Labour Flashcards
Labour may be defined as
onset of regular and painful contractions associated with cervical dilation and descent of the presenting part
Signs of labour include
regular and painful uterine contractions
a show (shedding of mucous plug)
rupture of the membranes (not always)
shortening and dilation of the cervix
Labour may be divided in to three stages which are:
stage 1: from the onset of true labour to when the cervix is fully dilated
stage 2: from full dilation to delivery of the fetus
stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered
Monitoring in Labour
FHR monitored every 15min (or continuously via CTG)
Contractions assessed every 30min
Maternal pulse rate assessed every 60min
Maternal BP and temp should be checked every 4 hours
VE should be offered every 4 hours to check progression of labour
Maternal urine should be checked for ketones and protein every 4 hours
Stage 1 - from the onset of true labour to when the cervix is fully dilated. In a primigravida lasts typical
10-16 hours
Stage 1 phases?
latent phase = 0-3 cm dilation, normally takes 6 hours
active phase = 3-10 cm dilation, normally 1cm/hr
?% of babies are vertex at present
90%
Head enters pelvis in ?position. The head normally delivers in an ?position.
Head enters pelvis in occipito-lateral position. The head normally delivers in an occipito-anterior position.
Labout stage 2 different parts of second stage?
‘passive second stage’ refers to the 2nd stage but in the absence of pushing (normal)
active second stage’ refers to the active process of maternal pushing
Which stage is most painful 1 or 2
1 as pushing masks pain
Stage 2 lasts approximately ?
What to do if longer than this?
1 hours
if longer than 1 hour (can be left longer if epidural) consider Ventouse extraction, forceps delivery or caesarean section
in stage 2 episiotomy may be necessary following crowning
true
Stage 2 is associated with transient fetal tachy/bradycardia
bradycardia
Induction of labour describes a process where labour is started artificially. It happens in around ?% of pregnancies
Induction of labour describes a process where labour is started artificially. It happens in around 20% of pregnancies
Induction of labour , Indications
prolonged pregnancy, e.g. > 12 days after estimated date of delivery
prelabour premature rupture of the membranes, where labour does not start
diabetic mother > 38 weeks
rhesus incompatibility
Induction of labour methods?
membrane sweep
intravaginal prostaglandins
breaking of waters
oxytocin
Cardiotocography (CTG) records what?
pressure changes in the uterus using internal or external pressure transducers
The normal fetal heart rate varies between
100-160 / min
<100 brady, >160 tachy
Baseline fetal bradycardia causes
Increased fetal vagal tone, maternal beta-blocker use
Baseline fetal tachycardia causes
Maternal pyrexia, chorioamnionitis, hypoxia, prematurity
Loss of baseline variability is what?
Causes?
< 5 beats / min
Prematurity, hypoxia
What is Early deceleration
Deceleration of the heart rate which commences with the onset of a contraction and returns to normal on completion of the contraction
What is Early deceleration caused by
Usually an innocuous feature and indicates head compression
What is late deceleration
Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction