Labour Flashcards
Define Labour.
Painful uterine contractions leading to effacement and dilation of the cervix
What percentage of births are natural, instrumental and C-section?
- Natural = 60%
- Instrumental = 10%
- C-section = 30%
Define Braxton-Hicks contractions.
Painless contractions with no cervical change
What are the stages of labour?
- 1st stage = painful uterine contractions up to full (10cm) cervical dilatation
- Latent phase = painful, irregular contractions; dilation up to 4cm
- Established stage 1 = regular painful contractions; ≥4cm dilation
- 2nd stage = urge to push until delivery of the foetus
- In nulliparous women = 3 hours (epidural) or 2 hours (no epidural)
- In multiparous women = 2 hours (epidural) and 1 hour (no epidural)
- 3rd stage = delivery of placenta and foetal membranes
- Normally 5-10 mins but up to 30 mins
What is the widest point of the pelvic inlet and outlet?
- Pelvic inlet = Transverse
- Pelvic outlet = Anterior-posterior
What determines the progress of labour?
- 3 P’s
- Power - contractions
- Passage - dimensions of pelvis
- Passenger - diameter of foetal head
Define Restitution.
Brining head in line with the shoulders
Define Shoulder Dystocia.
When a baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body.
What are the risk factors for shoulder dystocia?
- Macrosomia
- High maternal BMI
- DM or GDM
- Prolonged labour
What are the signs and symptoms of shoulder dystocia?
- Difficult face/chin delivery
- ‘Turtling’ head (retracting)
- Failure of restitution
- Failure of shoulder descent
What is the management of shoulder dystocia?
1) Call for senior help + discourage pushing
2) McRobert’s manoeuvre (legs up to abdomen) and suprapubic pressure – 90% success
3) Evaluate for episiotomy
4) Either:
- Rubin’s manoeuvre (push anterior shoulder towards baby’s chest)
- Woods’ Screw (Rubin’s + push posterior shoulder towards baby’s back à rotation)
- Deliver posterior arm (then, rotate 180 and deliver the other arm)
5) Change position to all fours and repeat the above manoeuvres
6) Symphysiotomy, cleidotomy (divide clavicles) or Zavanelli (reversal of normal delivery movements)
* Should all take <5 minutes
What scoring system is used to assess how likely a women is to go into labour soon?
Bishop’s score
Define Effacement/Thinning.
Percentage from 0% (normal length cervix) to 100% or complete (paper thin cervix).
Define Foetal station.
Position of the baby’s head relative to the ischial spines of the maternal pelvis.
- If the head is level with the spines, the score is 0; however, above or below them can modify the score
Describe the Bishop’s score.
- <3 = IOL unlikely to be successful
- 3-5 = IOL with PV prostaglandin gel (should start labour or ripen cervix)
- 6-8 = ARM (amniotomy ± oxytocin infusion if labour does not begin)
- ≥9 = labour likely to occur spontaneously
If induction of labour doesn’t occur, what should be offered to try and induce labour?
Offer x2 PGE2 and then ARM
What is the management of the 1st stage of labour?
- One-to-one midwifery care
- Vaginal examinations performed 4-hourly or as clinically indicated
- Progress of labour is monitored using a partogram with timely intervention if abnormal
- Ensure adequate:
- Analgesia ± antacids
- Hydration and light diet to prevent ketosis (which can impair uterine contractility
What is the normal rate of progress in Latent 1st phase?
- 1 cm every hour (a well flexed head will speed this up)
What is delayed rate of progress in Latent 1st phase?
<1cm over 2 hours
Describe Latent 1st phase.
- Is generally silent as the cervix gradually effaces over a period of days/weeks
- Intervention should be avoided where possible
- Standing upright may encourage progress of labour - mobility is encouraged
- Mobilise and managed away from the labour suite