Labour and Birthing

Question 1

Normal Labour

Answer 1

Occurs spontaneously
37-42 weeks gestation
Singleton
Cephalic presentation
Regular contractions resulting in cervical dilation
No intervention
Can last 4-24hrs

Question 2

Second Stage

Answer 2

Full dilatation to birth of baby
Strong contractions, 2-4mins apart lasting 60-90sec
Full dilation to 10cm
Urge to push
Advancement of the presenting part to birth of the baby
1-2hrs in duration

Question 3

Third Stage

Answer 3

From birth of baby to birth of placenta
Up to 1hr physiologically
Oxytocic is given usually
Estimate blood loss

Question 4

Pre-labour Rupture of Membranes (PROM)

Answer 4

10% of pregnancies
Diagnosis difficult - history, examination and Amnisure
Check for infection
NO VE
Reasonable to induce them the next day or send home and wait up to 96hrs

Question 5

Pre-term Pre-labour Rupture of Membranes (PPROM)

Answer 5

23-36+6 weeks
RF - PHx PPROM, infection, smoking, APH, polyhydramnios, multiple pregnancy
Give antibiotics (erythromycin) and steroids
Wait to at least 34 weeks to deliver if no signs of infection

Question 6

Pre-viable PPROM

Answer 6

<24 weeks
Causes include iatrogenic (amniocentesis) and spontaneous (infection, cervical incompetence, abruption).
Fetal complications include death, severe prematurity, sepsis, pulmonary hypoplasia and skeletal deformities

Question 7

Pain relief options in labour

and their side effects

Answer 7

Non-pharmacological - hot water, massage, positioning, music, rocking, medicine ball
Nitrous oxide gas (S/E: dizziness, dry mouth, nausea)
Pethidine IM (S/E: maternal and fetal sedation, risk of sciatic nerve injury)
Epidural/spinal anaesthetic (S/E: anaesthetist, paralysis, infection, loss of motor function, IV access, catheter, maternal hypotension, increased chance of needing syntocinin)

Question 8

Indications for Induction of labour

Answer 8

Maternal health (DM, PET)
Distressed baby
>41 weeks
PROM
Prolonged first stage (cervix dilating <1cm/hr)

Question 9

Methods of inducing labour

Answer 9

Membrane sweep (can be done at 39-40 weeks)
ARM
Prostaglandins if cervix is unfavourable
Oxytocin if cervix is favourable

Question 10

Indications for instrumental delivery

Answer 10

Maternal exhaustion
Inability to push (e.g. due to epidural)
Prolonged 2nd stage
Fetal distress
Twins - for the second twin

Question 11

Forceps complications

Answer 11

Maternal - injury to vaginal wall, requires episiotomy, fecal incontinence, infection, dyspareuria
Fetal - may leave mark on the babies face however this will fade, facial nerve palsy, cephalhaematoma, subconjunctiva haemorrhage, skull fracture

Question 12

Forceps requirements

Answer 12

Confirmed ROM
Fully dilated cervix
Presenting part below the ischial spines
Adequate analgesia
Empty bladder (catheter)
Cephalic presentation
No obvious cephalic-pelvis disproportion
Position of fetus is known

Question 13

Ventouse Contraindications

Answer 13

Bleeding disorder
Predisposition to fracture (e.g. OI)
Fetal head above ischial spines
Significant prematurity (<34 weeks)
Face presentation

Question 14

Looking for fetal distress in labour

Answer 14

Liquor
Fetal heart rate
CTG
Fetal scalp blood sampling