Labour Flashcards
What is the role of progesterone in labour?
Inhibits contractions
Prevents formation of gap junctions
What is the role of oestrogen in labour?
Makes uterus contract
Promotes prostaglandin production
What is the role of oxytocin in labour?
Initiates & sustains contractions
Promotes prostaglanidn release
What are the 2 phases of the first stage of labour?
Latent phase (up to 3-4cm dilated) Active phase (4cm onwards)
When is the second phase of labour prolonged in a nulliparous woman?
> 3 hours (or >2 hours without analgesia)
When is the second phase of labour prolonged in a multiparous woman?
> 2 hour (>1 hour without analgesia)
What is the average duration of the third stage of labour?
10 mins
What can be used to lower the risk of PPH in the third stage of labour?
Oxytocic drugs & cord traction
What changes happen to the cervix in labour?
Softening (increased hyaluronic acid)
Ripening (decreased collagen allignment & increase in cervical decorin)
What are Braxton-Hicks contractions?
Non-painful ‘practice’ contractions (>30 weeks)
What is the normal progression of true contractions?
Get longer
More frequent
More intense
Where does the placenta separate?
Spongy layer of decidua basalis
What is considered a normal time for placental expulsion?
< 30 mins
How long does it normally take for the fundal height to return to within the pelvis?
2 weeks
What are the hormonal changes post labour?
Decrease in oestrogen
Decrease in progesterone
Prolactin is maintained
When does diuresis commence post delivery?
2-3 days
When is failure to progress suspected in the first stage of labour?
<2cm in 4 hours
What 3 factors can cause failure to progress?
Power
Passages
Passenger
What does a foetal partogram assess?
Foetal heart Amnioticfluid Cervicaldilation Descent Contractions Obstruction (moulding) Maternal observations
How is foetal distress assessed?
Doppler auscultation of foetal heart
How do you interpret a CTG?
D - Determine R - Risk C - Contractions Bra - Baseline Rate (120-160) V - Variability A - Accelerations D - Deccelerations O - Overall Impression
What are accelerations?
Increase of >15 bpm in 15 seconds
Normal = at least 2 every 15 mins
What are decceleration?
Decrease of >15bpm in 15 second
Early = normal
Variable = potential cord compression (change position)
Late (start at peak of contraction) = insufficient blood flow
What should be done if there is late decelerations?
Foetal blood sampling for pH(if acidic = significant foetal hypoxia and need for emergency c section)
What does a sinusiodal pattern of CTG indicate?
Severe foetal hypoxia
Severe foetal anaemia
Foetal/maternal haemorrhage
EMERGENCY!!!!!!
What manouvere is recommended in shoulder dystocia?
Hyperflex legs & apply suprapubic pressure
McRobert’smanouvere
