Labour Flashcards
What are the 4 phases of labour?
Latent phase
Active phase
Transition
Pushing
Which phases occur in the first stage of labour?
Latent phase
Active phase
Transition
Which phase overlaps between the second and third stages of labour?
Pushing
What dilation is the cervix during the latent phase?
0-3cm
What dilation is the cervix during active phase?
3-7cm
What dilation is the cervix during transition?
7-10cm
What dilation (cm) is fully dilated?
10cm
What is the term to describe when the fetus finds the best way to fit inside the pelvis?
Best fit
What two things can make the mechanism of labour problematic?
The curve of the birth canal due to walking upright
A large fetal head due to brain development
What are 5 features of a gynaecoid pelvis?
Inlet is transversely oval Pelvic cavity is roomy and shallow Sacrum is broad and curved Sub pubic angle is 90 degrees Ischial spines are blunt
What are 5 diameters of the pelvic brim?
Transverse Left oblique Right oblique Anterior Posterior
What is the pelvic brim?
The edge of the pelvic inlet
What is the curve of the sacrum in the pelvis referred to as when describing the mechanism of labour?
The curve of carus
What area of the skull is located: At the back of the head? At the front of the head? Between the two? Transversely across the skull?
Posterior fontanel
Anterior fontanel
Sagittal suture
Biparietal
What is the general diameter of the biparietal?
9.5cm
In order, what are the 6 steps in the mechanism of labour?
Engagement Decent and flexion Internal rotation Extension External rotation Lateral flexion
What happens during engagement?
The Transverse diameter of the head descends through the pelvic brim
How to you describe engagement?
5ths palpable
What 8 things do you check for in a VE?
In vagina: Dilatation of cervix (cm) Consistency of cervix Length of cervical canal (effaced) Position of cervix In cervical os: Station of presenting part Presentation Position Membranes (in tact?)
What are the three consistency’s of a cervix?
Soft, medium, hard
What is a membrane sweep?
Separating the membranes of the amniotic sac to attempt to bring on labour to avoid going overdue
ARM
Artificial rupture of membranes
FSE
Fetal scalp electrode
What is umbilical cord prolapse?
When the umbilical cord drops through the open cervix into the vagina ahead of the baby
What is placenta praevia?
When the placenta is lying unusually low in your uterus, next to or covering your cervix
DR. C BRAVADO
DR- define risks C- contractions BRa- Baseline Rate V- variability A-accelerations D-decelerations O- overall impressions
Why should you expect accelerations on a CTG?
Because during contractions, oxygen levels fall and CO2 levels rise temporarily so heart rate increases to deliver enough oxygen but between contractions they return to normal
4 features of a normal CTG?
Baseline rate- 110-160 BPM
Baseline variability- 5BPM or more
Accelerations present
No decelerations
What is the usual baseline rate for a CTG?
110-160 BPM
What is a reassuring baseline variability?
5BPM or more
What is the definition of an acceleration?
15BPM above baseline lasting 15 seconds or more
What is the definition of decelerations?
Slowing of the fetal heart rate below the baseline of 15BPM for 15 seconds or more
In what instances may you catheterise a woman?
Prior to a C- section
Prior to an instrumental delivery
If woman is unable to pass urine during labour
Urinary retention
Risks of catheterisation
Infection
Blocked catheter
Bladder trauma
What may you document after catheterisation?
Consent
What are 3 aims of VE’s during labour?
Assess progress
Perform ARM
Identify fetal position
When would you refrain from giving a VE?
Lack of consent
Antepartum haemorrhage
Preterm labour
What are the three positions of the cervix on VEs?
Anterior, central, posterior
What should you check following VE?
Fetal heart (and mother’s pulse)
What landmark of the spine has the fetal head reached when it is described as 0?
Ischial spines
The third stage of labour can be managed in two ways, what are these referred to as?
Active management
Physiological management