The First Stage of Labour

Question 1

what range of the weeks of gestation are classed as ‘term’:

Answer 1

37-42 weeks

Question 2

‘normal’ labour should be completed how quickly for a primiparous?

Answer 2

within 18 hours

Question 3

‘normal’ labour should be completed how quickly for a multiparous?

Answer 3

within 12 hours

Question 4

the first stage of labour is divided into…

Answer 4

the latent phase

the active phase

Question 5

the latent phase of labour is identified by two key elements:

Answer 5

irregular but not continuous painful contractions
cervical change (up to 4cm)

Question 6

the active first stage of labour can be identified by:

Answer 6

regular painful contractions

progressive cervical dilatation (from 4cm)

Question 7

liquor colour should be clear/straw-like, other colours may indicate:

Answer 7

green - meconium
red - fresh bleed, possible abruption
strong odour - possible infection

Question 8

what are sign physical symptoms women may suffer with before onset of labour?

Answer 8

backache
nausea
'nesting'
changes in bowel movement
restlessness
high anxiety

Question 9

oxytocin is released by the:

Answer 9

posterior pituitary gland

made by hypothalamus

Question 10

what inhibits oxytocin?

Answer 10

adrenaline

to avoid this, women should be kept at home at long as possible to avoid stress

Question 11

why are multiparous women likely to give birth quicker?

Answer 11

muscle memory
(doesn't apply to those who have had previous c-sections)

Question 12

what are some physiological changes that occur during the first stage of labour?

Answer 12

increased heart rate and cardiac output (extra 300-500ml of blood in circulation)

blood becomes more concentrated with red blood cells and haemoglobin (to prepare for clotting)

changed respiration rate (to prevent respiratory acidosis)

oxytocin reduces amount of urine produced (anti-duretic)

Question 13

a contraction is always strongest at which part of the uterus?

Answer 13

the fundus

FUNDAL DOMINANCE

Question 14

what is carried out to ensure fetal wellbeing in the first stage of labour?

Answer 14

abdominal palpation (including measurement - symphisis pubis to fundus)

growth chart

check position of placenta and lie of baby

auscultation of fetal heart rate

checking liquor colour

checking regularity of contractions

Question 15

during the latent phase of labour, the cervical canal shortens to what length?

Answer 15

from 3cm long to 0.5cm long

Question 16

labour appears multifactorial in origin with a combination of hormonal and mechanical factors, give an example of three:

Answer 16

maternal oestrogen levels rise, overcome inhibiting effects of progesterone

oestrogen increases number of oxytocin receptors

placenta releases prostaglandins that produce enzymes which break down collagen in the cervix, softening it

Question 17

the transitional stage of labour occurs from when the cervix is how many cms dilated?

Answer 17

8cm - fully

brief lull in intensity of contractions
many women feel the urge to push during this stage
also associated with women experiencing wide range of emotions (from inner calm to acute distress)

Question 18

myometrium:

Answer 18

middle layer of uterine wall
made of smooth muscle cells
main function is to induce uterine contractions

Question 19

what is polarity?

Answer 19

neuromuscular harmony that occurs between two poles of the uterus

during each contraction, the upper pole contracts strongly to expel the fetus while lower pole dilates to allow expulsion to take place

Question 20

good practice to not commence a partogram until…

Answer 20

active labour has begun

Question 21

the ferguson reflex:

Answer 21

example of positive feedback

pressure to the internal end of the cervix causes oxytocin to be released which stimulates uterine contractions until baby is delivered.