1. engagement 2. descent 3. flexion 4. internal rotation 5. crowning and extension 6. restitution and external rotation (head adopts optimal position for shoulder) 7. expulsion, anterior shoulder first

Labour Flashcards by Katy Russell

which hormone makes the uterus contract

oestrogen
oxytocin

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oxytocin role in labour

initiates and sustains contractions

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what is the bishop score

determines if it’s safe to induce labour.
5 things, and we need at least 4/5

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what are the elements of bishop score

dilatation
effacement
station
cervical consistency
cervix position

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first stage of labour

latent phase, up to 3-4cm dilatation

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full dilatation cervix measurement

10cm dilatation

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active phase

4cm onwards to full dilatation

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second stage

full dilatation to delivery of baby

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third stage of labour

delivery of baby to expulsion of the placenta and fetal membranes

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average duration of third stage

10 mins

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how long do we give the third stage before we intervene with surgery to get the placenta out

1 hour

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what drugs can be used to help get the placenta out

oxytocic drugs

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what are braxton hicks contractions

give the woman a false sensation that she is having real contractions.
Tightening of the uterine muscles, thought to aid the body prepare for birth

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where is smooth muscle of uterus at its highest density?

fundus

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normal frequency of contractions

3-4 in 10 mins
initially 10-15 seconds, max 45 secs

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cervical assessment

effacement
dilatation
firmness
position
level of presenting part or station (where is the head in relation to ischial spines)

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7 cardinal movements

engagement
descent
flexion
internal rotation
crowning and extension
restitution and external rotation (head adopts optimal position for shoulder)
expulsion, anterior shoulder first

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how often should vaginal examination be carried out in normal labour

approx 4 hourly

delayed cord clamping

give at least a minute

when does expulsion of the placenta usually occur

5-10 mins after delivery, considered normal up to 30 mins

normal blood loss

<500mls

what is puerperium

the 6 weeks after birth

methods to induce labour

artificial rupture of membranes
Propess (vaginal prostaglandin)
Cooks balloon (mechanical cervical dilatation)

signs of failure to progress (FTP) / obstructed labour

slow/no cervical dilatation
no descent or high presenting part
caput / moulding of presenting part
haematuria
“too good” a CTG with no stress on baby despite regular contractions
ascites at c-section
Bandl’s ring at c-section

should baby present OA, OP or OT

What do we do if baby presents transverse/oblique lie at delivery

Needs section due to risks of cord presentation and prolapse at SRM

what is chorioamnionitis?

Intrauterine infection (amniotic fluid and placenta) that can be life threatening to baby and to mother

when do the risks of chorioamnionitis increase?

duration of time between SRM and delivery, particularly if pre-term

what is PPROM

Pre-term, pre-labour rupture of membranes

what is PROM

Prelonged rupture of membranes

in PPROM, what antibiotic is given as prophylaxis

erythromycin

signs and symptoms of chorioamnionitis

- Maternal signs of sepsis/abnormal bloods - Fetal tachycardia/abnormal CTG - Offensive/blood stained liquor - Abdominal pain - Intrauterine pus at section

antepartum haemorrhage definition

Vaginal bleeding from 24+0 until delivery

in antepartum haemorrhage, what needs excluded before going ahead with a digital examination?

placenta praevia

what serious pathologies need ruled out in antepartum haemorrhage?

placental abruption, uterine rupture, chorioamnionitis

Primary post partum haemorrhage vs secondary

Primary PPH within 24 hours and secondary PPH thereafter

post partum haemorrhage 4 Ts

Tone – Use uterotonics to improve Trauma – Repair tear/uterus Tissue – Make sure uterus is empty with no placental tissue/membranes Thrombin – Consider blood products, tranexamic acid

cord prolapse definition

Descent/prolapse of umbilical cord following rupture of membranes

why is cord prolapse life threatening to baby

vasospasm and impaired blood supply to baby

cord prolapse management

rapid delivery via section coupled with displacing PP off cord to relieve pressure (manually or via bladder insufflation)

risk factors for cord prolapse

transverse/unstable lie, polyhydramnios, induced labour with high PP

shoulder dystocia definition

Bony obstruction of fetal shoulder against maternal pelvis causing delayed delivery and hypoxia

shoulder dystocia risk factors

Previous shoulder dystocia Diabetes (T1>T2>GDM) even without macrosomia Fetal macrosomia (i.e. EFW >97th centile, LBW >4.5kg) Narrow pelvic outlet

how many contractions is expected in 10 mins in active labour

3-4