Normal Labour

Question 1

What changes occur in the body in the lead up to labour?

Answer 1

Progesterone decreases

Extracellular calcium increases

Question 2

What happens to this increased extracellular calcium?

Answer 2

It moves intracellular under the action of oxytocin and prostaglandins to cause uterine contraction

Question 3

Initial signs of labour?

Answer 3

Drop feeling
Rupture of membranes
Cervical dilatation

Question 4

What is the initiation of stage 1?

Answer 4

Regular contractions

Question 5

What are the stages of stage 1?

Answer 5

Passive
the
Active

Question 6

Describe the passive phase?

Answer 6

Slow cervical dilation to 4cm

Takes 10-12hrs primigravida

Contractions every 3-4 mins

Question 7

Describe active phase?

Answer 7

Rapid dilatation of cervix from 4cm to 10cm

Slowly decelerates as baby descends

Question 8

What monitoring is done in stage 1?

Answer 8

Observation
Vaginal exam
CTG

Question 9

What ends stage 1?

Answer 9

Full cervical dilatation

Question 10

What initiates stage 2?

Answer 10

Full cervical dilatation

Question 11

What are the two phases of stage 2?

Answer 11

Passive

Active

Question 12

Describe the passive phase?

Answer 12

Dilated fully but not pushing

Question 13

Describe the active phase

Answer 13

Should be <1hr

Question 14

What are indications for forceps delivery?

Answer 14

Active stage 2 >2hrs

Question 15

Describe the sequence of delivery

Answer 15

Descent
Flexion of neck
Internal rotation
Extension of neck
Restitution
Delivery of anterior shoulder
Delivery of posterior shoulder

Question 16

When does stage 2 end?

Answer 16

Delivery of baby

Question 17

What is stage 3 of labour?

Answer 17

Delivery of placenta and membranes

Question 18

What happens in stage 3?

Answer 18

The placenta seperates and descends

Question 19

What are the 2 types of stage 3?

Answer 19

Active

Passive

Question 20

Describe passive management?

Answer 20

let the woman do it herself

No prostaglandins/syncontin

Question 21

What is a delayed passive stage 3?

Answer 21

> 1 hr

Question 22

What is active management of stage 3?

Answer 22

Use of uterotonic drugs

Controlled cord traction

Question 23

When should the cord be clamped in passive stage 3?

Answer 23

Once pulsation ceases

Question 24

What is a delayed active stage 3?

Answer 24

> 30 mins

Question 25

What are the 3 Ps of abnormal delivery?

Answer 25

Power
- Reduced contraction

Passenger

• Breech
• Size

Passage
- Cephalo-pelvic ratio too high

Question 26

What score is used to assess if induction will be successful?

Answer 26

Bishop score

Question 27

What are the 5 components of bishops score?

Answer 27

worth 0,1,2,3 respectfully

Cervical orientation - anterior, intermediate, posterior, -
Cervical consistency - firm, intermediate, soft, -
Cervical effacement - 0-30%, 30-60%, 60-80%, 80% +
Cervical dilatation - <1cm, 1-2cm, 2-5cm, 5+cm
Foetal station - -3 , -2 , -1 or 0. +1 or +2

Primigravida = -1
Previous vaginal birth = +1 for each

Question 28

How can bishop scores be interpreted?

Answer 28

<5 = induction likely unsuccessful
5-9 = might be successful 
>9 = very successful

Question 29

“A primigravida woman with an anterior cervix that is firm, effaced 70% and dilated 3cm needs induced. Foetal station = 0. What is her bishop score and will induction be successful?”

Answer 29

Anterior cervix = 2
Firm = 0
70% effaced = 2
3cm dilatation = 2
Foetal station = 2
Primigravida = -1

Total score = 7 - induction might be successful