labour Flashcards
stage 1 of labour
initiation to full dilation of cervix. amniotic membranes rupture
0-10cm dilation
1cm/h in nulliparous and 2cm/h in multiparous
stage 2 of labour
full dilation to delivery of foetus
passive phase and active phase (active is pushing and passive is until the head reached the pelvic floor)
can last between 40min - 2 hours in nulliparous and 20min-1 hour in multiparous
stage 3 of labour
delivery of placenta
around 15 mins
3Ps to check during labour
Power
Passenger (presentation, lie)
Passage
ways passage can be disrupted
obstruction due to fibroids, hydrocephalus, placenta praevia
cephalopelvis disproportion
ways passenger can be disrupted
malpresentation due to breech, shoulder presentation, transverse lie, malposition of foetal head leading to cephalopelvic disproportion
score used to indicate how close labour is
bishops score
assesses the dilation, length of cervix, consistency, position, station
investigations during labour
- Vaginal examination to establish cervix dilation and foetal presentation
- Foetal heart auscultation
- 4-hourly maternal observation
- Partogram (monitor progression of labour, foetal heart rate, and presentation)
- Cardiotocography (CTG) — DR C BRAVADO)
- Foetal Blood Sampling (if evidence of foetal distress, helps identify foetal hypoxia by looking at the pH and lactate levels)
cardiotocography interpretation
Define Risk
Contractions
Baseline Rate
Accelerations
VAriability
Decelerations
Overall impression
foetal blood sampling interpretation
pH ≥7.25 OR lactate ≤4.1 mmol/L = NORMAL.
- Repeat if the foetal heart rate abnormality persists
pH 7.21–7.24 OR lactate 4.2–4.8 mmol/L = BORDERLINE.
- Repeat FBS within 30 min or consider delivery
pH ≤7.2 OR lactate ≥4.9 = ABNORMAL.
- Immediate delivery indicated
indications of induction of labour
post date- term +7 days ie over 41 weeks
diabetes
PROM
IUGR
pre eclampsia
growth concerns
placental insuffiency
management of induction of labour
membrane sweep
if bishops score>8 offer vaginal prostaglandins
cook balloon (mechanical dilation)
amniotomy (head must be engaged)
syntocinon (oxytocin for uterine contraction)
investigations for induction of labour
palpate foetal lie and presentation
CTG
vaginal exam - bishops score
foetal blood sampling
when to use foetal blood sampling
if evidence of foetal distress, helps identify foetal hypoxia by looking at the pH and lactate levels
indications for C section
foetal distress
failure to progress in labour
failed induction of labour
malpresentation
severe pre eclampsia
twin pregnancy with non cephalic presenting twin
repeat C section
