the foetus to when the placenta and the membranes have been completely delivered

Question 4

what is involved in the monitoring during labour

Answer 4

 FHR = 15mins or continuously via CTG
 Contractions= 30mins
 Maternal Pulse rate = 60 mins
 Maternal Bp and temp = 4hrs
 VE (vaginal examination) = 4 hours to monitor progression of labour
 Maternal urine = 4hrs (ketone and protein)

Question 5

during monitoring poor progress is suggested by

Answer 5

<2cm dilation in 4hrs

Question 6

what are the 3ps that cause poor progress

Answer 6

 Power: uterine weakness
 Passenger – size, position or presentation of the baby
 Passage = pelvic problem

Question 7

what is done in the 4 hourly VE

Answer 7

feel fontanelles & sutures of skull, cervical effacement & dilation, head station and a palpable cord = cord prolapse

Question 8

what happens in the 3rd stage of labour

Answer 8

physiologically placenta may be expelled 10mins to 1hr (**remember it carries risk of PPH)

Question 9

what may be given to help expel the placenta

Answer 9

• Oxytocin or synometrine IM may be given at the anterior shoulder

Question 10

Signs of foetal distress during intrapartum monitoring

Answer 10

 Abnormalities on intermittent auscultation
 Meconium in liquor which can lead to neonatal pneumonitis
 Significant moulding = overlapping of skull bones

Question 11

what is CTG

Answer 11

cardiotocography

Question 12

what is the mnemonic for the review of CTG

Answer 12

• DR C BRAVADO
 Define risk = ↑or↓ risk pregnancy
 Contractions= regular contractions suggest labour = e.g. 4 in 10
 Baseline rate = normal = 110-160bpm, <100 or >180 is abnormal
 Variability =
Normal & reassuring = 5-25bpm for 30-50mins
Non-reassuring = <5 for 50mins
Abnormal is >5 for >50mins or >25 for >25mins

 Accelerations= should be occasional ↑ in FHR in response to its environment
 Declarations
Early deceleration + in time with contractions = normal
Late deceleration = 20-30 seconds after contraction = hypoxia
Variable deceleration = cord compression
 Overall impression