Intrapartum Care & Normal Birth

Question 1

Understand the need for a team approach to managing women in labour

Answer 1

• Obstetrician
• Midwives, nurses
• Anaesthetic team
• +/- Paedeatricians

Question 2

Describe the physiology of the first, second and third stages of labour

Answer 2

FIRST stage

• cervical effacement & dilation –> until full 10cm dilation
• descent of fetal head (station)
• dilation due to stretch by fetal head + contractions, effacement due to uterine contractions
• latent phase (variable time, <3cm), active phase (rate 1cm/hr)

SECOND stage

• full dilation cervix (10cm) until delivery of baby
• moulding baby head (change size), flexion (ideal vertex position, change size), rotation (OA)

THIRD stage

• delivery of baby –> delivery of placenta
• 3 active mx: oxytocic, cord traction, clamp cord
• 3 sx separation: fresh PV blood, lengthening of cord, uterus becomes firm

Question 3

Understand the physical demands of labour on women

Answer 3

CV: increased CO, increased HR & SV

Haem: increased blood volume (phys anaemia of preg)

GIT: reduced oesophageal sphincter tone, risk aspiration pneumonia

Question 4

Recognise the potential for fetal distress in labour and understand the principles of fetal surveillance in labour

Answer 4

Causes fetal distress in labour

• Hypoxia: cord prolapse, low maternal O2 –> asphyxia
• abnormal biophysical profile, tachycardia/bradycardia, late decelerations, variable decelerations - all indicators of fetal distress (hypoxia, cord compression, anaemia)

Fetal surveillance
a) Auscultate: every 15min S1, or after every contraction S2. Cont CTG monitoring if antenatal RF’s (PE, DM, IUGR, APH) or intrapartum RF’s (mesoconium, abn fetal HR)

b) Amniotic fluid: mesoconium staining (sx fetal distress)

Question 5

Understand how to assess and document progress in labour

Answer 5

Documented on partogram

• cervical effacement & dilation
• descent of presenting part
• over time (hrs)

Question 6

Outline how you would assess & manage a normal labour

Answer 6

1. Assess mother
   
   • infection: fever, HR
   • PE: BP, urinalysis
   • intrapartum haem: PV loss, BP/pulse
   • well-being
2. Fetal surveillance
   a) Auscultate: every 15min S1, or after every contraction S2. Cont CTG monitoring if antenatal RF’s (PE, DM, IUGR, APH) or intrapartum RF’s (mesoconium, abn fetal HR)
   b) Amniotic fluid: mesoconium staining (sx fetal distress)
3. Progress:
   - hourly abdo palp (descent of presenting part)
   - 4hrly vag exam: effacement & dilation, presenting part descent relative to ischial spines
4. Fluids/food
   - IV line & nil oral is risk GA, otherwise light diet early labour, late labour only fluids
5. Abx
   - screen GBS vaginal & anal swab at 36wks
   - Prophylaxis for carriers: intrapartum Penicillin
   - also admin Abx if prolonged ROM, suspected chorio-amnionitis
6. Pain relief
   - Spinal
   - Epidural