Labour

Question 1

What are the 3 major diagnostic features of labour?

Answer 1

• Regular contractions (at least one every 10 mins)

- Cervical changes (effacement, dilatation) ± rupture of membranes

Question 2

What is the latent phase of the first stage of labour?

Answer 2

• From onset of labour (hard to define) until cervix is 4cm dilated
• Usually takes ±8 hours, but there is no set time limit

Question 3

What is the active phase of the first stage of labour?

Answer 3

• From 4cm cervical dilatation until delivery

- Cervical dilatation should occur at minimum 1cm/hour [1,5cm in multigravidae, 1,2cm in primigravidae]

Question 4

What is the clinical importance if a patient crosses the “warning line” in the first stage of labour?

Answer 4

• Poor progress of stage 1 (i.e. dilating too slowly)
• Patient MUST be examined
• Reason for poor progress must be identified and addressed

Question 5

What is the clinical importance if a patient crosses the “action” in the first stage of labour?

Answer 5

• Patient must be delivered ASAP

- A doctor must evaluate the patient

Question 6

When to suspect cephalopelvic disproportion?

Answer 6

• Head does not descend into pelvic inlet (>2/5 of head above pelvis) AND cervix is dilating

Question 7

How to exclude cephalopelvic disproportion?

Answer 7

• 2/5 or less of head is palpable above the pubic bone

Question 8

Which bones may overlap in moulding?

Answer 8

• Occipital-parietal

- Parietal-parietal

Question 9

Grades of moulding

Answer 9

0 Bones normally separated
+ Bones touching each other
++ Bones overlapping but may be separated with fingers
+++ Bones overlapping and inseparable

Question 10

Maternal monitoring in first stage of labour

Answer 10

• 4-hourly assessment: abdominal and vaginal examinations

- 2-hourly assessment IF: >8cm; alert line crossed; evidence of maternal or fetal distress

Question 11

Fetal monitoring in first stage of labour

Answer 11

• Every hour in latent phase
• Every 30mins in active stage (level 1 patients)
• Continuous CTG in all level 2 and 3 patients, or with meconium-stained liquor

Question 12

Fetal monitoring in second stage of labour

Answer 12

• After every contraction

- Can alternatively use CTG

Question 13

Active management of third stage of labour

Answer 13

1. Ensure there isn’t an undelivered twin still inside!
2. Administer oxytocin (10 IU, given IM)
3. Clamp and cut umbilical cord
4. Controlled traction of the cord until placenta is delivered

Question 14

At what gestational age will the head engage in a primi gravida?

Answer 14

36/52

Question 15

What are the components of intrauterine resuscitation?

Answer 15

IV fluids
O2 for mother
Left lateral position
Tocolyse
Monitor fetus