Normal Labour and Delivery

Question 1

What is labour?

Answer 1

The onset of regular, painful uterine contraction with cervical effacement and dilation

Question 2

What is cervical effacement and dilation?

Answer 2

Tubal cervix is progressively shortened prior to dilation

Question 3

When does labour end?

Answer 3

Full cervical dilation at 10cm

Question 4

What are the stages of labour?

Answer 4

Latent
Active
Delivery

Question 5

What is the latent phase?

Answer 5

Slow progress to full cervical effacement and 3cm dilation, variable duration

Question 6

What is spurious labour?

Answer 6

Painful regular contraction not associated with cervical change

Question 7

What is rupture of membrane?

Answer 7

Fused chorion and amnion constitute “the membrane”

- rupture can occur spontaneously or artificially

Question 8

Why artificially rupture membrane?

Answer 8

Induce production of hormones to induce/augment the progress of labour

Question 9

What does low amnionic fluid indicate?

Answer 9

Chronic placenta insufficiency?

Question 10

What can you tell from the appearance of AF?

Answer 10

Passage of meconium

Question 11

What are the pattern of contractions?

Answer 11

Shortening interval

Lengthening of contraction

Question 12

What foetal factors do you consider?

Answer 12

Size

Lie and presentation

Question 13

What are the presentations?

Answer 13

Cephalic (head first)
Breach (bottom first)
Cord first

Question 14

What is the lies?

Answer 14

Transverse, oblique, longitudinal

Question 15

What is the attitude?

Answer 15

Position of the head, flexion vs extension

Question 16

What is the passage?

Answer 16

Bony and soft tissue of birth canal

Question 17

What is chorioamnionitis?

Answer 17

Infections of placental membrane and placenta

Question 18

What do you observe in the mother during delivery?

Answer 18

Temp
BP, pulse
Pain and emotional control

Question 19

What are the pain relief options?

Answer 19

Non pharmacological
- Massage, relaxation/breathing techniques, position change

Pharmacological

• Inhalational agents - NO
• Systemic analgesics - Opioids
• Neuraxial analgesia - epidural, spinal/CSE
• Local - pudendal nerve block, perineal infiltration

Question 20

Why do a combined spinal/epidural?

Answer 20

Strong start off with the spinal

Then leave the catheter in for the epidural and prolonged relief

Question 21

What happens to foetal blood flow during contractions?

Answer 21

Reduces by 40% during contractions

Question 22

How do you monitor the foetus during labour?

Answer 22

Auscultation

Amount and colour of amniotic fluid

Question 23

What determines the length of first stage of labour?

Answer 23

Parity

Duration of latent phase

Question 24

How do you assess maternal well being?

Answer 24

Review history
- medical history/medications
- past OH
- Complications during preg
- GBS status, double check hep C, HIV
- Blood group
Labour history
Examination

Question 25

How do you assess foetal well being?

Answer 25

Colour and volume of amniotic fluid auscultation of fetal heart beat or admission CTG assess ? indication for continuous electronic fetal monitoring

Question 26

How do you assess progress of labour?

Answer 26

Progress of contractions Vaginal exam - every 4 hours Documented on partogram

Question 27

Routine care in normal labour consistents of what?

Answer 27

``` Observations Activity - ambulate as desired Fluids and diet IV access not routine Abx prophylaxis - if positive swab ```

Question 28

How long does the second stage of labour last?

Answer 28

1-2 with no epi | 2-3 with epi

Question 29

What is caput?

Answer 29

Two plates of bone coming into contact with each other

Question 30

What is moulding?

Answer 30

Two plates of bone overlapping

Question 31

What are the diameters depending on attitude?

Answer 31

Suboccipitobregmatic diameter - 9.5 Occipitofrontal - 11cm Supraoccipitomental (Brow) - 13.5cm Face presentation - 9.5cm

Question 32

What are the narrowest diameter?

Answer 32

Ischial spines

Question 33

Why does the baby turn?

Answer 33

Because the ischial spine in the midpelvis is narrower than the AP diameter at that point

Question 34

In what order does the body come out?

Answer 34

Head Anterior shoulder Posterior shoulder

Question 35

What is the third stage of labour?

Answer 35

Separation and expulsion of the placenta

Question 36

How do you help expulsion of placenta?

Answer 36

Controlled cord traction

Question 37

What is a first degree tear?

Answer 37

Laceration involving perineal skin or vaginal mucosa only

Question 38

What is a secondary degree tear?

Answer 38

Extending into the submucosal tissues of the vagina or perineal muscles

Question 39

What is a third degree tear?

Answer 39

Extending to involve anal sphincter

Question 40

What is a fourth degree tear?

Answer 40

Involvement of rectum

Question 41

What is position?

Answer 41

Location of the presenting part in relation to location in maternal pelvis