O&G - Labour and Delivery

Question 1

List the stages of labour?

Answer 1

1st stage

• latent phase
• active phase (established labour)

2nd stage

• passive
• active

3rd stage

Question 2

How long does the first stage of labour last in a first time mum?

Answer 2

8 - 18 hrs

Question 3

how long does labour last in a mum who has had previous babies?

Answer 3

5 - 12 hrs

Question 4

Describe the 1st stage of labour?

Answer 4

Latent phase

• painful contractions AND some cervical change
• dilation up to 4cm

Active

• regular painful contractions
• progressive cervical dilation from 4cm

Question 5

Describe the 2nd stage of labour?

Answer 5

Passive
- full dilatation of cervix before or in the absence of involuntary expulsive contractions

Active
- full dilatation and expulsive contractions or active maternal effort to delivery of the fetus

Question 6

describe the 3rd stage of labour?

Answer 6

time from birth of baby to expulsion of the placenta and membranes

Question 7

What are the three important Ps in relation to the mechanism of normal labour?

Answer 7

Passage

• shape of pelvis
• pelvic fracture, pathology, fibroid?

Powers
- uterine contractions

Passenger
- variabilities in size of fetus

Question 8

Summarise the 6 steps for the movement of a fetus through the birth canal?

Answer 8

1. engagement
   - head engages
2. descent and flexion
   - head descends int vagina through dilated cervix
3. internal rotation
   - as fetus descends it rotates into an occipito-anteiror position
4. extension
   - hits sacrum, slimbs up sarcral curve via extension of neck
5. restitution
   - head now external to mother
   - returns to transverse
   - in line with shoulders
6. external rotation
   - fetal shoulder corkscrew to come under symphysis pubis
   - allows delivery of torso

Question 9

what i used to ensure that slow progress is identified and acted upon?

Answer 9

WHO 4 hr action line

expected progress: 2cm every 4hrs in 1st labour stage

in 2nd stage no longer than 4hrs

Question 10

pain reflief options available when giving birth

Answer 10

• coping strategies: breathing, relaxation

Non-phara: transcutaneous electrical nerve stimulation (not in established labour)

inhalation: Entonox
opioids: pethidine, diamorphine

regional analgesia: epidural or combined spinal epidural

Question 11

what non-pharmacological agents could be used to induce labour?

Answer 11

• cervical dilatation
• balloon catheter or osmotic dilators
• artificial rupture of membranes

Question 12

what pharmacological agents used to induce labour?

Answer 12

• prostaglandins

- oxytocin infusion

Question 13

what are the two different management options for the 3rd stage of labour?

Answer 13

Active management

1. uterotonic drugs (oxytocin)
2. defer clamping and cutting cord
3. controlled cord traction post signs of placental separation

physiological

1. no drugs
2. no clamping until pulsation has stopped
3. delivery of placenta by maternal effort

active management: decreases risk of PPH

Question 14

What score is used for assessment of fetal neonatal wellbeing ?

Answer 14

APGAR

A-appearance
P-pulse
G-grimace
A-activity
R-respiration

Question 15

complications of unrecognised slow progress in labour could be?

Answer 15

• fetal acidaemia
• PH
• uterine rupture

Question 16

5 complications of c-section?

Answer 16

1. Intrapartum/ postpartum haemorrhage
2. bladder injury - rare
3. DVT
4. pain and reduced mobility
5. infection (wound or endometriosis) common

Question 17

what are tocolytic drugs?

Answer 17

• medications to suppress labour

Question 18

what might be given to a mother having premature birth?

Answer 18

dexamethasone
- steroid injections to accelerate fetal lung maturity

magnesium sulphate

• fetal neuroprotection
• shown to reduce risk of cerebral palsy