Labour Flashcards
Three phases of 1st stage of labour are..
Latent phase
Active phase
Transition phase
In the latent phase of labour, there is _____ cervical dilation progressing at _____ an hour with _______ contractions
0-4cm dilation, 0.5cm an hour (nulliparous)
- Irregular contractions
In the Active phase of labour, there is _____ cervical dilation progressing at _____ an hour with _______ contractions
4-7cm dilation, 1cm per hour
- Regular, longer contractions
In the transitional phase of labour, there is _____ cervical dilation progressing at _____ an hour with _______ contractions every _____ minutes
7-10cm dilation
- Regular contractions every 2-3 mins
Delay of the first labour stage occurs when there is _______
<2cm cervical dilation in 4 hours.
First line management of crossing the ‘alert’ line in a partogram
Amniotomy, repeat assessment in 2 hours.
First line management of crossing the ‘action’ line in a partogram
Escalation to obstetric-led care
Delayed 2nd stage of labour occurs when…
Pushing lasts for >2 hours in nulliparous or 1 hour in multiparous
Causes of delayed 2nd stage of labour
3 Ps
- Power: weak uterine contractions
- Passenger: fetal complications
- Passage: shape/size of pelvis
Fetal qualities that can delay labour
Macrosomia
- shoulder dystocia can occur
Attitude
- Posture of the fetus
Lie
- Oblique and transverse
Presentation
- Breech/ shoulder
Delayed 3rd stage of labour is defined as…
> 30 mins with active management
> 60mins with physiological management
Risk factors for shoulder dystocia
Macrosomnia
Small pelvis
Interventions for shoulder dystocia
- McRoberts’s position (legs brought behind head)
- Pressure on pubic symphysis (pressure on anterior shoulder)
- Rubin’s manoevre
- Wood’s screw manoevre
Signs of shoulder dystocia
Obstruction in delivering shoulders
Failure of restitution (face remains downwards)
Turtle-neck sign (head retracting back to vagina)
Rubins manoevre
Manoevre for shoulder dystocia
Involves putting forward pressure on posterior aspect of anterior shoulder
The __________ manoeuver involves pushing the baby’s head back into the vagina during delivery for C-section
Zavanelli
Shoulder dystocia complications
Fetal hypoxia/ brain damage
Brachial plexus injury (i.e. Erb’s palsy)
Perineal tear
PPH
Shoulder dystocia complications
Fetal hypoxia/ brain damage
Brachial plexus injury (i.e. Erb’s palsy)
Perineal tear
PPH
Risk factors for uterine rupture
Previous c-section/ uterine surgery
VBAC
Multiple pregnancy
Oxytocin use for contractions/ induced labour
Older age
Methods for labour induction
- Membrane sweep
- Vaginal prostaglandin E2
- Cervical ripening balloon
- Artificial rupture of membranes
Methods for labour induction
- Membrane sweep
- Vaginal prostaglandin E2
- Cervical ripening balloon
- Artificial rupture of membranes
______ is used to induce labour in intrauterine foetal death
Oral mifepristone + misoprostol
_______ is a complication of vaginal prostaglandins
Uterine hyperstimulation
Uterine hyperstimulate describes
> 5 uterine contractions every 10 minutes
Complications of uterine hyperstimulation
Foetal hypoxia/ distress
Emergency C-section
Uterine rupture
Uterine hyperstimulation management
Stopping vaginal prostaglandins/ oxytocin
Tocolysis (terbutaline)
Neonatal resuscitation steps
- Warm the baby
- APGAR score (1, 5, 10 minuties)
- Stimulate breathing
- Inflation breaths
- 2 rounds of 5 breaths (lasting 3 seconds) - Chest compressions
- 3:1 with ventilation
Severe
- IV drugs and intubation
- (Near term)= therapeutic hypothermia
