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Reproductive Health (Y4) > 7- Normal pregnancy and labour (normal labour and delivery ) > Flashcards

7- Normal pregnancy and labour (normal labour and delivery ) Flashcards

1
Q

normal labour occurs between

A

37 and 42 weeks

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2
Q

Prostaglandins and labour

A
  • Trigger specific effects in local tissues
  • Stimulate contractions in uterine muscle
  • Role in ripening of the cervix before delivery

Prostaglandin E2 can be used to induce labour in the form of a pessary

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3
Q

define labour

A

progressive effacement and dilatation of the cervix in the presence of regular uterine contractions

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4
Q

define delivery

A

expulsion of fetus and placenta

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5
Q

define show

A

cervical mucus plug

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6
Q

define SROM

A

spontaneous rupture of membrane, can precede labour

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7
Q

define ARM

A

artificial rupture of membrane

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8
Q

define gravidity

A

total number of pregnanies including present

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9
Q

define parity

A

the state of having given birth

describes the number of births >24 weeks or >500g

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10
Q

length of labour

A
  • Nulliparous – slower
  • Multiparous – quicker
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11
Q

stages of labour

A
  1. Latent
  2. First stage
  3. Second stage
  4. Third stage
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12
Q

latent stage of labour

A
  • 0-3cm dilation of the cervix
  • Progresses at around 0.5 cm an hour
  • Irregular painful contractions
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13
Q

first stage of labour

A
  • Regular (true) contractions (3-4 times every 10 mins)
  • From 3-4 cm dilated until 10cm dilated (fully dilated)
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14
Q

Second stage

A

from 10cm dilation to when the baby is born

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15
Q

Third stage

A

from delivery of the baby until delivery of the placenta

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16
Q

Diagnosing onsent of labour

A
  • Show (mucus plug from cervix)
  • Rupture of membranes
  • Regular, painful contractions
  • Dilating cervix on examination
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17
Q

What occurs in the first stage of labour

A
  • cervical dilation (opening)
  • cervical effacement (thining)
  • the show falls out
  • three stages: latent, active and transition
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18
Q

progressive effacement and dilatation of the cervix

A

cause by prostaglandins

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19
Q

first stage- latent

A

Latent (not true first stage)
- 0-3cm dilation of the cervix
- Progresses at around 0.5 cm an hour
- Irregular painful contractions

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20
Q

first stage- active

A

Active (established first stage)
- 3-7cm dilation
- 1cm per hour
- Regular painful contractions

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21
Q

first stage- transition

A
  • 7-10cm
    -1cm per hour
  • Strong and regular contractions
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22
Q

braxton hick contractions

A
  • Occasional irregular contractions of the uterus
  • Occur during 2nd and 3rd trimester
  • Not true contractions and do not induce labour
  • Management : staying hydrate and relaxing
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23
Q

Second stage of labour: factors

A

Passage
Power
Passenger

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24
Q

power

A

strength of uterine contractions
- fundal dominance (coming from the top of the uterus)

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25
Q

passage

A

size and shape of the passageway, mainly the pelvis (can also be pelvic floor)

The pelvis: split into 3 diameters

dictates how the baby moves to fit through the holes

  • pelvic inlet
  • mid- cavity (widest)
  • pelvic outlet (narrowest)

The birth canal

  • soft tisses: lower uterine segment, cevrix, vagina, vulva, pelvic floor, perineum
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26
Q

causes of obstruction

A
  • Pelvis: macrosomnic baby or small mother
  • Brith canal: FGM and LETTZ
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27
Q

Passenger

A

The fetus
1) Size- esp head
2) Attitude- posture of the fetus
3) Lie – position of the fetus in relation to the mothers body
- Longitudinal lie- fetus is straight up and down
- Transverse lie- fetus is straight side to side
- Oblique- the fetus is at an angle
4) Presentation- the part of the fetus closest to the cervix
- Cephalic – head first
- Shoulder- shoulder first
- Breech position

28
Q

Breech positions

A
  • Complete breech (with hips and knees flex)
  • Frank breech- with hips flexed and knees extended, bottom first
  • Footling breech- with a foot hanging through the cervix
29
Q

how to determine the presentation/ position of a baby

A

do a vaginal examinationa dn look for 2 fontanellels for landmarks
o Posterior fontanelle (Occiput)- V shape
o Anterior – diamond shape

30
Q

why is the position of the head importnant

A

Degree of flexion or extension of head and positions makes a difference in the circumference of the head – smaller the easier

31
Q

How can the baby help with being delivered

A
  • Moulding of the fetal cranium
  • The more moulded the larger the circumference
32
Q

The mechanism of labour

A
  1. Engagement
  2. Flexion
  3. Descent
  4. Internal rotation
  5. Extension
  6. Restitution and External rotation
  7. Expulsion
33
Q

Engagement

A
  • Is when the baby is fixed in the pelvis
  • On abdominal exam you can only feel 2/5s of the babies head (due to being in the pelvis)
34
Q

flexion

A
  • Baby’s chin on chest
  • Ideally in transverse position
35
Q

descent

A

Baby moves further into the pelvis

Obstetricians describe the position of the baby’s head in relation to the mother’s ischial spines during the descent phase. Descent is measured in centimetres, from:
* -5: when the baby is high up at around the pelvic inlet
* 0: when the head is at the ischial spines (this is when the head is “engaged”)
* +5: when the fetal head has descended further out

