Labour Flashcards
What are the key objectives in the context of labour?
Normal Labour, Abnormal Labour
What defines normal labour?
Regular painful contractions resulting in progressive change of the cervix
May include +/- show and +/- rupture of membranes
What are the stages of labour?
- First stage: Onset of labour until full dilatation of cervix
- Second stage: Full dilation of cervix until delivery of baby
- Third stage: Delivery of baby until complete delivery of placenta and membranes
What is the latent phase of labour?
The period from the beginning of labour to when dilatation begins to progress actively
Onset of regular contractions to 4 cm
What are the characteristics of the active phase of labour?
Rapid cervical dilatation and descent of presenting part begins to occur
Contractions are q 2-3 mins and firm intensity
What is the duration of the latent phase for primigravida and multipara?
- Primigravida: 8.6-20 hours
- Multipara: 5.3-14 hours
What defines the second stage of labour?
Begins with complete dilatation of the cervix and ends with birth of the baby
Contractions q 2 minutes, lasting 60-90 seconds, strong intensity
List the mechanisms of labour.
- Engagement
- Descent
- Flexion
- Internal rotation
- Birth of head by extension
- Restitution
- External rotation
- Birth of the shoulders and body by lateral flexion
What is the most commonly used posture for pushing during delivery?
Dorsal position, where the mother leans back slightly
Squatting and lying on the side are also popular positions
What are the considerations in the decision to cut an episiotomy?
- Woman’s preference
- Size of baby
- Need for space to perform interventions
- Self-control of the woman
- Belief about episiotomy as prophylactic gynaecology
- Belief about cutting vs. tearing
What is the purpose of perineal support during delivery?
To reduce tears and protect perineal integrity
Combination of fetal head control and perineal support at crowning
What are the main components of normal labour?
- Powers
- Passages
- Passenger
What factors are included under ‘Powers’ in normal labour?
- Uterine contractions
- Maternal effort
What factors are included under ‘Passages’ in normal labour?
- Maternal pelvis
- Inlet
- Outlet
What factors are included under ‘Passenger’ in normal labour?
- Fetal size
- Fetal presentation
- Fetal position
- Moulding
What is abnormal labour also known as?
Dystocia or Dysfunctional Labour
What are some complications associated with abnormal labour?
- Intrapartum infection
- Uterine Rupture
- Constriction ring
- Fistula formation
- Pelvic floor injury
- Fetal complications of infection
What defines prolonged latent phase?
- > 20 hours in primip
- > 14 hours in multip
What are protraction disorders characterized by?
Protracted dilatation
< 1.2 cms/hour in primip and < 1.5 cms/hour in multip
What constitutes arrest disorders?
- Arrest of Active Phase: No change in 2 hours
- Arrest of Descent: No change in 2 hours for primip & 1 hour for multip without anesthesia
What are the prerequisites before administering oxytocin?
- Assess passage as a birth canal
- Assess passenger
- Keep focus on safety of practice
What can go wrong during the labour process?
- Poor contractions/Maternal effort
- Small pelvis/Pelvic shape
- Big baby/Presentation/Malposition
What are the types of assisted birth?
- Forceps
- Vacuum/Ventouse
- Caesarean section
What are the criteria for using forceps or vacuum?
- Expertise
- Consent
- Analgesia
- Fully dilated/membranes ruptured
- Bladder empty
- Position known
- Fully engaged
- Station @/below spines
What are complications of using forceps/vacuum?
- Failed attempt
- Trauma to baby
- Trauma to mother
What is shoulder dystocia and its management?
Call for help, avoid excess traction, consider episiotomy/analgesia, suprapubic pressure, McRoberts manoeuvre, Woods screw
Delivery of posterior shoulder may be necessary
What is the significance of face presentation in labour?
Occurs in 1/600-1/2000 deliveries and is associated with longer rotation time
What is a transverse lie in the context of labour?
Spine of baby perpendicular to maternal spine
Can occur due to factors like preterm fetus, multiparity, placenta previa
What is the occurrence rate of breech presentation?
3-4% of singletons, more common at earlier gestational ages
