Labour Flashcards
What is failure to progress?
Labour not developing at a satisfactory rate
Ps of progress in labour
Power: uterine contractions
Passenger: size, presentation and position of the baby
Passage: the shape and size of the pelvis and soft tissues
Psyche
Phases of first stage of labour
Latent
Active
Transitional
Latent phase
0-3cm dilation of cervix
0.5cm/hr
irregular contractions
Active phase
3-7cm dilation of cervix
1cm/hr
Regular contractions
Transitional phase
7cm-10cm dilation of cervix
1cm/hr progression
strong and regular contractions
Delay in labour:
First stage
Second stage
Third stage
1st stage:
Less than 2cm of cervical dilatation in 4 hours
Slowing of progress in a multiparous women
2nd stage:
Pushing more than 2 hours in nulliparous
Pushing more than 1 hour in multiparous
3rd stage:
>30 mins active management
> 60 mins physiological management
Passenger
Size: shoulder dystocia
Attitude: posture
Lie: position of fetus in relation to mother’s body
Presentation: part of fetus closest to cervix
Risk factors for uterine rupture in VBAC
Previous c section Previous uterine surgery Obstruction or induction of labour Multiparity Multiple pregnancies
Absolute contraindications to VBAC
Classical c section scar
Previous uterine scar
Contraindications to vaginal birth
Active management of the third stage of labour
im oxytocin
controlled cord traction
management of failure to progress
amniotomy: ARM
oxytocin infusion
instrumental delivery
c section
Relative contraindications to VBAC
Complex uterine scars
>2 prior lower segment c sections
Management of VBAC delivery
These women should deliver in a hospital setting with facilities for emergency caesarean and advanced neonatal resuscitation.
There should be continuous CTG monitoring.
Beware of additional analgesic requirements during the labour as may indicate impeding uterine rupture.
Avoid induction where possible.
If induction is required, the risk of uterine rupture is less using mechanical techniques (e.g. amniotomy) than induction with prostaglandins.
Be cautious with augmentation (increased risk of uterine scar rupture)
Any decisions about both induction and augmentation require input from a senior obstetrician.
After 39 weeks an elective repeat caesarean is recommended delivery method.
when does normal labour and delivery usually occur?
37-42weeks
definition of labour
progressive dilatation and effacement of cervix in presence of regular uterine contractions
delivery definition
expulsion of feotus and placenta
show defintiino
cervical mucus plus
gravidity
total number of pregnancuies
parity
the state of having given birth
>24 weeks
>500g