Stages of labour

Question 1

when does labour happen normally?

Answer 1

between 37-42 weeks gestation

Question 2

definition of labour

Answer 2

regular uterine contractions w/ progressive cervical change

Question 3

what are braxton-hicks contraction?

Answer 3

“practice contractions”

• often start in 2nd / 3rd trimester
• last a few mins then go away
• mild, cramping and irregular

Question 4

signs of labour?

Answer 4

• show
  
  • mucus plug from cervix
• rupture of membranes
• regular, painful contraction

Question 5

outline the 3 stages of labour

Answer 5

1. from closed os to full cervical dilatation (10cm)
2. from full cervical dilatation to delivery of baby
3. from delivery of baby to delivery of placenta

Question 6

describe 1st stage in detail

Answer 6

involves cervical dilatation & effacement (thinning)

3 phases:

• latent- 0.5cm x hr. Irregular contractions. 0-3cm
• active - 1cm x hr. Regular contractions. 3-7cm
• transition- 1cm x hr. Regular contractions. 7-10cm

Question 7

what does the success of 2nd stage rely on?

Answer 7

3 P’s: Powers, Passage, Passenger

• powers: strength of uterine contractions
• passage: size & shape of birth canal
• passenger
  
  • size
  • attitude- posture
  • lie- transverse/ oblique/ longitudinal
  • presentation- breech/cephalic/ shoulder

Question 8

what issue can there be with ‘powers’?

Answer 8

inadeuqate uterine contractions

Mx= IV Oxtyocin

Question 9

what issues can there be with passage & passenger?

Answer 9

• CPD
  
  • head of foetus too large for mother’s pelvis–> caput /moulding develop
• malpresentation
  
  • breech/ face/ shoulder / brow
• malposition
  
  • optimal= occipitoanterior

Question 10

Mx of malpresentation?

Answer 10

• breech
  
  • external cephalic version
  • if this fails –> C section
• ventouse contraindicated in face

Question 11

what are the Mx options for 3rd stage?

Answer 11

• physiological Mx
• Active Mx

Question 12

indications for active Mx of 3rd stage?

Answer 12

• haemorrhage
• >60 mins delay

Question 13

what does active mx of 3rd stage consist of and benefits to this

Answer 13

• IM Oxytocin (Syntocinon)
  
  • wait until 1st uterine contraction & then controlled cord traction
• reduces risk of bleeding

Question 14

potential issues w 3rd stage?

Answer 14

• retained placenta
• perineal tears
• PPH