Normal Labour

Question 1

What occurs in labour?

Answer 1

The foetus, membranes, umbilical cord and placenta are expelled from the uterus

Question 2

What is a birth plan?

Answer 2

A record of what the woman would like to happen during labour and after birth

Question 3

Which hormones play a role in the onset of labour?

Answer 3

Oestrogen

Oxytocin

Question 4

What is the role of oestrogen in labour?

Answer 4

Causes uterus contraction through prostaglandin production

Question 5

What occurs in Ferguson’s reflex?

Answer 5

The head pushing on the cervix sends messages to the pituitary to release oxytocin causing increased contraction

Question 6

When is the rupture of membranes useful?

Answer 6

Towards term - initiates labour

Question 7

Give some cervical changes that occur during labour

Answer 7

Decrease in collagen fibre alignment/strength

Decreased firmness

Question 8

What 5 criteria are assessed in Bishop’s score?

Answer 8

Position
Consistency
Effacement
Dilatation
Station in pelvis

Question 9

What is the purpose of Bishop’s score?

Answer 9

To determine if it is safe to induce labour

Question 10

What are the two phases of the first stage of labour?

Answer 10

Latent and active

Question 11

What occurs during the latent phase?

Answer 11

Mild irregular uterine contractions with cervix shortening and softening

Question 12

What occurs in the active phase?

Answer 12

Contractions getting stronger

Slow descent of presenting part

Question 13

What indicates the start of the second stage of labour?

Answer 13

Complete dilatation of the cervix

Question 14

When is the second stage considered prolonged?

Answer 14

Nulliparous - exceeding 3 hours with regional analgesia or 2 hours without
Multiparous - exceeding 2 hours with regional analgesia or 1 hour without

Question 15

What occurs in the third stage of labour?

Answer 15

Delivery of baby to expulsion of placenta/foetal membranes

Question 16

What is the average duration for the third stage of labour?

Answer 16

10 minutes

Question 17

What are Braxton-Hicks contractions?

Answer 17

Tightening of the uterine muscles that can be confused for labour

Question 18

Which hormone controls true labour contractions?

Answer 18

Oxytocin

Question 19

In true labour contractions, the length of time between contractions increases and duration of contractions decreases. True/false?

Answer 19

False - length of time between contraction decreases and duration increases

Question 20

What are the three key factors in labour? (Three P’s)

Answer 20

Power
Passage
Passenger

Question 21

What is the normal timing for contractions?

Answer 21

Up to 3-4 in 10 mins

Question 22

What are the three main types of female pelvis?

Answer 22

Gynaecoid
Anthropoid
Android

Question 23

What is the normal foetal position during labour?

Answer 23

Longitudinal lie with cephalic presentation and occipito-anterior position

Question 24

What can be palpated to determine foetal position on vaginal examination?

Answer 24

Fontanelles

Question 25

Give some analgesia options that may be considered during labour

Answer 25

``` Paracetamol/co-codamol TENS Entonox Diamorphine Epidural Remifentanyl ```

Question 26

What are the 7 cardinal movements of labour?

Answer 26

``` Engagement Descent Flexion Internal rotation Crowning & extension Restituition & external rotation Expulsion ```

Question 27

What occurs in engagement?

Answer 27

The widest diameter of the presenting part passes below the plane of the pelvic inlet

Question 28

How can engagement be felt on palpation?

Answer 28

By palpating the foetal head in the abdomen - 3/5ths should have entered the pelvis

Question 29

How often should vaginal examinations be carried out in normal labour?

Answer 29

4 hourly

Question 30

What occurs in crowning?

Answer 30

There is appearance of a large segment of the foetal head at the introitus

Question 31

What is the purpose of delayed cord clamping?

Answer 31

To increase the red blood cells an infant receives at birth by 50%

Question 32

What is the current recommendation for skin to skin after birth?

Answer 32

Uninterrupted SSC for 1 hour after birth

Question 33

What three signs indicate completion of the third stage?

Answer 33

Uterus contraction and hardening Umbilical cord lengthens permanently Gush of blood

Question 34

What can be done to manage the third stage of labour?

Answer 34

Syntometerine (prophylaxis) | Oxytocin

Question 35

What is a normal blood loss seen in labour?

Answer 35

Less than 500ml

Question 36

How is haemostasis achieved in pregnancy?

Answer 36

Thrombosis of torn blood vessels | Contraction of uterine muscle to strangulate blood vessels

Question 37

What is puerperium and how long does it last?

Answer 37

The return of tissues to a non-pregnant state - lasts 6 weeks

Question 38

Give some uterine changes that occur in puerperium

Answer 38

Involution Fundal height falls Endometrium regenerates