Normal Labour & Delivery

Question 1

What is the process of normal labour?

Answer 1

• Normal labour = process in which the fetus, placenta and membranes are expelled via the birth canal
• Normal labour is a process which occurs spontaneously at term (37-42 weeks)

Question 2

What is Stage 1 of labour?

Answer 2

Stage 1:

Latent stage - Irregular contractions resulting in cervical dilataion of around 4cm

Established stage - Regular contractions resulting in cervical > 4cm

Question 3

What is Stage 2 of labour?

Answer 3

Stage 2 = full cervical dilatation through to birth of baby

Passive 2nd stage = full dilatation of cervix bin the absence of expulsive contractions

Active 2nd stage = Presenting part is visible and expulsive contractions

Question 4

What is Stage 3 of labour?

Answer 4

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

Question 5

How is the progress of labour assessed?

Answer 5

Maternal monitoring - BP, Pulse, Temperature, Respiratory rate, O2 sats, urine output & urinalysis

Abdominal palpation - assess fetal lie, presentation, position & engagement

Vaginal examination - presentation, engagement & station, cervical dilatation, presence/absence of membranes

Monitoring Liqour - colour, smell, volume

Auscultate fetal heart - 120-160 BPM

Palpate uterine muscle contractions

Question 6

What methods of anaelgesia and anesthesia are used during labour?

Answer 6

1) Breathing, massage, paracetamol, dihydrocodeine
2) Water
3) Entonox
4) Opioids (morphine, diamorphine)
5) Remifentanil
6) Epidural

Question 7

What is thought to trigger labour?

Answer 7

• Paracrine and autocrine signals

Question 8

What physiological changes occur to allow for expulsion of the fetus?

Answer 8

1) Cervix softens
2) Myometrial tone changes to allow for coordinated contractions
3) Progesterone decreases
4) Oxytocin and prostaglandins increase

Question 9

When is stage 1 of delivery complete?

Answer 9

• Stage 1 is complete when the cervix has dilated by 10cm

Question 10

How long should stage 1 for a primagravida and multigravida mother take?

Answer 10

• Primagravida = 8 hours
• Multigravida = 5 hours

Question 11

How much should the cervic dilate per hour?

Answer 11

0.5-1cm/hour

Question 12

How long after active 2nd stage starts should it take baby to be delivered in a primagravida and multigravida mother?

Answer 12

Primagravida = within 2 hours

Multigravida = within 1 hour

Question 13

What machine is used to monitor the fetal heart rate?

Answer 13

Cardiotocogram

Question 14

What are the possible fetal lie positions?

Answer 14

Longitudinal

Oblique

Transverse

Question 15

What is meant by fetal presentation?

Answer 15

The part of the babies body which is directly above the pelvic inlet

Question 16

What are some common fetal presentation positions?

Answer 16

Vertex

Breech

Shoulder

Question 17

What is fetal station?

Answer 17

How far down the pelvic cavity the babies head has progressed

Question 18

At what anatomical landmark is the fetal head when the fetal station is 0?

Answer 18

Ischial spines

Question 19

At what anatomical landmark is the fetal head when the fetal station is +5?

Answer 19

Ischial tuberosity

Question 20

Which part of the fetal head is used as a reference point for determining the position? I.e. OA, OP, ROA, LOA etc.

Answer 20

Occiput (posterior fontanelle)

Question 21

What is the normal/commonest lie/position/presentation of a fetus just before birth?

Answer 21

1 - Longitudinal

2 - Vertex

3 - Occiput Anterior