Normal Labour — Viva · MBBS viva

Q1: Stages (2 min)

"Describe the four stages of labour."

1st: onset of regular contractions to full dilatation (10cm)
2nd: full dilatation to delivery of baby
3rd: delivery of baby to delivery of placenta
4th: first hour postpartum (monitor for PPH)

Q2: Cardinal movements (2 min)

"Name the cardinal movements of labour."

Engagement, descent, flexion, internal rotation, extension, restitution, external rotation, expulsion

Q3: Third stage (3 min)

"Describe active management of the third stage."

Oxytocin 10 IU IM at anterior shoulder
Controlled cord traction (wait for separation signs first)
Uterine massage
Reduces PPH by 60%
Signs of separation: cord lengthens, blood gush, uterus firm/rises
Check placenta: 2 arteries, 1 vein, all cotyledons [1]

Q4: Apgar (2 min)

"What is the Apgar score?"

Appearance, Pulse, Grimace, Activity, Respiration
Each scored 0 to 2, total 0 to 10
At 1 and 5 minutes after birth
7 to 10 = normal, 4 to 6 = moderate, 0 to 3 = severe

References

[1]Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM. The Bristol third stage trial: active versus physiological management of third stage of labour BMJ, 1988.PMID 3144366
[2]Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM. The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials Br J Obstet Gynaecol, 1988.PMID 3277663
[3]Zhang J, Landy HJ, Branch DW, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes Obstet Gynecol, 2010.PMID 21099592
[4]The development of the WHO Labour Care Guide: an international survey of maternity care providers Reprod Health, 2021.PMID 33752712
[5]McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes Cochrane Database Syst Rev, 2013.PMID 23843134
[6]Apgar V. A proposal for a new method of evaluation of the newborn infant Curr Res Anesth Analg, 1953.PMID 13083014
[7]Geimonen E, Jiang W, Chou K, et al. Activation of protein kinase C in human uterine smooth muscle induces connexin-43 gene transcription through an AP-1 site in the promoter sequence J Biol Chem, 1996.PMID 8798588
[8]Alterations in gap junction connexin43/connexin45 ratio mediate a transition from quiescence to excitation in a mathematical model of the myometrium J R Soc Interface, 2014.PMID 25401181
[9]Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. Continuous support for women during childbirth Cochrane Database Syst Rev, 2012.PMID 23076901
[10]Kinugasa M, Hashimoto K, Nakanishi H, et al. Safety and efficacy of a combination of pethidine and levallorphan for pain relief during labor: An observational study J Obstet Gynaecol Res, 2019.PMID 30362203
[11]Dohbit JS, Foumane P, Tochie JN, et al. The increasing use of the WHO Safe Childbirth Checklist: lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon BMC Pregnancy Childbirth, 2021.PMID 34238244
[12]Oladapo OT, Tunçalp Ö, Bonet M, Lawrie TA, Portela A, Downe S, Gülmezoglu AM. WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing BJOG, 2018.PMID 29637727
[13]National Institute for Health and Care Excellence. Fetal monitoring in labour: summary and update of NICE guidance BMJ, 2022.PMID 36526275

Q3: Third stage (3 min)

"Describe active management of the third stage."

Oxytocin 10 IU IM at anterior shoulder

Controlled cord traction (wait for separation signs first)

Uterine massage

Reduces PPH by 60%

Signs of separation: cord lengthens, blood gush, uterus firm/rises

Check placenta: 2 arteries, 1 vein, all cotyledons [1]

Q4: Apgar (2 min)

"What is the Apgar score?"

Appearance, Pulse, Grimace, Activity, Respiration

Each scored 0 to 2, total 0 to 10

At 1 and 5 minutes after birth

7 to 10 = normal, 4 to 6 = moderate, 0 to 3 = severe

References

[1]Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM. The Bristol third stage trial: active versus physiological management of third stage of labour BMJ, 1988.PMID 3144366
[2]Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM. The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials Br J Obstet Gynaecol, 1988.PMID 3277663
[3]Zhang J, Landy HJ, Branch DW, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes Obstet Gynecol, 2010.PMID 21099592
[4]The development of the WHO Labour Care Guide: an international survey of maternity care providers Reprod Health, 2021.PMID 33752712
[5]McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes Cochrane Database Syst Rev, 2013.PMID 23843134
[6]Apgar V. A proposal for a new method of evaluation of the newborn infant Curr Res Anesth Analg, 1953.PMID 13083014
[7]Geimonen E, Jiang W, Chou K, et al. Activation of protein kinase C in human uterine smooth muscle induces connexin-43 gene transcription through an AP-1 site in the promoter sequence J Biol Chem, 1996.PMID 8798588
[8]Alterations in gap junction connexin43/connexin45 ratio mediate a transition from quiescence to excitation in a mathematical model of the myometrium J R Soc Interface, 2014.PMID 25401181
[9]Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. Continuous support for women during childbirth Cochrane Database Syst Rev, 2012.PMID 23076901
[10]Kinugasa M, Hashimoto K, Nakanishi H, et al. Safety and efficacy of a combination of pethidine and levallorphan for pain relief during labor: An observational study J Obstet Gynaecol Res, 2019.PMID 30362203
[11]Dohbit JS, Foumane P, Tochie JN, et al. The increasing use of the WHO Safe Childbirth Checklist: lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon BMC Pregnancy Childbirth, 2021.PMID 34238244
[12]Oladapo OT, Tunçalp Ö, Bonet M, Lawrie TA, Portela A, Downe S, Gülmezoglu AM. WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing BJOG, 2018.PMID 29637727
[13]National Institute for Health and Care Excellence. Fetal monitoring in labour: summary and update of NICE guidance BMJ, 2022.PMID 36526275