Labour Flashcards
Do contractions mean labour is occuring?
Labour = ? AND ?
What is another indication of labour?
Note that 1st contraction ≠ labour- only when regular, painful contractions are occurring 5 mins apart
Labour= regular painful contractions AND cervical effacement and dilatation which are assessed via vaginal exam
Another indication of labour is ‘the show’= cervix opens and the mucus plug leaves the vagina. Look for pink, viscous mucus deposit
4 theories for the induction of labour?
Progesterone withdrawal can lead to onset of contractions + induce labour
Maybe neuronal stimulation from cervical pressure (baby head pressing on the cervix) may release oxytocin and subsequent uterine contractions?
PGs: Local inflammatory reaction in the cervix
Cortisol and its products initiate labour. Perhaps CRH levels reach a critical threshold, starting the cervical inflammatory reaction
Labour consists of 3 stages. What is the 1st stage, describe the phases of the first stage
1st stage: period between onset of ? to ?
2 phases:
Latent: duration for cervix to become ? Regular contractions can take ?
? which disrupts ?
From the latent phase, the ? –> ?. This = the duration for the cervix to ?
1st stage: period between onset of regular, painful contractions to full cervical dilatation (10cm). 2 phases:
Latent: duration for cervix to become effaced (from 3cm long to <0.5cm) and dilated to 3cm. Regular contractions can take 6-8 hrs in a nullipara and 4-6 hrs in a multipara.
PGs vasodilate and increase capillary permeability, which disrupts cervical collagen fibrils.
From the latent phase, the contractions get stronger–> active phase. This = the duration for the cervix to dilate fully from 3 to 10cm. The rate of cervical dilatation= ~1cm per hr
What are partograms?
Rate ?
Descent of ?
Contraction ?
Foetal ?
? of ?
? of the head
Maternal ?
What is worrying?
Partogram=graph of labour progress, recording:
Rate of cervical dilatation
Descent of the head
Caput and moulding of the head
Contraction frequency + duration (measured every 10 mins)
Foetal heart rate
Colour and quantity of liquor
Maternal parameters (pulse, BP, temp, urine output and analysis)
No progression during labour= worrying
What is the normal progression of contractions and the foetal head position?
At the start of labour ?
Later on?
At first, contractions are usually 2 every 10 mins. They last <20s
This then increases to 3, then 4 every 10 minutes
By the end of labour, contractions are every other min that last longer
At the start of labour, 5/5 of the foetal head can be palpated in the abdomen
Later on, we should be able to feel 0/5 as the foetal head should have fully descended into the pelvic cavity, where it will no longer be palpable per abdomen
Describe this partograph
The alert line is drawn at a rate of ?
The action line is drawn ?
A partogram, we have alert and action lines
The alert line is drawn at a rate of 1cm/hr from admission cervical dilatation in the active phase.
If pt progressing slower than the alert line, we keep a close eye
The action line is drawn 4cm to the right and parallel to the alert line. If labour progresses to the right (slower than) action line we intervene! eg rupturing the membranes or giving oxytocin to increase contractions
Describe admission in labour
If we are unsure whether someone is in labour, we ?
If labour is ?, then ?
The perfect obstetrician…
Before admitting someone to labour ward, we must diagnose labour.
If we are unsure whether someone is in labour or not, observe instead of admitting them.
If labour is normal + low-risk, then input from obs is unnecessary –midwives are the experts.
The perfect obstetrician leaves a woman alone unless they have a very good reason to intervene. Communicate w midwives!!!
How do we manage the active phase of labour?
Reassurance: good one to one support
Hydration: labour leads to fluid loss, via increased breathing, sweating and blood loss
Pain relief – Entonox, pethidine, water births etc
A key point- stop stress. If they get scared, control will be lost. High cortisol levels have been proven to inhibit labour
What happens in the second stage of labour?
The mother will ?
Pt is ?
Urge to ?
3 other changes?
The mother will either go completely silent, or ‘lose it’
Pt is v restless
Urge to push – the foetal head will begin to press on the levator ani muscles, triggering the Ferguson reflex. This is where every contraction will stimulate an urge to push
Tachypnoea –RR increases to get more oxygen in
Vulval bulging and anal dilatation occurs as the foetal head begins to descend
Due to the shape of the pelvis, the foetus takes a very specific route on its way out
Initially ?
Foetal head then ? as it gets to ? before ? to pass out the ? with ?
The baby will then ? to allow ?, followed by the ?
Once the baby is out ?
Initially, the baby flexes its neck (tucking chin in) and twists its head to pass through pelvic inlet occipito-transversely
Foetal head then rotates internally as it gets to the pelvic floor, before extending the neck to pass out the pelvic outlet with the head in the occipito-anterior position
The baby will then externally rotate the head to allow delivery of the anterior shoulder from under the pubis, followed by the posterior shoulder
Once the baby is out- 2nd stage is complete
What happens in the third stage of labour?
As ? is delivered, ? given to cause ?
We apply ? until ?
Placenta and membranes are then ?
Estimate ?
Active management in the 3rd stage= recommended, as here things can go v wrong, v fast
As the anterior shoulder is delivered, IM syntometrine (oxytocin + ergometrine) given to cause uterus to stay contracted and shear off the placenta
We apply controlled cord traction until the placenta is delivered
Placenta and membranes are then checked for completeness. Retrieve if any is left inside the uterus
Estimate blood loss and check the perineum for tears, which will then be sutured if necessary
When do we and when do we NOT pull out the placenta?
We apply controlled cord traction until the placenta is delivered, whilst placing the left hand above the pubic symphysis to feel for the uterus
If the uterus moves as we apply cord traction, it means the placenta is still attached- pulling further will pull the uterus out- potentially cause huge haemorrhage
If the uterus doesn’t move and the cord does, then we can slowly pull the cord out and deliver the placenta
