Labour Flashcards
What can happen before labour begins which makes you think a female is in a labour?
Braxton Hicks
How many stages of labour are there?
what are they called?
3 stages
stage 1 - latent and active
stage 2 - baby delivery
stage 3 - placental delivery
What are Braxton hicks?
vague cramps in 3/3
Mild, Irregular, uncomfortable and painless tightening of uterine wall
What happens before labour begins?
Bloody show, mucus plug
Just before - spontaneous rupture of membranes (ROM),
What is happening to the cervix in stage 1?
it is shortening and widening
How long does stage 1 latent phase last for?
length for Primi vs multi
Dilation?
diameter and contractions?
20 hours Primi (1)
14 hours multi
Dilation <30%
0-4cm diameter
contractions 1-3 mins
How long does stage 1 active phase last for?
length for Primi vs multi
Dilation?
diameter and contractions?
6 hours primi
5 hours multi
dilation 30-100%
5-10cm diameter
contractions 60s every 1-2 mins
What is the dilation rate for primi/multi?
1.2cm primi
1.5cm multi
What is stage 2 of labour?
Length for Primi/multi?
Baby comes out
2 hours Primi
1 hour multi
What are the 3 Ps in stage 2 labour that affects labour time?
Power (tone)
Passage (pelvic inlet dimensions S2-S4)
Passenger (cephalopelvic proportion)
What are the movements of the foetus out of the mum?
Engage
Decent
Flexion
Internal rotation
extension
External rotation
Restitution
Expulsion
What is stage 3 of labour?
Time?
deliver the placenta + monitor Postpartum haemorrhage
30 mins
What do we check in the placenta?
check placental remnants
2 umbilical arteries and 1 umbilical vein
What is a portogram used for?
Labour progression
Parameters to measure maternal + fetal health during labour
can guide the need to add/change methods
eg. cat 1 c section if distressed
What is the bishop score used for?
to assess cervical ripeness
How likely a woman is to go into labour
What is the acronym for the bishop score?
CDEFP
What does CDEFP mean?
Consistency
Dilation
Effacement
Fetal station
Position
What are the different scores for the bishop criteria?
<5
5-7
>8
what do these mean?
<5
5-7
>8
<5 - Unripe therefore unlikely to spontaneously induce - need to induce labour
5-7 - intermediate
> 8 - Ripe, likely to spontaneously induce
What are some indications to induce?
Prolonged labour
Preterm premature rupture of membranes (PPROM)
Maternal issues = Gestational DM, Pre eclampsia, obs, Cholestasis
What bishop scores determine the different ways of inducing labour?
6 or less
more than 6
How is labour induced in a bishop score 6 or less?
Membrane sweep
Vaginal Prostaglandin (gel or pessary)
PO Misoprostol
What do prostaglandins do?
What is a common prostaglandin gel that’s used and what type of prostaglandin is it?
What type of pros is misoprostol?
Promote cervical ripening
Dinoprostone gel (Prostaglandin E2)
Prostaglandin E1
How is labour induced in a bishop score of above 6?
Amniotomy (ARM)
IV Oxytocin
What is an example of an oxytocin that is used and what does it do?
Syntocinon
Stimulates contractions
What is induction Contraindicated in?
Vasa previa and cord prolapse
What is a complication of inducing labour and what can this cause?
Uterine hyperstimulation
>6 contractions in 10 mins
Risk of foetal ischemia and uterine rupture
What is conservative pain relief for labour?
Perianal + fundal massage
TENS (transcutaneous electrical nerve stimulation)
what are some medications given in labour for pain relief?
Entonox
Pethidine
Morphine
What are the side effects of entonox?
N+V
What are the foetal and maternal side effects of pethidine/morphine?
foetal = Resp depression, diminished breast feeding/seeking behaviour
maternal = Euphoria/dysphoria, N+V, longer labour
How effective is the epidural?
85-90% effective
Epidural Contraindications?
