Birth Flashcards
Widest landmark of faetal head?
“the bi-parietal landmark”
“the more flexed the fetal head, the ____________”
"”the more flexed the fetal head, the smaller the diameter of the presenting part”
What are the 3 P’s for labour?
Passage: pelvis Passenger: size and position of baby Power: strength of uterine contractions
How do the waters usually break? What else can happen?
Spontaneous Rupture of Membranes (SROM) However they can break before labour commences (pre-labour Rupture of membranes) or even artificially (ARM).
Occassionally a baby is born with the membranes still intact: “encaul”
PPROM: preterm prelabour rupture of membranes***
What are the 3 phases of Stage 1 of labour?
Phase 1: Latent Phase. Cervical effacement and ~3cm dilitation. *In nulliparous women this can last 10-12 hrs*
Phase 2: Accelatory. ~1cm/hour dilitation with increased uterine contractions and the head descends.
Phase 3: Transition. onset of expulsion of the head of the baby
Describe Stage 2 of Labour
From full dilitation to the birth of the baby.
Can be latent (esp if epidural used)
Active is with mother actively pushing out
Describe Stage 3 of Labour
From birth of baby until birth of the placenta.
Uterine muscles contract to stop blood loss once the palcenta has seperated, and it is usually expelled <60 minutes.
Natural stage 3 of labour versus medically controlled?
Natural: Sometimes higher risk of blood loss
Medically controlled: With Oxytocin, clamping of the cord and using controlled cord traction Increased side effects of N+V+ HTN
the baby is said to be engaged when …..
The point of widest diameter of the presenting part (usually the head unless the baby is in breech) is past the pelvic inlet
What is IOL and how many women require it?
Induction of Labour is common and required by 15-20% of women
What scoring system is used to assess the need for IOL?
The Bishop score:
assesses the readiness/’ripeness’ of the cervix and the dose of medication required.
On the Bishop Scoring System, what does a low score vs a high score indicate for treatment?
Low Score: longer induction. Vaginal prostagladin gel or balloon catheter used.
High Score >5: Now a ARM (Artificial Rupture of Membranes) is usually done, so the IV oxytocin infusion (syntocin) can be used to start or increase contractions
ideal labour contractions shoudl be what?
Strong, lasting ~60seconds, around 3/4x per ten minutes
Reasons for poor uterine contractions
- Fatigue
- Dehydration
- exhaustion
- Pain and fear
- Idiopathic
Support for patients with poor uterine contractions
- IV fluids
- Amniotomy (ARM with Amniohook)
- Oxytocin
- Pain relief
- Support
Should Oxytocin be used to help multiparous women with utetrine contraction problems
**Caution**
unlikely to be due to inadequate uterine activity alone.
When using oxytocin ensure membranes are ruptured, give continuous monitoring and perform regular review.
What will cause accelerations on CTG
Contractions will block fetal blood flow, causing an acceleration of the heart rate.
Fetal movement can also cause accelerations.
What is the concern surrounding a decceleration on CTG?
Deceleration of the fetal HR during or after a contraction may indicate fetal stress.
A compromised fetus is more likely to get stressed and not cope, ultimately becoming acidotic and hypoxic
What are the causes of the differing types of decelerations
Early decelerations: Normal in the first stageof labour, indicatees head contractions not hypoxia.
Late Decelerations: associated with decreased uterine blood flow during contractions, can indicate fetal hypoxia
Variable Decelerations: Due to cord compression, can lead to fetal hypoxia
What are all the things we should be looking at within a CTG (anagram)
DR C BRAVADO
DR - Define Risk
C - Contractions
BR - Baseline rate
A - Accelerations
VA - VAriability
D - Decelerations
O - Overall impression
Normal HR and variability that can be seen on CTG
Baseline- 110-160 bpm
Variability- 5-25 bpm
Accelerations- rise 15bpm for 15secs
