9: Labour

Question 1

How is the diagnosis of labour made?

Answer 1

• Retrospectively
• Regular, painful contractions + show or ROM with
• Progressive cervical dilatation

Question 2

What findings on abdominal and vaginal examination are assessed during labour?

Answer 2

• Abdo: lie, presentation, descent, contractions

- VE: station, position of cervix, dilation of cervix, length, consistency, colour of liquor

Question 3

How is maternal and foetal wellbeing monitored during labour?

Answer 3

Maternal: obs, urinalysis, fluid balance

Foetal: auscultation, CTG

Question 4

What is a partogram?

Answer 4

Used to track progress in labour with respect to time

Question 5

The minimum acceptable rate of cervical dilatation is ___cm per hour

Answer 5

0.5cm per hour

Question 6

What are the components of the active management of the third stage of labour?

Answer 6

1. Ecbolic after delivery of anterior shoulder
2. Cord clamping
3. Controlled cord traction
4. Inspection of the placenta

Question 7

What are the common causes of slow progress in labour?

Answer 7

Power: fatigue, dehydration, pain, low morale

Passage: small pelvis, previous fracture or injury

Passenger: big baby, malpresentation (e.g. OP in primips)

Question 8

Cx of prolonged labour (maternal and foetal)

Answer 8

Maternal: infection, low morale, fatigue, bleeding, dehydration, fever, amnionitis, operative delivery, urinary retention, birth trauma

Foetal: distress, hypoxia, meconium aspiration

Question 9

How can slow progress in labour be managed?

Answer 9

Non medical: encouragement, hydration

Medical: good pain mx, augmentation with oxytocin (primip)

Question 10

What are the components of the ‘active mx of labour’?

Answer 10

• Routine AROM
• Strict rules for slow progress
• Oxytocin for uterine contractions
• One to one care