Labour Flashcards
What are the modes of delivery?
Vaginal birth after C-Section (VBAC)
Elective repeat C-Section (ERCS)
Vaginal Birth
Assisted Vaginal Delivery
What are the risks associated with VBAC?
Uterine rupture, delivery-related (perinatal death)
What are the indications for assisted vaginal delivery?
Slow progress in 2nd stage
Maternal exhaustion
To avoid raised ICP/BP
Presumed fetal compromise
What are the indications for induction of labour?
Agreed that the fetus/mother will benefit from a higher probability of a heathy outcome than if birth is delayed
Only considered when vaginal delivery is felt to be appropriate
Prolonged pregnancy: 41-42weeks past due date increases risk of perinatal mortality due to decreased placental function
Intrauterine growth retardation
PPROM/pre-labour rupture of membranes
Antepartum haemorrhage
Maternal hypertension or diabetes
Poor obstetric history
Intrauterine death
Maternal request
What are the contraindications of induction of labour?
ABSOLUTE: Acute fetal compromise Unstable lie Placenta praevia Pelvic obstruction RELATIVE: Previous C-section High parity Prematurity Breech
When should a membrane sweep be offered?
Prior to formal induction of labour women should be offered a vaginal examination for membrane sweeping
Nulliparous: 40-41 weeks Parous: 41 weeks
What are the components of a Bishop Score? What does the score help with?
Each given a score 0-3: Dilatation Length of cervix Station Position of cervix Consistency Helps determine whether IOL needed 0-5 unfavourable- IOL likely needed 6-13 favourable- Spont labour likely
What are the methods used to induce labour?
- Stretch & sweep: Release membranes from lower segment of the uterus & release prostaglandins for spont labour
- Prostaglandin: Cervical priming with prostaglandin inserted into the posterior fornix, multiple doses may be required
- ARM: With/without Oxytocin, favourable cervix (Bishop >5), some uterine activity, aseptic technique
What are the complications of induction of labour?
- Fetal distress
- Precipitate delivery
- Failure: Operative delivery
- Uterine hypertonia with possible rupture: >7contractions/15mins
- Amniotic fluid embolus
- Systemic effects: N&V, diarrhoea
Describe the mechanism of labour
As the foetus descends through the pelvis, soft tissue and bony structures exert pressures which lead to
descent through to the birth canal. In normal
labour the head engages into the pelvis in the left or
right occipito-anterior position
What are the stages of labour?
1: From onset of established labour (4cm) to full dilatation of the cervix (10cm)
2: From full dilatation to birth of the baby
3: From birth of the baby to expulsion of the placenta & membranes
What is included in the first stage of labour?
oConcerned with the opening of the cervix (usually women dilated a minimum of 2cm/4hours
oDescent of the baby’s head (in relation to the ischial spines of the pelvis- station of the head, also assessed on abdo palpation by how many 5ths of the baby’s head can be felt)
oBoth encouraged by women mobilising- walking & upright position in stage 1 reduce duration of labour, need for epidural, risk of C-section
Define multigravida & primigravida
M: Cervical dilatation <2cm in 4hours or slowing down of progress
P: Cervical dilatation <2cm in 4hours
How is slow progress of labour managed?
1: ARM
2: Syntocinon infusion
What is included in the second stage of labour?
oPASSIVE: Full dilatation of the cervix prior to/in the absence of involuntary expulsive contractions
oACTIVE: Expulsive contractions/active maternal effort with a full dilatation of the cervix
Once fully dilated the head moves down the pelvis & applies pressure to the pelvic floor causing the urge to push
What is included in the third stage of labour?
oDelayed cord clamping: Waiting for the cord to stop pulsating >1min reduced the risk of anaemia in babies
oActive management: Routine use of uterotonic drugs- Syntometrine, controlled cord traction- reduces risk of post-partum haemorrhage
oPhysiological management: No routine uterotonic drugs, no late clamping, delivery of placenta by maternal effort
What is ‘breech’ position? What are the different types?
In utero fetal position that leads to the buttocks being delivered first. 3% incidence
Frank/extended= 65%
Complete/flexed= 10%
Incomplete/footling= 25%
How is labour monitored?
Partogram: Pictorial record of labour
Charts: Cervical dilatation & descent of the head, frequency of contractions, fetal HR, liquor colour, maternal obs
How is breech position managed in the antenatal phase?
Vaginal breech delivery
C-Section
External cephalic version (36-37weeks)
What are the contraindications of external cephalic version?
Absolute: Placenta Praevia Uterine malformation Rupture membranes Multiple pregnancy Abnormal CTG Relative: Previous C-Section Active labour Pre-eclampsia Oligohydramnios Fetal abnormality Hypertension of fetal heart Maternal cardiac disease
At what dates are twins delivered?
- Dichorionic diamniotic: 37-38weeks
- Monochorionic diamniotic: 34-37weeks
- Monochorionic monoamniotic: 34weeks C-Section
What care is given in labour?
Eating & drinking: Encourage drinking throughout, light meals when desired
Bladder care: Encourage to pass urine regularly, may need a catheter (epidural)
Obs: Vital signs, urine analysis, vaginal loss (colour of liquor, fresh blood) contractions
Analgesia
Fetal monitoring: Identify hypoxia before sufficient enough to lead to damaging acidosis & long-term neuro adverse effects
What analgesia can be given in labour?
Pharmacological: Paracetamol, gas&air, epidural, opiates (Diamorphine)
Non-pharmacological: Water, mobilise, massage, relaxation & breathing
What instruments are used in an assisted vaginal delivery?
Rotational/traction forceps Vacuum extraction (Ventouse)
