Normal Labour

Question 1

what is labour

Answer 1

physiological process during which the fetus membranes, umbilical cord and placenta are expelled from the uterus

Question 2

when do you have women going through the consultant led unit for labour

Answer 2

abnormal growth
complications
most women

Question 3

when do you go through the midwife led unit for labour

Answer 3

more homely
no complications
simple birth

Question 4

what is a birth plan

Answer 4

record of what women would like to happen during labour and after the birth

Question 5

what induced labour

Answer 5

change in oestrogen/progesterone ratio

fetal adrenals and pituitary hormones

mechanical stretch of cervix - positive feedback on oxytocin

Ferguson reflex

Question 6

what does progesterone do in labour

Answer 6

keeps uterus settled

hinders contractibility of myocytes

Question 7

what does oestrogen do in labour

Answer 7

makes uterus contract

promotes prostaglandin production

Question 8

what does oxytocin do in labour

Answer 8

oxytocin initiates and sustains contractions

acts of decimal tissue to promote prostaglandin release

number of oxytocin receptors increases in myometrial and decidual tissues near the end of pregnancy

Question 9

what happens after rupture of membranes

Answer 9

baby moves down and presses on the cervix

Question 10

what happens to the cervix in labour

Answer 10

softens (decrease in collagen fibre alignment and strength, decrease in tensile strength of the cervical matrix, increase in cervical decorin)

dilates - about 10cm

Question 11

what is bishops score

Answer 11

determines if it is safe to induce labour

Question 12

what are the 5 elements of the bishops score

Answer 12

Position 
Consistency 
Effacement 
Dilation 
Station in pelvis

Question 13

what are the stages of labour

Answer 13

First stage:
latent phase - up to 3-4cms
active stage - 4-10cms

Second stage:
Full dilatation - deliver of the baby

Third stage
Delivery of baby - expulsion of placenta and membranes

Question 14

what is the second stage of labour

Answer 14

from complete dilatation of the cervix (10cm) to delivery of the baby

if 1st baby -considered prolonged if it exceeds 3 hours with regional analgesia or 2 hours without

if 2nd baby - considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without

Question 15

what is the third stage of labour

Answer 15

delivery of the baby to expulsion of the placenta and fetal membranes

average duration 10 minutes but can be 3 minutes or longer

after 1 hours preparation made for removal under general anaesthetic

expectant management - spontaneous delivery of placenta

active management - oxytocin drugs and controlled cord traction is preferred for lowering risk of post partum haemorrhage

Question 16

what are Braxton Hicks Contractions

Answer 16

tightening of the uterine muscles, though to aid the body prepare for brith

can start 6 weeks into pregnancy - more often felt in the third trimester

irregular, do not increase in frequency or intensity

resolve with ambulation or change in activity

relatively painless

Question 17

what are true labour contractions

Answer 17

timing of contractions become evenly spaced and the time between gets shorter and shorter

length of time the contraction lasts will also increase

real contractions will also get more intense and painful over time

tighten the top part of your uterus pushing the baby downward into the birth canal in preparation for delivery

also promotes thinning of cervix

very painful!!

Question 18

what are the analgesia options for birth

Answer 18

Paracetamol/co-codamol 
TENS 
Entonox 
Diamorphine 
Epidural 
Remifentanyl 
Combined spinal/epidural

Question 19

what is a partogram

Answer 19

a graphic record of key data (both maternal and fetal) contained on one sheet used to asses the progress of labour

Question 20

what are the 3 key factors at play in labour

Answer 20

Power - uterine contractions
Passage - maternal pelvis
Passenger - fetus

Question 21

what happens to the uterus in contractions

Answer 21

Uterine muscle (smooth muscle in connective tissue) - density is highest at the fungus

Pacemaker - region of tubal Ostia - wave spreads in downward direction

synchronisation of contractions waves from both Ostia

upper segment contracts and retracts, lower segment and cervix are stretched - dilate and relax

Question 22

what is the normal rate of contractions before birth

Answer 22

3-4 in 10 mins

duration 10-15 seconds - max 45 seconds

Question 23

what is the normal fetal position

Answer 23

longitudinal lie
cephalic presentation

presenting part: vertex

position: occipito-anterior, head engages occipito-transverse
flexed head

Question 24

what is abnormal fetal position

Answer 24

breech
oblique
transverse lie

position: occipto-posterior

Question 25

how do you describe the position of the fetus

Answer 25

left or right where the occipital is joining

Question 26

1st cardinal movement of labour

Answer 26

Engagement passage of widest diameter of the presenting part to a level below the plane of the pelvic inlet 3/5ths of the fetal head have entered the pelvis 2/5ths still felt abdominally

Question 27

2nd movement of labour

Answer 27

Descent - downward passage of presenting part through the pelvis maternal discomfort, feeling of pressure vaginal examination should be carried out approximately 4 hourly in normal labour - see how dilated/how dar down the baby's head is

Question 28

3rd movement of labour

Answer 28

flexion: fetal head flexes as it descends due to the shape of the bony pelvis

Question 29

4th movement of labour

Answer 29

Internal rotation rotation of presenting part from its original position to the anterior position as it passes through the pelvis

Question 30

5th movement of labour

Answer 30

extension occurs once the fetus has reached the level of the interotius bringing the base of the occiput in contact to the inferior margin at the symphysis pubis

Question 31

6th movement of labour

Answer 31

external rotation is return of the fetal head to the correct anatomic position in relation to the fetal torso

Question 32

7th movement of labour

Answer 32

Expulsion delivery of the rest of the fetal body

Question 33

what is crowning

Answer 33

appearance of a large segment of fetal head at the Introits labia are stretched to full capacity largest diameter of fetal head is encircled by vulval ring burning and stinging feeling for mother care of the perineum is vital to reduce trauma head delivery should be down slowly with hands guiding episiotomy may be required

Question 34

why is delayed cord clamping done

Answer 34

leaving it to pulse for up to 3 mins after expulsion allows the baby to get more blood and reduce anaemia at 2 months and increases duration of earl y breast feeding

Question 35

why is skin to skin contact needed immediately after birth

Answer 35

helps keep the baby warm and calm and considered to improve other aspects of transition to life outside the womb recommendation says uninterrupted SSC for 1 hour following birth

Question 36

what are the signs of the third stage of labour

Answer 36

uterus contracts, hardens and rises Umbilical cord lengthens permeently gush of blood in variable amount placenta and membranes appear at introitus

Question 37

what is active management of the third stage

Answer 37

prophylactic Syntometerine OR oxytoxin Cord clamping and cutting Controlled cord traction Bladder emptying

Question 38

what is the puerperium

Answer 38

period of repair and recovery return of tissues to non-pregnant state 6 weeks loch: vaginal discharge containing blood, mucus and endometrial casting