Normal Labour & Management

Question 1

How many women died in childbirth every day in 2020?

Answer 1

800

Question 2

What is the frequency of maternal deaths globally?

Answer 2

1 every 2 minutes.

Question 3

What are the leading preventable causes of maternal death?

Answer 3

Severe bleeding, infection, pre-eclampsia.

Question 4

How many stillbirths occur annually?

Answer 4

Nearly 1.9 million.

Question 5

What percentage of stillbirths occur during labour?

Answer 5

Over 40%.

Question 6

What are key preventable causes of stillbirth during labour?

Answer 6

Inadequate fetal heart rate monitoring, poor partogram use.

Question 7

What signals the onset of labour?

Answer 7

Forces of release > forces of retention.

Question 8

Name 5 factors that promote uterine retention during pregnancy.

Answer 8

Progesterone, Cervix integrity, Adrenaline, Relaxin, CRH.

Question 9

What are the three P’s of labour?

Answer 9

Passage, Power, Passenger.

Question 10

Define ‘tone’ in the context of uterine physiology.

Answer 10

Resting tone of uterus between contractions.

Question 11

What is ‘fundal dominance’?

Answer 11

Uterine contractions stronger at the fundus.

Question 12

How frequent are contractions in labour?

Answer 12

Typically 4 in 10 minutes.

Question 13

What are Braxton Hicks contractions?

Answer 13

Irregular, non-labour uterine contractions.

Question 14

What is the smallest diameter of the fetal skull?

Answer 14

Suboccipito-bregmatic (9.5 cm).

Question 15

What is the largest diameter of the fetal skull?

Answer 15

Mento-vertical (13 cm).

Question 16

What is the purpose of fontanelles in the fetal skull?

Answer 16

Allow skull overlap during birth (moulding).

Question 17

Which is the most common fetal position at engagement?

Answer 17

Occipito-transverse (LOT or ROT).

Question 18

What are the three stages of labour?

Answer 18

• First stage – Regular contractions to full dilatation.
• Second stage – Full dilatation to baby’s delivery.
• Third stage – Delivery of placenta and membranes.

Question 19

What happens in the latent phase?

Answer 19

Irregular contractions, cervical effacement.

Question 20

What defines first stage?

Answer 20

3-4 cm to 10 cm dilation with regular contractions.

Question 21

What defines second stage?

Answer 21

Full dilation to baby delivery; includes passive and active phases.

Question 22

What defines third stage?

Answer 22

Delivery of placenta; involves contraction and haemostasis.

Question 23

What is the expected rate of cervical dilation?

Answer 23

~0.5 cm per hour.

Question 24

What are the 7 cardinal movements of labour?

Answer 24

Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion.

Question 25

What causes haemostasis in third stage?

Answer 25

Uterine muscle contraction around blood vessels.

Question 26

What drug can help deliver the placenta?

Answer 26

Synthetic oxytocin.

Question 27

What are key elements in managing normal labour?

Answer 27

Birth plan review Maternal/fetal risk assessment Observations (MEWS) IA or CTG monitoring Partogram use VE every 4 hours One-to-one support Bladder emptying Analgesia

Question 28

What are the methods of fetal monitoring?

Answer 28

Intermittent auscultation CTG (Cardiotocography)

Question 29

Name some analgesia options in labour.

Answer 29

Simple oral analgesics TENS Entonox Systemic opiates (Pethidine, Meptid, Morphine, Diamorphine) Epidural

Question 30

How can pain affect labour?

Answer 30

Pain may slow labour progress.

Question 31

When does an obstetrician need to intervene?

Answer 31

Failure to progress (1st or 2nd stage) Fetal compromise (e.g., hypoxia, sepsis) Maternal compromise (e.g., haemorrhage, sepsis) Delayed third stage

Question 32

What are the four pelvic types?

Answer 32

Gynecoid, Android, Anthropoid, Platypelloid