Labour Flashcards
Latent phase of labour observations? (5)
4 - 6 hourly
- bp
- pulse
- temperature
- Pv: dilatation, cervical length, membranes, foetal head position, kaput + moulding
- Rr
2 hourly
- foetal heart rate
- contractions
Urine when passed ‘
Define active labour
Cervical dilatation 4 cm or more
Active phase of labour observations? (7)
4 hourly
- temperature
- rr
2 hourly
- pv
- head above brim
1 hourly
- bp
- pulse
Half hourly
- foetal heart
- contractions
Urine when passed
Define second stage labour and duration
Cervix fully dilated until delivery
First phase: full dilatation → desire to bear down
Second phase: desire to bear down → active pushing/delivery
PRIMI up to 3h
Multi up to 2
Second stage of labour observations? (2)
- Foetal heart after every 2nd contraction
- Pv every 15 minutes to assess decent
Oxytocin regimen for augmentation of labour? (4)
- 5 u oxytocin to 1 l ringers
- start infusion 25 ml /hour
- increase infusion by 50 ml /h every 30 min (50,100, 150, 200) until 3-4 strong contractions > 40 sec
- if reaches 200 ml /h and still not strong contractions, increase dose by starting infusion 10 u in 1 L at 150 ml /h, increasing to 200 if necessary
Management abnormal foetal heart / contraction pattern after oxytocin infusion in labour? ((4)
- Stop infusion. Replace line with ringers.
- No improvement: salbutamol 500 ug/ml injection preparation. 250 ug as a single injection. Give slowly iv over 5 minutes
- continuous foetal, monitoring.
- c/s if no improve
Name 2 signs shoulder dystocia
- Turtle sign: retraction of delivered foetal head against perineum
- inability to deliver foetal shoulders with routine traction in axial direction
Name 8 antepartum risk factors shoulder dystocia
- Multiparity
- post term gestation
- maternal obesity
- maternal diabetes
- Prior shoulder dystocia
- prior macrosomic child
- excess gestational weight gain
- foetal macrosomia
Name 6 intrapartum risk factors shoulder dystocia
- Induction/augmentation labour
- abnormal labour
- prolonged 1st stage
- prolonged 2nd stage
- epidural
- operative vaginal delivery
Name 2 maternal complications shoulder dystocia
- Serious vaginal laceration
- Postpartum haemorrhage
Name 5 perinatal complications shoulder dystocia
- Brachial plexus injury
- fractures
- hypoxia ischaemic encephalopathy
- long term neurological disability
- death
Management shoulder dystocia (9)
HELPERR
First line
- help: call for help
- edge of bed + evaluate for episiotomy
- legs: McRobert’s maneuvre (knees to chest )
Second line
- pressure suprapubically + downward traction on foetal head to deliver ant arm
- enter: rotational manoeuvres: posterior axilla sling traction, woods or Rubin’s
- remove posterior arm.
(Consider repeating)
- roll pt onto all fours (gaskin maneuvre )
3rd line
- zavinelli (push head back) for c/s
- clavicular #
Active phase labour average length?
PRIMI: 12 hours
Multi: 10 hours
Analgesia for labour
Pethidine 1 mg / kg (max 100 mg)
Or
Morphine 0,1 mg/kg (max 10mg) IM 4 hourly
Typical duration latent phase labour?
About 24 hours
What must be noted on pv during labour? (5)
- Dilatation
- cervical length
- membranes
- kaput + moulding
- position foetal head
Partogram: 1 block = how many hours in latent and active phases?
Latent: 1 block = 2 hours
Active: 1 block = 1 hour
How describe liquor on partogram? (4)
I/c/m/b
Intact: membranes not ruptured
Clear:
Meconium stained
Blood stained
Define caput and how to describe on partogram
Swelling of infant’s scalp.
0,1 +,2+
Define moulding and how to describe on partogram
Foetal skull bones moving closer/overlap to fit through pelvis. Try to separate sutures
O: sutures separate
1+ sutures opposed
2+ overlapped but reducible
3+ overlapped and not reducible
Management partogram on action line?
4 ps
Power
Passage: CPD
Passenger: presentation, size…
Psyche: pain…
Name 3 indications assisted delivery
- Maternal: inefficient effort eg exhaustion, underlying condition precluding pushing eg cardiac
- foetal: non-reassuring ctg
- other: prolonged second stage labour
Name 6 contraindications assisted delivery
- Non vertex presentation
- unengaged foetal head
- unknown foetal head position
- premature <34 weeks
- known foetal coagulation disorder
- known foetal demineralisation disorder
Pre-op Checklists for assisted delivery? (4)
- Maternal
- foetal
- uteroplacental
- other
Pre-op maternal checklist for assisted delivery? (7)
- Informed consent
- analgesia
- lithotomy
- empty bladder
- adequate pelvis
- consider episiotomy
- for vacuum, uterine contractions and maternal effort must be present!
Pre-op foetal checklist for assisted delivery? (5)
- Vertex
- foetal head must be engaged: 0/5 above brim
- known foetal head position
- document estimated foetal weight. Ideally 2500 - 4000g
- assess foetal head attitude, kaput, moulding, asynclitism (oblique malpresentation)
Pre-op uteroplacental checklist for assisted delivery? (3)
- Fully dilated cervix
- no placenta praevia
- ruptured membranes
Pre-op procedural/other checklist for assisted delivery? (5)
- Alert anaesthesia, nursing, neonatology
- experienced operator
- monitor foetus continuously
- be able to perform emergency Caesar
- be prepared for shoulder dystocia
How choose assisted delivery instrument?
Forceps: safer for foetus. Generally preferred
Vacuum: safer for mother ; need uterine contractions and maternal effort
Describe vacuum assisted delivery ( 5)
- Cup applied over flexion point, which is 3-4 cm in front of occiput in midline, indicated by sagittal suture
- begin with suction at 0,7 - 0,8 kg/cc^2
- Traction in direct line of vaginal canal perpendicular to head
- no rocking motions. Should not last > 5 mins.
- discontinue if cup slips off 3 times
Describe forceps assisted delivery ( 3 )
- Appropriate application so that forceps grasp sides of foetal head.
- long axis of blades correspond to occipital - mental diameter. Tips of blades over cheeks.
- blades equidistant from sagital suture, which bisects horizontal plane. posterior fontanelle is 1 finger breadth anterior to this plane.
- Fenestrated blades should admit no more than 1 finger breadth between heel of fenestration and foetal head.
- don’t grasp maternal tissue
- abandon if difficulty applying, no descent with traction, not delivered in reasonable time, after 3 pulls
Name 7 maternal complications assisted delivery
- pain at delivery, perineal pain
- lower genital tract lacerations/haematoma
- urinary retention, incontinence
- anal incompetence
- pelvic organ prolapse
- fistulae
- Anaemia
Name 8 foetal complications assisted delivery
- Intracranial haemorrhage
- bruises
- abrasions, lacerations
- facial nerve palsy
- cephal haematoma
- retinal haemorrhages
- skull fracture
- subgaleal haematoma
