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OBS & GYNAE (Obstetrics & Gynaecology) > Intrapartum Care - Onset of Labour > Flashcards

Intrapartum Care - Onset of Labour Flashcards

1
Q

When does Labour and Delivery usually occur in Pregnancy?

A

Between Week 37 and Week 42.

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2
Q

What is Labour?

A

The onset of regular and painful contractions associated with cervical dilation and descent of the presenting part.

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3
Q

What is a Failure to Progress?

A

Labour is not developing at a satisfactory rate (more likely in nulliparous women).

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4
Q

What is Progress in Labour influenced by? (4)

A

3Ps :
1. Power (Uterine Contractions).
2. Passage (Shape and Size of Pelvis and Soft Tissues).
3. Passenger (Size, Attitude, Lie and Presentation of Baby).
4*. Psyche (Support and Antenatal Preparation).

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5
Q

What are the Stages of Labour? (3)

A
  1. First Stage.
  2. Second Stage.
  3. Third Stage.
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6
Q

What is the First Stage of Labour?

A

The period between the onset of labour (true contractions) until the cervix is fully dilated to 10cm.

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7
Q

What does the First Stage of Labour involve?

A
  1. Cervical Dilation (Opening Up).

2. Cervical Effacement (Getting Thinner).

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8
Q

What is the ‘Show’?

A

The falling out of the blood-stained mucus plug in the cervix (creating space for the baby to pass through) - it prevents bacteria from entering the uterus during pregnancy.

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9
Q

What are the signs of labour? (4)

A
  1. Show (Mucus Plug Falling Out).
  2. Rupture of Membranes (not always).
  3. Regular Painful Contractions.
  4. Dilating Cervix on Examination.
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10
Q

What are the NICE Guidelines on Intrapartum Care?

A
  1. LATENT First Stage :
    A. Painful Contractions.
    B. Changes to Cervix (e.g. Effacement and Dilation up to 4cm).
  2. ESTABLISHED First Stage :
    A. Regular Painful Contractions.
    B. Dilation of the Cervix above 4cm onwards.
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11
Q

How are women during the First Stage of Labour monitored?

A

Partogram :

  1. Cervical Dilation (4 Hourly Vaginal Examination).
  2. Descent of Foetal Head (in relation to Ischial Spines).
  3. Maternal Observations.
  4. Foetal Observations.
  5. Frequency of Contractions.
  6. Status of Membranes, Presence of Liquor, Blood, Meconium.
  7. Drugs and Fluids Administered.
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12
Q

How are Uterine Contractions measured?

A

Contractions per 10 minutes.

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13
Q

What are the 2 lines on a Partogram?

A
  1. Alert Line (right = indication for amniotomy and repeat examination in 2 hours).
  2. Action Line (right = escalation to obstetric-led care).
    A delay will cause the readings to be on the right of these lines.
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14
Q

What are the Three Phases of the First Stage of Labour?

A
  1. Latent Phase.
  2. Active Phase.
  3. Transition Phase.
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15
Q

What is the Latent Phase?

A

Between 0-3cm Dilation of the Cervix, progressing at around 0.5cm/hour with irregular contractions (usually 6 hours).

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16
Q

What is the Active Phase?

A

Between 3-7cm Dilation of the Cervix, progressing at around 1cm/hour with regular contractions.

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17
Q

What is the Transition Phase?

A

Between 7-10cm Dilation of the Cervix, progressing at around 1cm/hour with strong and regular contractions.

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18
Q

What is a Delay in the First Stage of Labour? (2)

A

Either :

  1. Less than 2cm Cervical Dilation in 4 Hours.
  2. Slowing of Progress in Multiparous Women.
19
Q

What is the Second Stage of Labour?

A

The period between 10cm (full) cervical dilation up to delivery of the baby (lasting approximately 1 hour and less painful since pushing masks the pain).

20
Q

How do babies present?

A

90% are Vertex (head-down) i.e. occipito-lateral position to deliver in an occipital-anterior position.

21
Q

What are the 2 types of the Second Stage of Labour?

A
  1. Passive Second Stage : Absence of Pushing (Normal).

2. Active Second Stage : Active Maternal Pushing.

22
Q

When are interventions required in the Second Stage of Labour?

A
  1. If longer than 1 hour (consider Ventouse Extraction, Forceps Delivery, Caesarean section).
  2. Episiotomy (following Crowning).
23
Q

What effects does the Second Stage of Labour have on the foetus?

A

Can Cause Transient Foetal Bradycardia.

24
Q

What are the steps of Second Stage of Labour? (5)

A
  1. Foetus Head is Flexed, Descends and Engages into Pelvis.
  2. Foetus Internally Rotates to Face Maternal Back.
  3. Foetus Head Extends to Deliver Head.
  4. Foetus Restitution (External Rotation) so Shoulders are now AP.
  5. Anterior Shoulder Delivered First and Expulsion of Rest of Foetus.
25
Q

What is a common sign of the Second Stage of Labour?

