Labour Flashcards
What are the different stages of labour?
3 different stages with the first stage being broken into Latent and Active Stages.
Describe the Latent First stage of labour
Latent first stage normally occurs at around 37 wks when the foetus is ready to be born.
The stretching of the cervix causes signals in the brain causing release of Oxytocin. (Uterine Contraction Stimulator)
The Foetus itself also causes the placenta to release Prostaglandins (Uterine Contraction Stimulator) when it’s ready to be born.
Uterine contractions start (Painful, Regular contractions)
What diameter of the cervix indicates Latent vs Active first stage?
Latent First stage is up to 3cm diameter.
Active stage is from 3cm up to Full dilatation - Around 10cm.
Describe the Active First stage of labour
From 3cm cervical dilatation the mother enters the active first stage.
The Active First stage refers to the point between 3cm dilatation and full dilation (~10cm).
Uterine contractions continue.
Crowning occurs when you can see the head of the baby through the cervix.
What occurs during the second stage of labour?
The second stage is from Full cervical dilatation until the baby is born.
Uterine contractions continue and remain Painful and Regular.
When does the Mother enter stage 3 of labour?
Once the baby is born.
(Stage 3 describes the passage of the placenta)
What occurs in stage 3 of labour?
Stage 3 describes the Placental Delivery.
During this stage the placenta slowly detaches itself from the uterine lining as the Uterus continues to contract and becomes smaller.
Some bleeding is normal as the Placenta is passed.
What are the two main managements for stage 3?
Active or Physiological
What is the Physiological management of stage 3?
Physiological requires no drugs and just allows the placenta to be passed with Gravity and contractions.
Higher risk of Haemorrhage. (only used if at low risk of heavy blood loss)
- Mum in Upright position.
- Skin to skin contact and breastfeeding can help (produces more Oxytocin naturally)
How long can Physiological Management of Stage 3 take?
Up to 1 hour - shouldn’t take longer than that.
What is the Active management of stage 3?
THIS IS THE MOST ENCOURAGED MANAGEMENT - to reduce risk of PPH.
The active management of stage 3 involves an injection of Syntocinon (Oxytocin) or Ergometrine into the thigh to speed up delivery of the placenta.
The Midwife may also pull gently on umbilical cord and apply pressure to the abdomen.
How long should active management of stage 3 take?
Up to 30 mins.
What are the Pros and Cons of Active management for stage 3?
Pros:
- Reduces chance of haemorrhage.
- Faster process.
Cons:
- Nausea and vomiting.
- Can increase risk of High BP.
What are the Pros and Cons of the Physiological Management for stage 3?
Pros:
- Less risk of increasing BP.
- Doesn’t require any drugs.
Cons:
- Higher risk of Severe Haemorrhage.
In a Patient wishing to undergo Active management of stage 3 with a recent BP of 142/91mmHg and Mild Gestational Hypertension. Which Drug should be administered?
10 IU Oxytocin by IM injection.
Don’t give Ergometrine in patients with High BP.
- Oxytocin also causes less Nausea and vomiting.
