normal labour + delivery

Question 1

what is the mucus plug?

Answer 1

forms in front of cervix due to oestrogen
prevents things getting in
usually out by labour

Question 2

what is crowning?

Answer 2

head of baby fully on cervix opening

cervix fully dilated + head visible

Question 3

what can occur if meconium swallowed?

Answer 3

chemical pneumonitis

Question 4

what does meconium liquor indicate\?

Answer 4

breech position

foetal distress eg hypoxia

Question 5

how do hormones change in childbirth?

Answer 5

all drop

Question 6

how does labour start and finish? what determines onset of labour?

Answer 6

starts - regular + painful contractions
onset determined as cervical dilation + effacement
ends - delivery of placenta

Question 7

how long does labour last?

Answer 7

12-18h first time

6-9 subsequent times

Question 8

define labour

Answer 8

regular painful contractions associated with cervical dilation + descent of the presenting part

Question 9

what may indicate labour?

Answer 9

regular + painful contractions show - shed mucus plug
rupturing membranes
cervix shortens + dilates

Question 10

what is 1st stage of labour

Answer 10

onset of true labour till cervix fully dilated

Question 11

what is 2nd stage labour

Answer 11

from full dilation to delivery of foetus

Question 12

what is 3rd stage labour

Answer 12

from delivery to when placenta + membranes fully delivered

Question 13

monitoring in labour

Answer 13

FHR every 15min or continuous
contractions assessed half hourly
mum pulse hourly
mum BP + temp 4hrly
offer VE 4hrly to check progression
mum urine for ketones + protein 4hrly

Question 14

how long does 1st stage labour last

Answer 14

primip 10-16h

Question 15

how long does latent phase last

Answer 15

6h

Question 16

how long does active phase last

Answer 16

7h?

Question 17

what position does head enter pelvis?

Answer 17

occipito-lateral

Question 18

what position does head normally deliver in

Answer 18

occipito-anterior

Question 19

what are the components of first stage of labour?

Answer 19

latent stage
active phase
transition phase

Question 20

describe latent phase (of first stage)

Answer 20

dilates - 0-3
contractions - every 5-30 mins (last 30 sec)
lasts - 8-12h

0-30% effacement

Question 21

describe active phase (of first stage)

Answer 21

3-3-3-:
dilates - 3-7cm
contractions - every 3-5 mins (last 1+ min)
lasts - 3-5h

80% effacement

Question 22

describe transition phase (of first stage)

Answer 22

0.5-2, 0.5-2

lasts - 0.5-2h
intense contractions - every 0.5-2min + last 1 min
dilates - 7-10 + 100% effacement
crowning

Question 23

what is the second stage of labour? active vs passive? how long last? things to be aware of?

Answer 23

lasts 1h

pushing:
Power
Passenger
Passage (route)

passive 2nd stage - 2nd stage in absence of pushing
active 2nd stage - pushing

less painful than 1st
episiotomy may be needed after crowning
associated transient foetal brady

Question 24

what is the 3rd stage of labour? what happens?

Answer 24

delivery of placenta - uterus contracts + it separates from wall
it’s removed till no remnants left
active management recommended to avoid PPH

Question 25

active management of 3rd stage of labour: what is done before cord is cut?

Answer 25

give oxytocin IM
examine for signs of separation of placenta
clamp naval + placental ends of cord
cut between the 2

Question 26

after cord is cut placenta is delivered - how is this done?

Answer 26

check for the 3 signs of placental separation
1 hand on contracted, round uterus + other on symphysis
apply downward traction on cord + upward motion on uterus - to avoid uterine inversion
when placenta appears at vulva, pull cord up
deliver membranes slowly to avoid tearing
note time

ANTT throughout

Question 27

what are the 3 signs of placental separation?

Answer 27

uterus well contracted
cord lengthened
small trickle blood

Question 28

how do you manage a woman post placental delivery?

Answer 28

1) assess her condition + vol blood loss
2) palpate uterus
3) examine + swab genital tract + anus
4) assess placenta for abnormalities

Question 29

how to read a CTG?

Answer 29

DR - define risk
C - contractions
BRa - baseline rate
V - variability
A - accelerations
D - decelerations
O - overall impression

Question 30

what to do if 2nd stage labour lasting >1h?

Answer 30

can be longer if epidural

consider ventouse, forceps or caesarean