Labour Flashcards
definition of the latent stage in the 1st stage of labour?
‘Painful contractions and some cervical change upto 4cm dilation with effacement and contractions every 3 in 10mins.
definition of the 1st stage of labour?
Beyond 4cm dilation up to full dilation
Observations in the first stage of labour
Half hourly documentation of contraction frequency on partogram
4 hourly temp and BP
4 hourly VE with maternal consent
Definition of the second stage of labour?
Onset of the active part of labour. Full dilation of the cervix before or in absence of involuntary expulsive contractions at 10 cm. full dilation of the cervix before or in the absence of involuntary expulsive contractions.
Observations in the 2nd stage of labour?-
Half hourly documentation of contraction frequency, hourly BP, 4 hourly temp, frequency of voiding, Offer VE w. maternal consent hourly in response to woman’s wishes (after abdominal palpation and assessment of vaginal loss)
What is it important to note at the start of the second stage of labour?
Noting fetal wellbeing and station at the start of the second stage.
How often and for how long should the fetal heart be auscultated in the second stage of labour?
IA after contraction for 1 minute at least every 5 minutes- palpate the woman’s pulse every 15 mins to differentiate between the 2 heartbeats.
List some risk factors for compromised fetal well being in labour
- Induction/augmentation of labour
- Post epidural administration/topup
- Abnormal bleeding in labour
- Pain different from normal labour
- Maternal pyrexia
- Maternal tachycardia
- Significant meconium
- Intermittent auscultation
- <100bpm or >160bpm, raising baseline, decelerations
How should IA in the first stage of labour be conducted?
One full minute after a contraction at least every 15 minutes
What is an acceleration of the fhr?
‘Transient increase in FHR of 15bpm or more lasting 15 seconds
What is a deceleration?
A fall of 15 beats or more for more than 15 seconds (note some late decelerations do not drop so far)
What is a late deceleration, what do they look like and why is it an issue?
Could be cord compression or placental issues.
If they last more than 60 seconds, reduced baseline variability, failure to return to the baseline, biphasic shape, no shouldering
Definition of a normal CTG
All features are reassuring, baseline between 110-160
Variability above 5 bpm
No decelerations or early deceleration’s only
Accelerations present
Suspicious CTG?
set of 1 non-reassuring 2 reassuring:
Non reassuring baseline 100-109 or 161-180, variability less than 5 for 30 to 50 minutes or more than 25 for 15 to 25 mins
With variable decels
Pathological CTG?
1 abnormal or 2 non-reassuring
= below 100 bpm or above 180, variability less than 5 for more than 50 mins or more than 25 for 25 minutes.