36
Q

internal rotation

A
  • Anticlockwise rotation so the occiput (back of the head) is anterior
37
Q

extension

A

neck extends under the symphysis pubis

38
Q

Restitution and external

A
  • Where the shoulder align with the head
39
Q

monitoring in labour

A

x2
the mother
the baby

40
Q

maternal monitoring

A
  • Low risk- midwifery driven
  • High risk- obstetrician driven
41
Q

bladder care and

A
  • If epidural in/out catheter (or indwelling if unable to void) catheter- Full bladder may obstruct head
42
Q

maternal position in labour

A

If women lying on back the uterus will be pressing on the great vessels, reducing blood flow, which can cause maternal and therefore foetal hypotension

43
Q

perineum

A

check for trauma after delivery

44
Q

fetal monitoring

A
  • Low risk- intermittent monitoring
  • High risk- continuous monitoring (cardiotocogram CTG)
45
Q

what is monitored for fetal wellbing

A
  • fetal heart monitoring
  • colour of liquor (if meconium is brown- sign of distress)
46
Q

Partogram

A

A partogram or partograph is a composite graphical record of key data (maternal and fetal) during labour entered against time on a single sheet of paper. Relevant measurements might include statistics such as cervical dilation, fetal heart rate, duration of labour and vital signs.

47
Q

what parameters are included on partogram

A
  • Foetal heart rate
  • Dilation and descent of baby
  • Contractions
  • Drugs and IV fluids
  • Blood pressure and pulse
  • Urine
    o Protein
    o Acetone
    o Glucose
  • Temp
48
Q

normal progression of labour

A

Ideally a women would progress (cervical dilatation) 1 cm every hour
- Yellow = normal progress
- Purple = stop line (to show if a labour is progressing too slowly and an intervention needs doing)

49
Q

the thrid stage

A
  • From the completed birth of the baby to the delivery of the placenta
  • Physiological management
    or
  • Active management
50
Q

physiological management of labour

A

Placenta is delivered by maternal effort without medications or cord traction

51
Q

active management of labour

A
  • Midwife or doctor assist in delivery of the placenta
  • Oxytocin and controlled cord traction
  • Shortens and reduces risk of bleeding
  • Haemorrhage of delay of >60 mins should prompt active management
52
Q

what does active management entail

A
  • Intramuscular oxytocin -> helps uterus contract and expel placenta
  • Careful traction applied to umbilical cord to guide placenta out of uterus and vagina
53
Q

when can induction of labour be offered

A

between 41 and 42 weeks

54
Q

when may induction of labour be indicated in a women who is not overdue

A
  • Prelabour rupture of membranes
  • Fetal growth restriction
  • Pre-eclampsia
  • Obstetric cholestasis
  • Existing diabetes
  • Intrauterine fetal death
    *
55
Q

which score is used to determine whether to induce labour

A

Bishops score

Fetal station (scored 0 – 3)
Cervical position (scored 0 – 2)
Cervical dilatation (scored 0 – 3)
Cervical effacement (scored 0 – 3)
Cervical consistency (scored 0 – 2)

A score of 8 or more predicts a successful induction of labour. A score below this suggests cervical ripening may be required to prepare the cervix.

56
Q

options for induction of labour

A
  • membrane sweep
  • vaginal prostaglands
  • cervical ripening balloon
  • articfudual ruptuee of membrane with oxytocin infusion
  • oral mifepristone (anti-progesterone) plus misoprostol
57
Q

membrane sweep for IOL

A

used from 40 weeks gestation
- involves a finger into the cervix to stimulat ethe cervix and begins the prcoess of labour
- should produce onset of labour within 48 hours

58
Q

Vaginal prostaglandin E2 (dinoprostone) for IOL

A

involves inserting a gel, tablet (Prostin) or pessary (Propess) into the vagina. The pessary is similar to a tampon, and slowly releases local prostaglandins over 24 hours. This stimulates the cervix and uterus to cause the onset of labour. This is usually done in the hospital setting so that the woman can be monitored before being allowed home to await the full onset of labour.

59
Q

Cervical ripening balloon (CRB) for IOL

A

is a silicone balloon that is inserted into the cervix and gently inflated to dilate the cervix. This is used as an alternative where vaginal prostaglandins are not preferred, usually in women with a previous caesarean section, where vaginal prostaglandins have failed or multiparous women (para ≥ 3).

60
Q

Artificial rupture of membranes with an oxytocin infusion

A

can also be used to induce labour, although this would only be used where there are reasons not to use vaginal prostaglandins. It can be used to progress the induction of labour after vaginal prostaglandins have been used.

61
Q

when are oral mifepristone plus misoprostol used to induce labour

A

where intrauterine fetal death has occurred.

62
Q

monitoring induction of labour

A
63
Q

complication of induction opf labour

A

Uterine hyperstimulation

64
Q

Uterine hyperstimulation

A

where the contraction of the uterus is prolonged and frequent, causing fetal distress and compromise.

The two criteria often given are:

  • Individual uterine contractions lasting more than 2 minutes in duration
  • More than five uterine contractions every 10 minutes
65
Q

uterine hyperstimulation can lead to

A
  • Fetal compromise, with hypoxia and acidosis
  • Emergency caesarean section
  • Uterine rupture - esp if previous VBAC

Reproductive Health (Y4) (34 decks)

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