MBBS FINAL YEAR OBG Q AND A

Description

Q 1) MECHANISM OF NORMAL LABOUR, STAGES OF LABOUR, MANAGEMENT OF EACH STAGE OF LABOUR

Ans) spontaneous onset, regular, coordinated uterine contractions that result in the delivery of the foetus, placenta, and membranes.

Stages of Normal Labor

Normal labour is divided into three main stages:

1. First Stage of Labor (Cervical Dilatation and Effacement)

The first stage begins with the onset of true labour contractions and ends with full cervical dilatation (10 cm). This stage is further divided into two phases:

Latent Phase: Characterized by slow cervical dilation, progressing from 0 to 3-4 cm.

• Contractions are mild and irregular, often lasting 8-12 hours for nulliparous women and 6-8 hours for multiparous women.
• Cervical softening and effacement occur.

Active Phase: accelerated cervical dilation, typically progressing from 4 to 10 cm.

• Contractions are longer-averaging around 3-4 contractions every 10 minutes.
• The average rate of cervical dilation in the active phase is 1.2 cm per hour in nulliparas and 1.5 cm per hour in multiparas.
• Regular monitoring of maternal and fetal vitals, hydration, and pain management as needed.

2. Second Stage of Labor (Fetal Expulsion)

The second stage begins when the cervix is fully dilated and ends with the delivery of the fetus. This stage is divided into:

• Passive Phase: Characterized by descent of the fetal head, without active maternal pushing, facilitated by uterine contractions.
• Active Phase: Contractions are intense, occurring every 2-3 minutes, and the fetal head gradually advances through the birth canal.

The average duration is approximately 20-50 minutes for multiparas and up to 2 hours for nulliparas.

the cardinal movements of labour: engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion, enable the fetus to navigate through the maternal pelvis.

 

 

3. Third Stage of Labor (Placental Delivery)

begins after the birth of the baby and ends with the delivery of the placenta and membranes.

Normally, the placenta separates within a few minutes, and signs of placental separation include a gush of blood, lengthening of the umbilical cord, and elevation of the uterine fundus.

The third stage generally lasts 5-30 minutes.

Active management of this stage includes:

administering uterotonic agents (e.g., oxytocin) immediately after delivery to enhance uterine contractions and prevent postpartum haemorrhage (PPH).

Gentle traction on the cord, combined with controlled cord traction assists in placental expulsion without risking uterine inversion.