labour Flashcards
hormonal uterine changes in normal labour
progesterone keeps uterus settled
oestrogen makes uterus contract
oxytocin initiates and maintains contractions
cervical changes in normal labour
softening (increase in hyaluronic acid)
ripening (decrease in collagen fibre alignment and strength of cervical matrix and increase in decorin)
signs of third stage of labour
uterus contracts, hardens and rises
umbilical cord lengthens
latent phase of the 1st stage
mild uterine contraction
cervix shortens and softens
durable variation
active phase of the 1st stage
4cm > full dilation
contractions become more rhythmic and stronger
1-2cms per hour
second stage of labour
starts with complete dilation of cervix (10cm)
prolonged 2nd stage in nulliparous women
3+ hours with regional analgesia
2+ hours without regional analgesia
prolonged 2nd stage in multiparous women
2 hours with analgesia
1 hours without
3rd stage of labour
delivery of baby to expulsion of the placenta and fetal membranes
normally 10 minutes
when to prepare of surgical removal of placenta in 3rd stage
after an hour
active management of third stage
use of oxytocic drugs and controlled cord traction
prophylactic administration of syntometerine
pacemaker of contractions
tubal ostia
7 cardinal movements of labour
engagement
decent
flexion
internal rotation
crowning and extension
restitution and external rotation
expulsion, anterior shoulder first
what is an epidural
levobupivacaine +/- opiate
between L3-L4
complications of epidural
hypotension
dural puncture
headache
high block
atonic bladder
obstructed labour risks
sepsis
uterine rupture
obstructed AKI
post partum haemorrhage
fistula formation
fetal asphyxia
neonatal spesis
signs of obstruction
moulding
caput
anuria
haematuria
vulval oedema
suspected failure to progress (stage 1)
nulliparous < 2cm dilation in 4 hours
parous < 2cm dilation of in 4 hours or slowing in progress
causes of failure to progress- 3Ps
powers: inadequate contractions, frequency, strength
passages: short stature, severe pelvic trauma, shape
passenger: big baby, malposition
doppler auscultation of fetal heart
stage 1: during and after a contraction, every 15 minutes
stage 2: at least every 5 minutes during and after a contraction for 1 whole minutes
normal heart rate on CTG
110-150bpm
normal variability on CTG
5-25bpm
hypoxia on CTG
loss of accelerations
repetitive deeper and wider decelerations
rising of fetal baseline heart rate
loss of variability
management of abnormal CTG
change maternal position
IV fluids
stop syntocinon
scalp stimulation
consider tocolysis- terbutaline 250
maternal assessment
consider fetal blood sampling
operative delivery- category 1
standard indications for operative delivery
delay: failure to progress stage 2
fetal monitoring concern
special indications for operative delivery
maternal cardiac disease
severe PET/eclampsia
intra-partum haemorrhage
umbilical cord prolapse stage 2
most common cause of PPH
tone- uterine atony
uterus fails to contract adequately following delivery due to lack of tone in the uterine muscles
management of uterine atony causing PPH
bimanual compression to stimulate uterine contraction
empty bladder- foley catherter
pharmacological measures that increase uterine contraction: oxytocin (syntocinon), ergometrine, carboprost, misoprolol
consider surgical measures- intrauterine balloon tamponade, haemostatic suture around uterus, bilateal uterine or internal iliac artery ligation, hysterectomy
management of trauma causing PPH
primary repair of laceration, if uterine rupture: laparotomy and repair or hysterectomy
tissue- cause of PPH
the retention of placental tissue which prevents the uterus from contracting
management of tissue cause of PPH
administer IV oxytocin, manual removal of placenta with regional or general anaesthetic and prophylactic antibiotics in theatre
start IV oxytocin infusion after removal
