Labour

Question 1

what happens during the first stage of labour?

Answer 1

early latent phase and an active phase

onset of regular painful contractions and cervical changes
…until full dilation and cervix is not palpable.

Question 2

what happens in the early latent phase?

Answer 2

cervix becomes effaced, shortens in length and dilates up to 4cm

Question 3

what happens in an active phase?

Answer 3

the cervix dilates from 4cm to full dilatation

Question 4

what happens in the 2nd phase of labour?

Answer 4

full dilatation to delivery of the fetus

Question 5

what happens in the 3rd phase of labours?

Answer 5

time between delivery of the fetus and delivery of the placenta

considered normal up to 30mins

Question 6

what are the signs to indicate the separation of the placenta and membranes?

Answer 6

uterus contracts, hardens and rises

umbilical cord lengthens permanently

gush of blood variable in amount

placenta and membranes appears at introitus

Question 7

when do you move from physiological management to active management for placental expulsion?

Answer 7

if there is excessive bleeding
failure to deliver the placenta within one hour
patient’s desire to shorten 3rd stage

Question 8

when is delay in the 3rd stage diagnoses?

Answer 8

60 minutes of physiological management

30 minutes of active management

Question 9

how much is the cervix expected to dilate in 4 hours during labour?

Answer 9

more than or equal to 2cm

Question 10

what are uterotonic drugs?

Answer 10

uterine stimulants are medications given to cause a woman’s uterus to contract, or to increase the frequency and intensity of contractions

Question 11

what are some examples of uterotonic drugs?

Answer 11

oxytocin

syntometrine (ergometrine and oxytocin)

Question 12

what are Braxton Hicks contractions?

Answer 12

contractions which are believed to be the uterine muscles preparing for labour

Question 13

the initiation of labour involves what changes to progesterone, oestrogen and prostaglandin action?

Answer 13

progesterone withdrawal

increases in oestrogen and prostaglandin action

Question 14

what hormone initiates and sustains contractions?

Answer 14

oxytocin

Question 15

what are the 7 cardinal movements?

Answer 15

engagement
descent
flexion
internal rotation
extension
external rotation
expulsion

Question 16

how many women will achieve a normal delivery?

Answer 16

60% normal delivery
25% caesarean section
15% forceps

Question 17

what are situations of abnormal labour?

Answer 17

malpresentation
malposition (OP / OT)
too early (<37wks)
too late (>42wks)
too painful
too quick (<2hrs)
too long
fetal distress

Question 18

what are the 3 Ps of labour?

Answer 18

power
passages
passenger

Question 19

what problems can their be with power?

Answer 19

inadequate contractions either in the strength or frequency of contractions

Question 20

what problems can there be with passages?

Answer 20

trauma
shape
cephalopelvic disproportion

Question 21

what problems can there be with passenger?

Answer 21

big baby

malposition causing a relative cephalo-pelvis disproportion

Question 22

in labour there is a vaginal examination every 4 hours to assess what?

Answer 22

cervical dilatation
descent of presenting part
signs of obstruction

Question 23

what are some different types of forceps?

Answer 23

outlet forceps
mid-cavity/low-cavity forceps
rotational forceps

Question 24

what forceps are used for Wrigley’s forcep?

Answer 24

outlet forceps

Question 25

what forceps are used for Neville-Barnes, Andersons & simpsons?

Answer 25

Mid-cavity/low-cavity forceps

Question 26

what forceps are used for Kielland's forceps

Answer 26

rotational forceps

Question 27

what are the requirements for forceps delivery?

Answer 27

``` FORCEPS Fully dilated cervix Occipitoanterior position Ruptured membranes Cephalic presentation Engaged presenting part Pain relief Sphincter empty ```

Question 28

what are the indications for operative vaginal delivery?

Answer 28

failure to progress to 2nd stage of labour fetal distress maternal exhaustion

Question 29

what are the advantages of caesarean section?

Answer 29

avoid tears and so long-term urinary/faecal incontinence no injury to cervix/high vaginal areas less chance of neonatal trauma

Question 30

disadvantages of caesarean section?

Answer 30

major surgery so risk of haemorrhage, infection, visceral injury, venous thromboembolism longer hospital stay & recovery

Question 31

what are the three potential injuries with ventouse delivery?

Answer 31

caput succedaneum cephalohaematoma subgaleal haemorrhage

Question 32

when does induction of labour occur?

Answer 32

when the risk to mother or baby of continuing pregnancy exceeds the risks of inducing labour

Question 33

what are indications for induction?

Answer 33

``` prolonged pregnancy (>42wks) pre-eclampsia placental insufficiency & IUGR antepartum haemorrhage rhesus diabetes mellitus chronic renal disease ```

Question 34

what does the Bishop score look at?

Answer 34

``` dilatation effacement station consistency cervix position ```

Question 35

what are some methods of induction?

Answer 35

stripping of membranes / sweep | AROM

Question 36

what is a partogram?

Answer 36

graphic representation of maternal and fetal data during labour and often started as soon as woman is admitted to the delivery suite

Question 37

what is labour pain due to?

Answer 37

compression of para-cervical nerves and myometrial hypoxia during cotnractions

Question 38

what types of analgesia are available in labour?

Answer 38

``` narcotic analgesia (morphine, pethidine, remifentanil) inhalation (entonox) TENS Epidural Spinal Pudendal nerve block ```

Question 39

what is the mnemonic for looking at CTGs?

Answer 39

DR C BRAVADO

Question 40

what is DR C BRAVADO?

Answer 40

``` DR - define risk C - contractions BRA - baseline rate V - variability A - accelerations D - decelerations O - overall impression/diagnosis ```

Question 41

how many contractions do you expect in labour?

Answer 41

3-5 every 10 minutes

Question 42

how much should a fetal baseline heart rate be?

Answer 42

110 - 160 beats per minute

Question 43

where does normal fetal pH lie?

Answer 43

7.25 - 7.35

Question 44

what are the 4Hs and 4Ts of maternal collapse?

Answer 44

Hypovolaemia Hypoxia Hypo/hyperkalaemia Hypothermia Thromboembolism Toxicity Tension pneumothorax Tamponade