Labour

Question 1

What is the definition of labour?

Answer 1

Regular, painful contraction with changes of the cervix +/- show +/- ROM

Question 2

How many contractions are normal in 10 minutes? Define uterine hyperstimulation.

Answer 2

3-4 contractions/10 minutes is normal

> 5 contractions/10 minutes is defined as hyperstimulation

Question 3

What is the Bishop’s score and it’s components?

Answer 3

Scoring system that assesses the cervix and predicts likelihood of induction

4 Mother:
Dilation
Consistency
Effacement
Position

1 Baby:
Station

Question 4

What are options for analgesia in labour?

Answer 4

Paracetamol
Stemetil (prochlorperazine)
Pethidene
Gas and air
Epidural

Question 5

What are the three stages of labour?

Answer 5

First stage - onset until full dilation
Second stage - full dilation until delivery of baby
Third stage - delivery of baby until delivery of placenta and membranes

Question 6

Define latent and active phases of labour.

Answer 6

Latent - 0-4cm, contractions irregular of mild-moderate intensity
Active - 4-10cm, contractions 2-3 mins of firm intensity

Second stage - contractions 60-90sec, strong

Question 7

List the eight mechanisms of labour.

Answer 7

1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension and crowning
6. Restitution
7. External rotation
8. Delivery of shoulders

Question 8

What is dystocia?

Answer 8

Abnormal/difficult labour

Question 9

What are 5 complications of difficult labour?

Answer 9

1. Infection
2. Uterine rupture
3. Pelvic floor injury (tear)
4. Foetal distress
5. Haematomas and fractures

Question 10

What are the 4 grades of perineal tears?

Answer 10

1. Perineal skin
2. Perineal skin and muscle
3. Involvement of the EAS
4. Involvement of the EAS and IAS

Question 11

How are perineal tears managed?

Answer 11

Grade 1/2 - suturing on the ward
Grade 3/4 - repaired in theatre

Question 12

Give 3 side effects of oxytocin.

Answer 12

1. Hyperstimulation of the uterus
2. Foetal compromise
3. Placental abruption or uterine rupture

Question 13

What are the components of labour (3 P’s)?

Answer 13

Powers - contractions and pushing
Passages - pelvis (inlet and outlet)
Passenger - foetal size, presentation and position

Question 14

What can go wrong in the 3 P’s of labour?

Answer 14

Power - hyperstimulation, maternal exhaustion
Passage - inadequate pelvis
Passenger - shoulder dystocia, malpresentation, malposition

Question 15

Give three types of assisted birth.

Answer 15

1. Forceps
2. Vacuum/ventouse (Kiwi)
3. C-section

Question 16

What are indications for instrumental delivery? What are the complications?

Answer 16

1. Failure to progress
2. Foetal distress
3. Maternal medical condition where she cannot push (e.g. stroke)

Question 17

What are 5 risk factors for transverse lie?

Answer 17

1. Pre-term
2. Polyhydramnios
3. Placenta praevia (placenta blocking engagement)
4. Multiparity (uterine wall is lax)
5. Abnormal uterus

Question 18

How is transverse lie managed at term?

Answer 18

Admit and schedule for an elective C-section - evaluate position of the spine (back up or down); if down - vertical incision

Question 19

What are the 3 signs that the third stage of labour is occurring?

Answer 19

1. Gush of blood
2. Lengthening of the cord
3. Firm, globular uterus