L/D Flashcards
What is labour?
The point where contractions become regular and cervical effacement and dilation becomes progressive.
What are causes of poor progress in the 1st stage?
*Inefficient uterine activity (power—commonest cause).
*Malpositions, malpresentation, or large baby (passenger).
*Inadequate pelvis (passage).
How would you review a poorly progressive 1st stage labour? How would you managed this?
The partograph is a printed graph representing the stages of labor. Once a woman is in active labor, the skilled provider regularly plots the descent of the baby as well as the dilation of the woman’s cervix to help keep track ofwhether the woman’s labor is progressing normally and identify when intervention may be needed. In addition, the provider records details about the condition of both mother and fetus, including the fetal heart rate, the color of the amniotic fluid, the presence of molding, the contraction pattern, and the medications that have been given to the woman.
Amniotomy (artifical rupture of membranes (ARM)) and reassess in 2h.
- Amniotomy + oxytocin infusion and reassess in 2h: this should always be considered in nulliparous women.
- Lower segment CS (if there is fetal distress).
What happens during the 2nd stage of labour?
How is the 3rd stage managed?
Active management
Injection of a drug called oxytocin into your thigh, usually as you give birth
The cord is clamped and cut between 1 and 5 minutes after the birth
The placenta is pulled out by the midwife once it has separated from the wall of the uterus (womb)
Physiological management
No injection is given
The cord is clamped and cut once it has stopped pulsing
You push the placenta out with contractions, which can take up to 1 hour
Why is cord clamping delayed for a minute?
Allows extra blood to be transferred from the placenta, increasing the amount of iron transferred to your baby. Iron is essential for brain development and infants with better iron levels seem to do better on tests of neurodevelopment later in childhood.
Do not delay if FHR <60bpm
What are the benefits of active 3rd stage labour?
reduced PPH/maternal anaemia/length of 3rd stage/need for blood transfusion
What are the causes of PPH?
Tone – uterine atony
Trauma – e.g. vaginal tear
Tissue – e.g. retained placenta
Thrombin – e.g. coagulopathy in pre-eclampsia
How can breastfeeding help reduce bleeding?
The suckling action during breast feeding leads to the secretion of oxytocin from the posterior pituitary. Oxytocin causes uterine contraction so should reduce vaginal bleeding.
How is PPROM managed?
Speculum examination to assess for pooling of amniotic fluid in the posterior vaginal vault but digital examination should be avoided due to the risk of infection
regular observations to ensure chorioamnionitis is not developing
oral erythromycin should be given for 10 days
antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
consider delivery at 34 weeks
When is a c-section indicated?
IUGR
Failure to progress during labour
fetal distress
malpresentation: brow
HIV viral load >50 copies at 36 weeks
active herpes
placental praevia/abruption
PET
How do you induce labour?
Membrane sweep
PGE2 vaginal gel
IV oxy
amniotomy (break waters)
What is Transient tachypnoea of the newborn?
commonest cause of respiratory distress in the newborn period. It is caused by delayed resorption of fluid in the lungs
It is more common following caesarean sections, possibly due to the lung fluid not being ‘squeezed out’ during the passage through the birth canal
Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure.
Management
observation, supportive care
supplementary oxygen may be required to maintain oxygen saturations
