labour Flashcards
stage 1 of labour, phases?
from the onset of true labour to when the cervix is fully dilated
latent phase = 0-3cm dilation (takes 6hrs ish)
active phase = 3-10cm, normally 1cm/hr
position baby’s head enters pelvis vs position it’s delivered
pelvis - occipito-lateral
delivers - occipito-anterior position
stage 2 of labour
from full dilation to delivery of fetus
passive 2nd stage = no pushing
active 2nd stage = pushing (pushing masks pain)
should last 1hr, if longer - ventouse, forceps or csection
(can be left longer if epidural))
stage 3 of labour
from delivery of fetus to when placenta membranes have been completely delivered
lasts around 5-15mins
active management of stage 3 of labour
- use of uterotonics
- clamping + cutting of cord
- controlled cord traction
active mx begins with delivery of anterior shoulder with injection of syntocinon
indications for induction of labour
- prolonged pregnancy - 1-2wks after expected
- prelabour premature rupture of membranes where labour doesnt start
- intrauterine fetal death
maternal medical problems
- diabetics >38wks
- pre-eclampsia
- obstetric cholestasis
what is the bishop score used for
to help assess whether induction of labout will be required
a score <5 = labour unlikely to start without induction
> =8 = cervix is favourable, high chance of spontaneous labout
methods of induction of labour
Bishop score <=6
- vaginal prostaglandins or oral misoprostol
Bishop >6
- amniotomy (breaking waters)
- IV oxytocin infusion
other methods -
- membrane sweep - finger in uterus to separate chorionic membrance from decidua
- cervical ripening balloon - inflated to dilate cervix
complications of induction of labour
uterine hyperstimulation
management of uterine hyperstimulation
- removing vaginal prostaglandins + stopping oxytocin infusion if used
- consider tocolysis (drugs to delay birth)
what does crossing the alert line on a partogram indicate
Crossing the alert line is an indication for amniotomy
(first stage)
consequences of uterine hyperstimulation
- intermittent interruption of blood flow to baby - fetal hypoxemia + acidemia
- uterine rupture
criteria for delay in 1st stage
less than 2cm of dilation in 4hrs
slowing of progress in a multiparous women
definition of delay in 3rd stage
> 30mins with active management
> 60 mins with physiological management
(active = IM oxytocin + controlled cord contraction)
management of failure to progress
1st = oxytocin infusion to stimulate contractions
- started low + titrated up
other mx - amniotomy, intrumental delivery, Csection
normal fetal heartbeat
100-160
CTG info
fetal baseline heart rate
accelerations = good
decelerations = bad
variability = good
umbilical cord prolapse
umbilical cord descendinging ahead of the presenting part of the fetus
- can lead to compression or cord spasm causing fetal hypoxia + irreversible damage or death
risk factors for cord prolapse
- prematurity
- multiparity
- polyhydramnios
- twin preg
- cephalopelvic disproportion - fibroids
- abnormal presentations - breech, transverse lie
when do most cord prolapses occur
at artificial rupture of membranes (50%)
- fetal heart rate becomes abnormal + cord is palpable / visible vaginally
management of cord prolapse
- presenting part may be pushed back into uterus
- patient put on all 4s until C-section can be organised
- tocolytics to reduce contractions
retrofilling bladder - elevates presenting part - if cord is past introitus, there should be minimal handling + kept warm/moist to avoid vasospasm
how can preterm prelabour rupture of membranes (PPROM) be confirmed
sterile speculum examination -> look for pooling of amniotic fluid in posterial vaginal vault
NO digital exam (infection)
if pooling NOT observed:
- test fluid for placental alpha microglobulin-1 protein (PAMG-1) or insulin-like growth factor
management of preterm prelabour rupture of membranes (PPROM)
- admit
- observe - watch for chorioamnionitis
- oral erythromycin for 10 days
- antenatal corticosteroids
consider delivery at 34wks
