ILA Flashcards
Difference between pregnancy and labour
Labour is an inflammatory condition - during labour CRP increases
After 20-23 weeks - baby positions in cephalic position
Membrane rupture
Contractions
Oxytocin - activates myometrium
Release of prostaglandins (breakdown of connective tissue within cervix, thins out cervix and starts to dilate - cervical ripening)
Main cause of preterm labour
Infection MC (any infection can trigger labour process) - can cause activation of myometrium and activate prostaglandin release
Steps of labour progression
- Head at pelvic brim in L or R occipito-transverse
- Neck flexes so presenting diameter is occipito-bregmatic (head is not engaged if you feel it in the abdomen)
- Head descends and engages
- Head reaches pelvic floor, occiput rotates to occipito-anterior
- Head delivers by extension
- Descent of shoulders in AP position
- Head restitutes
- Baby delivered
What can affect baby position during labour?
Breech positioning
Fibroids (can affect cervix dilatation) or uterine abnormalities
Macrosomia
Low-lying placenta
Pelvic abnormalities
Describe ideal contractions
4 contractions every 10 minutes, strong on palpation, resting in between, lasts around 40-50 seconds
What are the risks of too many contractions?
- Oxygen supply to the foetus decreases and the foetus responds by reducing their heart rate therefore if too many contractions happen foetal hypoxia can happen which leads to foetal distress.
- Labour progresses very quickly which increases risk of PPH.
- Increasing maternal exhaustion.
Describe first stage of labour
Onset of labour until full dilatation (active phase of labour):
- Regular uterine contractions progressively painful (ideal contraction)
- Cervix must be dilated (from 4 cm dilated)
- Rate of change from active labour to the 2nd stage is ½ cm every 1 hour (usually examine women every 4 hours and see a change of 2 cm) - can last around 12 hours.
Describe second stage of labour
Full dilatation until head delivered:
If 1st pregnancy - are given 3 hours (can take longer). If had babies before - are given 2 hours. If it doesn’t happen after 2 or 3 hours, the obstetrician gets involved.
Describe third stage of labour
From delivery of baby to delivery of placenta:
1. IM injection of oxytocin is given to women as soon as the baby is born to facilitate placenta delivery within 30 min to an hour to reduce risk of PPH by 30-40%.
2. Risks of prolonged placenta not expelling - infection
Pain relief in labour?
Entonox
Diamorphine - NSAIDS not given!!
Epidural
Slow labour complications?
Foetal distress
Intrauterine infection
Maternal anxiety, psychological distress
Loss of confidence in care
Significance of meconium liquor during labour?
Meconium-stained amniotic fluid indicates that the fetus has passed stool in utero. It can be a sign of fetal distress, particularly if it is thick or greenish in colour. Meconium aspiration syndrome can occur if the fetus inhales meconium-stained amniotic fluid, leading to respiratory complications after birth.
Most favourable position of a baby for vaginal delivery
Occipito anterior
Which breech presentation is associated with the highest risk of cord prolapse?
Footling breech presentation
Which breech presentation is the most ideal during birth?
Extended breech presentation (Frank breech)
