Labour Flashcards
At what rate should the cervix dilate in a primip?
1cm in 2 hours
What are the causes of delayed labour?
Power, passenger, passage
What are the normal movements of the baby through labour?
Engagement (in OT position) Descent Flexion Internal rotation (to OA position Extension Restitution / external rotation Delivery of anterior shoulder Delivery of posterior shoulder Delivery of placenta
What things are assessed on a CTG?
Baseline HR
Variability
Accelerations / decelerations
How often should a PV exam be performed?
Every 4 hours to assess for progression
What are the stages of labour?
Stage 1 (latent): 0-4cm dilated Stage 1 (active): 4-10cm dilated Stage 2 (passive): 10cm until woman has urge to push Stage 2(active): pushing Stage 3: delivery of placenta
What are options for management of stage 3?
Expectant
Active: oxytocin ± traction ± manual removal
What is the presentation of uterine rupture?
1) Previous C-section - ruptures through scar
2) Acute onset of foetal distress (CTG changes)
3) Maternal tachycardia, pain, bleeding, shock
What is management of uterine rupture?
Call for help, ABCDE resus, emergency laparotomy
What is definition of primary PPH?
> 500mL of blood within 24 hours of delivery
What are the different grades of PPH?
Minor: 500-1000mL
Major: 1000-1500mL
Massive: >1500mL
What factors affect PPH?
Tone, tissue, trauma and thrombin
What is the management of PPH?
Call for help, ABCDE resus
Tone: Bimaual compression, oxytocin, etc.
Trauma: explore genital tract for trauma
Tissue: Inspect placental completeness
Thrombin: FBC, clotting, replace factors
+ empty bladder + consider balloon tamponade
What are the main causes of secondary PPH?
Infection and retained products
What are complications of C-section?
Bleeding, infection, slower recovery, damage to bladder, bowel, ureters.
Can consider VBAC if only one C-section.
