Labour Flashcards
What is the first stage of labour?
From the onset of labour to up to 10cm dilated
What is the second stage of labour?
From 10cm cervical dilation up to the delivery of the baby
What is the third stage of labour?
From delivery of the baby until delivery of the placenta
What is the latent phase of the first stage of labour?
Up to 3cm cervical dilation
Irregular contraction
Progresses at 0.5cm per hour
What is the active phase of the first stage of labour?
From 3cm to 7cm cervical dilation
Regular contractions
Progresses at 1cm per hour
What is the transition phase of the first stage of labour?
From 7 to 10cm cervical dilation
Strong regular contractions
Progresses at 1cm per hour
What are Braxton-Hicks contractions?
Occassional irregular contractions that can be felt during the second and third trimesters of pregnancy. They do not progress or become regular
What are the signs of labour?
Mucus plug from the cervix
Rupture of membranes
Regular, painful contractions
Dilating cervix on examination
What is rupture of membranes (ROM)?
When the amniotic sac has ruptured
What is spontaneous ROM?
The amniotic sac has ruptured spontaneously
What is pre-labour ROM?
The amniotic sac has ruptured before the onset of labour
What is preterm pre-labour ROM?
The amniotic sac has ruptured before the onset of labour and before 37 weeks gestation
What is prolonged ROM?
The amniotic sac ruptures more than 18 hours before delivery
What is the definition of prematurity?
Delivery before 37 weeks gestation
What is cardiotocography?
Used to measure fetal heart rate and contractions of the uterus
How is CTG recorded?
Two doppler ultrasound transducers are placed on the abdomen:
- One above the fetal heart
- One above the fundus of the uterus
What are the indications for continuous CTG monitoring?
Sepsis
Maternal tachycardia
Significant meconium
Pre-eclampsia
Fresh antepartum haemorrhage
Delay in labour
Use of oxytocin
Disproportionate maternal pain
What are the 5 key features of CTG?
Contractions
Baseline fetal heart rate
Variability
Accelerations
Decelerations
What is a reassuring baseline fetal heart rate?
110-160
What is a non-reassuring baseline fetal heart rate?
100-109 or 161-180
What is an abnormal fetal heart rate?
Below 100 or above 180
What is normal variability of fetal heart rate?
5-25
What is a non-reassuring variability of fetal heartrate?
Less than 5 for 30-50 minutes or more than 25 for 15-25 minutes
What is an abnormal variability of fetal heartrate?
Less than 5 for over 50 minutes or more than 25 for over 25 minutes
What are decelerations?
Fetal heartrate dropping in response to hypoxia
What are early decelerations?
Dips and recoveries in heart rate that correspond with uterine contractions - they are normal
What are late decelerations?
Gradual falls in heart rate that start after the contraction has began. They are caused by hypoxia in the fetus and are pathological
What are variable decelerations?
Decelerations that may be unrelated to uterine contraction. They are related to compression of the umbilical cord
What are prolonged decelerations?
A drop of more than 15bpm from baseline that lasts between 2 and 10 minutes
What is progress in labour influenced by?
Power - uterine contractions
Passenger - size, presentation and position of baby
Passage - size and shape of pelvis
What is failure to progress in the first stage of labour?
Less than 2cm of cervical dilation in 4 hours
Slowing of progress in a multiparous woman
What is a partogram?
Monitoring system during the first stage of labour
What is the attitude of the fetus?
The posture of the fetus
What is included in a partogram?
Cervical dilation
Descent of fetal head
Maternal pulse, BP, temp and urine output
Fetal heart rate
Frequency of contractions
Status of the membranes
Drugs and fluids that have been given
What is failure to progress in the second stage of labour?
When the active (pushing) phase of the second stage lasts more than 2 hours in a nulliparous woman or 1 hour in a multiparous woman
What is oblique lie?
The fetus is at an angle
What is longitudinal lie?
The fetus is straight up and down
What is cephalic presentation?
The head presents first
What is transverse lie?
The fetus is straight side to side
What is shoulder presentation?
The shoulder presents first
What is a complete breech presentation?
Breech presentation (feet first) with hips and knees flexed
What is a frank breech presentation?
A breech presentation with hips flexed and knees extended - bottom first
What is a footling breech?
A breech presentation with a foot hanging through the cervix
What is delay in the third stage of labour?
More than 30 minutes with active management
More than 60 minutes with physiological management
What is the management of failure to progress in labour?
ARM - artifical rupture of membranes
Oxytocin infusion
Instrumental delivery
C-section
What is active management of the third stage of labour?
When the doctor/midwife assists in the delivery of the baby
How is the third stage of labour actively managed?
IM oxytocin after delivery of the baby