Low platelets (Risk of bleeding)
On DOAC/Aspirin
High ICP
bleeding disorders
allergy
Side effects of an epidural?
Urine retention
Hypotension (low BP)
Hypoanalgese
Headache (1/100 post epidural)
When can an epidural be denied?
Foetal distress
Antepartum haemorrhage
What are 2 other things that can be given in labour?
IV Benzylpenicillin
RhoGAM
Why would benzylpenicillin + RhoGAM be given?
If there is Group B strep bacteria in urine (GBS) or UTI at any time in pregnancy
If Rhesus negative
What can be given instead of benzylpenicillin if they’re allergic?
Clindamycin
C section is what % of births?
25%
What are the 3 types of incisions?
Classical (midline)
Joel Cohen Incision
Pfannenstiel
classical (midline) incision
is it done?
Increased risk of?
not done
Increased risk of uterine rupture with vaginal birth after caesarian
CI to VBAC
What is a Joel Cohen incision?
Incision through 7 layers
What are the 7 layers that are incised through?
Skin
Scarpa fascia
camper fascia
Rectus sheath
Rectus abdominis
Peritoneum
Uterus
what is a CI to vaginal birth?
2 or more C Section
Complications of C section?
VBAC rupture (1/200)
Postpartum haemorrhage
Endometriosis
TTON
What are some indications for a c section?
Placenta previa
Vasa previa
Failure to progress
Active genital herpes
Cord prolapse
Fetomaternal distress
CAT:
1
2
3
4
What do these mean?
Cat 1 - emergency <30 mins
Cat 2 - <75 mins
Cat 3 - needed not immediate
Cat 4 - elective
What is a CTG?
what does it stand for?
What is it used for?
Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother’s abdomen. CTG is widely used in pregnancy as a method of assessing fetal well‐being, predominantly in pregnancies with increased risk of complications.
What is the acronym for CTG findings interpretation?
DR C BRAVADO
what does DR C BRAVADO stand for?
DR = Define risk
C = contractions
BRA = Baseline heart rate
V = Variability
A = accelerations
D = decelerations
O = overall
What does
Define Risk
Contractions mean?
DR - High or low risk?
C - No of contractions in 10 mins, duration and intensity
3-5 every 10 mins
What does
Baseline Heart rate
Variability mean?
BRA - Check 10 mins, 110-160 bpm
V - variation of foetal HR from 1 beat to the next - 5-25 bpm normal
What does
Accelerations
Decelerations
Overall mean?
Abrupt increase or decrease in fetal HR of 15 bpm longer than 15 secs
Overall good or bad
When can you only do a CTG?
28 WEEKS ONWARDS
Low risk (good) CTGs have?
Contractions?
HR?
Variability?
A or D
regular contractions
HR 110-160
Accelerations present
Early decels
High risk (bad) CTGs have?
HR?
Variability?
A or D
Bradycardia/tachy
Variability <5
No acceleration
late (or variable) decels
What does it mean when <40 variability?
sleeping foetus
What would you consider if CTG is high risk/bad?
what would be seen on that?
Fetal scalp sample
low pH = indicates HYPOXIA
What are the 2 types of instrumental delivery methods?
Ventouse (vacuum cup) - suction cup
Forceps
What are the 2 things the ventouse can cause?
cephalohematoma (blood under scalp) - bad
Caput Succedaneum (swelling of scalp) - better
When do you offer instrumental aid in birth?
Fetal distress
Premature delivery
HTN/Comorbidities
What is cephalohematoma?
when does it resolve?
Subperiosteal bleed confined to suture lines
resolves in 3 months or less
What can happen that is even worse than a cephalohematoma?
Subgaleal (extra cranial bleed of emissary veins, crosses suture lines, fetal distress and shock)
What is caput succedaneum?
SC oedema resolves in days
not confused
What can forceps delivery cause?
can cause CN7 palsy
