Normal labour and its management

Question 1

Causes of maternal morbidity -

Answer 1

1. exhaustion
2. dehydration
3. electrolyte disturbance
4. demoralised
5. pain, fear

Question 2

Risks of vaginal delivery -

Answer 2

Acute and chronic trauma to pelvic structures

Question 3

Risks of c-section -

Answer 3

Trauma to abdo organs
Future labour complications
Anaesthetic complications Haemorrhage

Question 4

What causes the onset of labour?

Answer 4

Forces of release > forces of retention

Question 5

Forces of retention:

Answer 5

• Progesterone
• Adrenaline
• Cervix firm and fibrous
• Hypervolemia
• Relaxin
• CRH

Question 6

Why is hypervolemia a force of retention?

Answer 6

Inhibits release of oxytoxin and vasopressin from PP gland

Question 7

Forces of release:

Answer 7

Oestrogen
Oxytoxin
Vasopressin
Cortisol
Prostaglandins
CRH
Uterine distension

Question 8

Hormones which increase contractions:

Answer 8

Oxytocin

Vasopressin

Question 9

Oxytocin and vasopressin are released from:

Answer 9

Posterior pituitary gland

Question 10

Cortisol from the foetal adrenal gland blocks the action of:

Answer 10

Progesterone

Question 11

Function of prostaglandins:

Answer 11

Sensitise uterine muscles to oxytocin receptos

Cause cervical dilation

Question 12

Posterior border of pelvic inlet

Answer 12

Sacral promontory

Question 13

Anterior border of pelvic inlet

Answer 13

Pubic symphysis

Question 14

lateral border of pelvic inlet

Answer 14

Iliopectineal line

Question 15

Lateral border of pelvic outlet:

Answer 15

Ischial tuberosity and sacrotuberous ligament

Question 16

Posterior border of pelvic outlet:

Answer 16

Tip of coccyx

Question 17

Anterior border of pelvic outlet:

Answer 17

Pubic arch

Question 18

Transverse diameter is greater where

Answer 18

Inlet

Question 19

AP diameter is greater where

Answer 19

Outlet

Question 20

Most common female pelvis shape =

Answer 20

Gynecoid

Question 21

Most common male pelvis shape =

Answer 21

Android

Question 22

Gynecoid pelvis =

Answer 22

Wider and broader outlet
Oval-shaped inlet
Less prominent ischial spines
Greater angles sub-pubic arch
Shorter sacrum

Question 23

Android pelvis =

Answer 23

More triangular

narrow pubic arch

Question 24

Anthropoid pelvis has a wide =

Answer 24

AP diameter

Question 25

Platypelloid pelvis has a wider =

Answer 25

Transverse diameter

Question 26

Pelvic floor is innervated by =

Answer 26

Pudendal nerve

Question 27

What can be used to make contractions more coordinated and efficient?

Answer 27

Oxytocinon drip

Question 28

Most favourable diameter of baby's head =

Answer 28

Suboccipito-bregmatic

Question 29

Suboccipital bregmatic diameter =

Answer 29

Babies head flexed

Question 30

Type of presentation that required C-section as diameter is too large to fit through pelvis =

Answer 30

Brow-presentation

Question 31

Best diameter to present of hear (number)

Answer 31

9.5 cm - fully flexed or fully extended

Question 32

How to feel for babies position:

Answer 32

Feel sagital sututre and fontanelles

Question 33

Shape of anterior fontanelle -

Answer 33

Diamond

Question 34

Shape of posterior fontanelle

Answer 34

Triangle

Question 35

Positions of head:

Answer 35

- OA (LOA, ROA) - OP (LOP, ROP) - OT (LOT, ROT)

Question 36

'Cardinal movements of labour'

Answer 36

- Engagement - Flexion - Internal rotation - Extension - External rotation - Expulsion

Question 37

Internal rotation =

Answer 37

Transverse to OA

Question 38

What position is head when babies head is visible?

Answer 38

OA

Question 39

External rotation =

Answer 39

OA to transverse

Question 40

Presentations:

Answer 40

Chephalic Shoulder Breach

Question 41

Effacement =

Answer 41

Cervix soften, become thinner

Question 42

Stages of labour (1)

Answer 42

Onset of contractions, first irregular and then more regular. 0-4 cm then 4-10 cm Cervix become effaced

Question 43

How long does 1st stage last?

Answer 43

``` NP = 9 hrs P = 6 hrs ```

Question 44

2nd stage of labour:

Answer 44

From full dilation to delivery

Question 45

How long does 2nd stage last?

Answer 45

``` NP = 1 hr P = 15 mins ```

Question 46

3rd stage of labour:

Answer 46

From delivery of baby to delivery of placenta

Question 47

Why is active management of stage 3 important?

Answer 47

Post-partum heamorrhage

Question 48

How to reduce blood loss:

Answer 48

Syntocininon, Syntometrine (oxytocin, syntocinon/gametrin) --> contraction of uterus

Question 49

How is labour managed?

Answer 49

- Birth plan - Partogram - Regular bladder emptying - Analgesia - Vaginal exam - Monitor mother and foetus - Episiotomy - Active management of 3rd stage

Question 50

Why is regular bladder emptying important?

Answer 50

May effect descent of head into pelvis

Question 51

Vaginal exams are performed every

Answer 51

4 hours

Question 52

Ex of something to observe for

Answer 52

Sepsis

Question 53

When is an episiotomy indicated?

Answer 53

Sign of perineum becoming over distended

Question 54

Analgesia used in labour:

Answer 54

- TENS - Entrenox - Systemic opiates - pethidine, morphine - Epidural

Question 55

Ways to monitor fetal well being

Answer 55

Intermittent auscultation | Continuous monitoring

Question 56

Why does a babies ECG look wiggly?

Answer 56

Receptors in fetal heart are more sensitive. Constantly change is response to minor changes. If baby becomes distressed, will lose ability to make microadaptations and line will flatten