Intrapartum Care Flashcards
In relation to pregnancy, what comprises the membranes?
- Fused chorion and amnion (contains foetus, placenta and amniotic fluids
What are the major physiological changes in pregnancy?
- Cardio - increase in CO (HR and SV)
- Haem - dilutional anaemia
- GI - LOS tone decrease (reflux, aspiration risk)
What are the two phases of the first stage of labour?
- Latent (slow dilation to 3cm, variable duration)
- Active (faster dilation, begins around 2-4cm)
What is a normal time-range for S1 of labour?
- Generally 6-18 hrs for a nullipara, 2-10 for a multipara. 1cm per hour dilation
How is labour diagnosed?
- Painful uterine contractions AND
- Cervical dilation (>3cm and thinned) OR
- Ruptured membranes OR
- Show (small blood loss)
Outline management of the normal first stage of labour
- Assessment
- Complications (Hx and Ex for size/lie/presentation, admission CTG)
- Hourly PR, BP, temp, 4hrly urine dipstick
- Foetal surveillance (auscultation, or CTG if risk)
- Progress monitoring (hourly palpation for descent, vaginal exam 4hrly for dilation, descent)
- Food and fluids (NBM and IV only if risk of GA)
- Antibiotics (GBS, prolonged ROM, chorioamnionitis, endocarditis prophylaxis)
- Pain relief
When are pregnant women screened for GBS?
- 36 weeks (low vaginal and anal swab)
- IV penicillin intrapartum if positive
How often is foetal monitoring performed during labour?
- Intermittent auscultation
- S1 - 15 mintuely
- S2 - After each contraction
- Continuous CTG
- In all pregnancies with risk factors
How would you evaulate a woman presenting in S1 of labour?
- Labour history (duration, show, ROM, bleeding, foetal movement)
- PMHx (medical, obstetric, GBS/HIV/HCV, blood type)
- Birth plan and extent of antenatal education
- Examination (pre-eclampsia, infection, bleeding)
What are the risk factors indicating CTG monitoring of a foetus may be required during labour?
- Antenatal risk factors
- Diabetes, hypertension, suspected growth restriction, bleeding during pregnancy
- Intrapartum risk factors
- Meconium/ blood stained liquor, abnormal FHR on intermittent auscultation
What kind of document is used to record the progress of labour?
A partogram
Describe (generally) how a baby navigates the birth canal to be born
- Descent, flexion (occiput first), internal rotation (OA), extension (delivery of head), external rotation (presentation of shoulders)
What diameter of the foetal head is the smallest?
What is the smallest diamter of the birth canal?
- Sub-occipito-bregmatic (SO to anterior fontanelle)
- Mid-pelvic bispinous (ischial spines) diameter
What does engagement mean in relation to labour?
- When the widest diameter of the presenting part is navigating the ischial spines
During a normal vaginal birth, how is the baby delivered after the head has successfully navigated the birth canal?
- Check for cord around the neck
- Deliver anterior shoulder by downward traction
- Deliver posterior shoulder by elevating head
- Deliver the rest by gentle shoulder traction
