Labour Flashcards
which hormone makes the uterus contract
oestrogen
oxytocin
oxytocin role in labour
initiates and sustains contractions
what is the bishop score
determines if it’s safe to induce labour.
5 things, and we need at least 4/5
what are the elements of bishop score
dilatation
effacement
station
cervical consistency
cervix position
first stage of labour
latent phase, up to 3-4cm dilatation
full dilatation cervix measurement
10cm dilatation
active phase
4cm onwards to full dilatation
second stage
full dilatation to delivery of baby
third stage of labour
delivery of baby to expulsion of the placenta and fetal membranes
average duration of third stage
10 mins
how long do we give the third stage before we intervene with surgery to get the placenta out
1 hour
what drugs can be used to help get the placenta out
oxytocic drugs
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
where is smooth muscle of uterus at its highest density?
fundus
normal frequency of contractions
3-4 in 10 mins
initially 10-15 seconds, max 45 secs
cervical assessment
effacement
dilatation
firmness
position
level of presenting part or station (where is the head in relation to ischial spines)
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
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
OA
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