A

Maternal desire to push.

26
Q

How long does the Second Stage of Labour take? (3)

A
  1. 20 minutes - 2 hours.
    PROLONGED :
  2. Nulliparous > 3 hours with epidural and > 2 hours without epidural.
  3. Multiparous > 2 hours with epidural and > 1 hour without epidural.
27
Q

Management of Prolonged Second Stage.

A

Instrumental Delivery (C-Sections are associated with increased maternal morbidity).

28
Q

What are the 4 Aspects of Passenger?

A

SLAP :

  1. Size e.g. Macrosomia - Shoulder Dystocia.
  2. Lie.
  3. Attitude (posture, rounding of back and flexing of limbs/head).
  4. Presentation.
29
Q

What is Lie? (3)

A

Position of foetus in relation to mother’s body :

  1. Longitudinal : Vertical.
  2. Transverse : Horizontal.
  3. Oblique : Diagonal.
30
Q

What is Presentation? (3C)

A

Which part of the foetus is closest to the cervix :
1. Cephalic (Head First).
2. Shoulder (Arm/Shoulder/Trunk?)
3. Breech (Legs First).
3A. Complete Breech - Hips and Knees are Flexed (Bottom First).
3B. Frank Breech - Hips Flexed but Knees Extended To Head (Bottom First).
3C. Footling Breech - Foot Hanging Through Cervix.

31
Q

Interventions in Second Stage of Labour (Failure to Progress) (7).

A
  1. Changing Positions.
  2. Encouragement.
  3. Analgesia.
  4. Oxytocin (Weak Uterine Contractions).
  5. Episiotomy.
  6. Instrumental Delivery.
  7. Caesarean Section.
32
Q

What is the Third Stage of Labour?

A

The period between the delivery of the baby until the delivery of the placenta and membranes.

33
Q

What are the 2 Management Options for the Third Stage of Labour?

A
  1. Physiological Management (1/2 - 1 Hour).

2. Active Management (5-10 minutes).

34
Q

What is Physiological Management of the Third Stage of Labour?

A

Placenta is delivered by maternal effort without medications or cord traction.

35
Q

What are the signs of Placental Separation and Imminent Placental Delivery? (3)

A
  1. Gush of blood.
  2. Lengthening of Umbilical Cord.
  3. Ascension of Uterus in Abdomen.
36
Q

What is Active Management of he Third Stage of Labour?

A

Midwife/Doctor Assistance in delivering the placenta - shortens the third stage and reduces risk of bleeding (but associated with of N&V).

37
Q

What does Active Management involve? (4)

A
  1. Dose of IM 10 IU Oxytocin (help uterus contract) after delivery of baby.
  2. Clamp Cord and Cut within 5 Minutes of Birth.
  3. Palpate Abdomen for Uterine Contraction.
  4. Careful Controlled Cord Traction to Umbilical Cord (Guide Placenta out of Uterus and Vagina).
38
Q

Who is Active Management offered to? (3)

A
  1. All women to reduce risk of PPH.
  2. If there is haemorrhage.
  3. If there is more than a 60 minute delay in delivery of the placenta (prolonged third stage).
39
Q

Why should there be a delay between delivery of the baby and clamping of the cord?

A

Delay of 1-3 minutes between - to allow blood to flow to the baby (unless requiring resuscitation).

40
Q

What is Controlled Cord Traction?

A

Help deliver the placenta in 1 piece (stop if resistance) and use other hand to press uterus upwards to prevent uterine prolapse.

41
Q

What should be done after Active Management? (2)

A
  1. Massage uterus until contracted and firm.

2. Examine placenta to ensure it is complete and no tissue remains in the uterus.

42
Q

Risks of Controlled Cord Traction (3).

A
  1. Reduced Risk of PPH and Anaemia.
  2. Nausea and Vomiting.
  3. Not Gentle : Uterine Inversion, Prolapse and Postpartum Haemorrhage.
43
Q

What is a Failure to Progress in the Third Stage of Labour ? (2)

A
  1. More than 30 Minutes in Active Management.

2. More than 60 Minutes in Physiological Management.

44
Q

How is Labour Monitored? (6)

A
  1. FHR every 15 minutes or continuously via CTG.
  2. Contractions every 30 minutes.
  3. Maternal Pulse Rate every 60 minutes.
  4. Maternal BP and Temperature every 4 Hours.
  5. VE offered every 4 hours to check progression of labour.
  6. Maternal Urine (Ketones + Protein) every 4 hours.

OBS & GYNAE (Obstetrics & Gynaecology) (73 decks)

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