Intrapartum Care Flashcards
What is the definition of labour?
the onset of painful uterine contractions accompanied by any one of:
rupture of membranes (ROM); bloody show; and
cervical dilatation and/or effacement
What is the description of first stage of labour?
Starts from the onset of true labour pains
and ends with complete dilatation of cervix
What are the characteristics of first stage of labour?
It can be divided into:
• Latent phase: Slow and gradual cervical
effacement and dilatation (up to 3 cm)
• Active phase: Active cervical dilatation
(3–10 cm) and foetal descent.
It comprises of:
– Acceleration phase
– Phase of maximum slope
– Deceleration phase
What is the definition of second stage of labour?
Stage II
Starts from full dilatation of cervix and ends
with expulsion of the foetus from birth canal
What is the definition of 3rd stage of labour?
Stage III
Begins after expulsion of the foetus and is associated with expulsion of placenta and membranes
What is the definition of fourth stage of labour?
Stage IV
Stage of observation which lasts for at least
1hour after the expulsion of afterbirths
What are the characteristics of latent phase ?
begins with onset of regular contractions, with contractions occurring after every 15–20 minutes, lasting 20–30 seconds
The cervix shortens from 3 cm in length to less than 0.5 cm
This phase ends when cervix becomes about 3–5 cm dilated
What is the duration of latent phase?
8–9 hours in the primi
less than 6 hours in multigravida.
What is prolonged latent phase?
greater than 20 hours in primigravida and greater than 14 hours in the multigravida.
What are the characteristics of active phase?
begins when the cervix is about 4 cm dilated and ends when it becomes fully dilated.
What does active phase consist of?
- Phase of acceleration:
- Phase of maximum slope: there is linear dilatation with time. According to Friedman, during this phase the minimum rate of progression is at least 1 cm/h.
- Phase of deceleration: This phase occurs at the end of active phase prior to complete dilatation.
What are the Symptoms indicating the onset of labour ?
1- Lightening
2- Bloody show
3- Increased frequency and strength of Braxton Hicks
4- Rupture of membranes
What is the definition of Foetal presentation ?
foetal body part which occupies the lower pole of the uterus and thereby first enters the pelvic passage.
What are the three types of foetal lie ?
(1) cephalic,
(2) podalic (breech),
(3) shoulder
What are the elements of Abdominal examination in labour ?
1- Uterine height
2- Foetal lie
3- Obstetric grips [Leopold’s manoeuvres ]
4- Uterine contractions
5 - Assessing the engagement of foetal presenting part
6- Auscultation of foetal heart.
What is the definition of Foetal position ?
the relationship of the denominator of the foetal presenting part with the fixed points of
maternal pelvis.
What is the denominator?
the most definable point of the foetal presenting part.
*for
vertex presentation is occiput;
*for breech presentation is sacrum;
*acromion for shoulder presentation;
*mentum
for face presentation.
What are the The fixed points of the maternal pelvis ?
symphysis pubis anteriorly and the sacrum posteriorly
What to estimate during vaginal examination in labour?
1-Cervical dilatation
2-Cervical consistency and effacement
3-Foetal presentation and position
4-Assessment of foetal membranes and amount of liquor.
5-Foetal descent [station of foetal head
6-Moulding of foetal skull
7-Pelvic assessment
How to estimate the Foetal descent ?
- must be defined vaginally only after an abdominal examination has been done.
Vaginally: the relationship to the ischial spine in centimetres above and below this landmark.
Abdominally : as the number of fifths of foetal head palpable per abdomen( important in case of moulding of foetal head)
How to determine the degree of moulding of foetal head ?
1- 0 (normal)
: Normal separation of the bones with open sutures
2- 1+ (mild moulding)
: Bones touching each other
3- 2+ (moderate moulding)
:Bones overlapping, but can be separated with gentle digital pressure
4- 3+ (severe moulding)
:Bones overlapping, but cannot be separated with gentle digital pressure
What is Caput succedaneum ?
type of foetal head swelling, is a reflection of scalp oedema.
usually indicative of prolonged labour, it may sometimes be even present in normal cases and therefore may not be useful in planning the management.
What are the investigations that should be done in labour?
1-Haematocrit + (CBC)
2-Urine for proteins (dipstick examination)
3-Blood typing (ABO and Rh)
4-Blood typing and screening (in case caesarean section is
anticipated)
5-VDRL, TORCH, HIV, (HBsAg)
(in case they have not been done in the antenatal period).
How to monitor the pregnant woman during labour?
*BP and pulse :should be recorded every hour during the first stage &
every 10 minutes during the second stage
*FHR should be recorded immediately after a contraction
at least every 30 minutes during the active phase of the
first stage & at least every 15 minutes during the second stage
