Obs: Normal labour

Question 1

What is the first stage of labour

Answer 1

Dilation of the cervix to 10cm - normally happens slowly on its own

one to one midewife, in any setting if no RF
CTG monitoring (doesnt have to be continuous)
vaginal exam every 4h - should dilate 1cm per 2h (2 in 4h)
contraction ideally 4 in 10

can use partogram for progression

Question 2

How can you modify first stage of labour and why

Answer 2

If the mother is not dilating adequatly, or contracting, or CTG is not reassuring can augment labour with Oxytocin infusion-
increase number of contacts

Question 3

What is the normal second stage of labour

Answer 3

First sign of stage 2 is an urge to push by the mother - check dilation of cervix
discouraged from being supine
Epidural and Entenox can be used
Epidural can interfere with pushing

Can watch the head drop - and when the head doesnt recede between contaction, thats crowning - delivery is soon
After that, woman should push too hard- rapid, shallow breaths

normaly last 2-3 max

Question 4

What is prolonged stage 2 of labour

Answer 4

Nullparitous is 3h, parous is 2h

consider augmentation with oxytocin, Instrumental delivery (ventouse>forceps)
CS would be not ideal when fully dilated but can happen

Question 5

Management of 3rd stage

Answer 5

normally 5-10 mins -

active mx- recomeended in all women - give Im oxytocin and expell placenta -use controlled cord traction
if gush of blood/lengthening of cord- suspect seperation
2% failure rate
>30 mins to prolonged active 3rd stage

phsyio - wait for mother to expel
assoc with heavier bleed, can take a while
if PPH or taking >60mins- active mx required

Question 6

Immediate care of the neonate -

Answer 6

Clamp the cord not immediate
dry the baby
then APGAR at 1,5,10 mins
skin to skin contact with mother helps release oxytoxcin
VitK in delivery room
check headsize, weight, temp