Labour Flashcards
When is labour diagnosed?
- regular and increasing uterine contractions
- bring about cervical effacement and/or dilation
What is cervical effacement?
cervical thinning
shortening of cervix
cervix pulls up into the uterus
becomes part of lower uterine wall
How many stages of labour are there?
3
What happens in the first stage of labour?
Period between regular uterine contraction and full dilation of the cervix
What happens in the second stage of labour?
Full cervical dilation (10cm) to delivery of the foetus
How long is the 2nd stage normally in a nulliparous woman (someone who has never given birth)?
1 hour
How long is the 2nd stage normally in a multiparous woman (someone who has given birth before)?
half an hour
What happens in the third stage of labour?
Period between the delivery of the foetus to the delivery of the placenta and amniotic membranes
How long does the 3rd stage normally last?
less than 15 minutes with active management
The first stage of labour has 2 phases. What are they?
latent phase
active phase
What happens in the latent phase of the first stage of labour?
- cervix becomes effaced (goes from 3cm long to less than 0.5cm long)
- then dilates to 3cm
How long does the latent phase take?
With regular uterine contractions this takes:
6-8 hours= NULLIIPAROUS
4-6 hours= MULTIPAROUS
What happens in the active phase of the first phase of labour?
- dilatation from 3cm to 10cm
- rate of cervical dilation on average is about 1cm/hour
What is a partogram?
graphic representation of the progress of labour
What does a partogram record?
- rate of cervical dilatation
- descent of the head
- contraction frequency and duration
- foetal heart rate
- colour and quantity of liquor (this is the amniotic fluid)
- maternal pulse, blood pressure, temperature, urine output and it’s analysis
- caput and moulding of the baby’s skull
What is a caput?
swelling that can be felt on the foetal skull
What is moulding?
overlapping of the skull bones= allows foetus head to move through the cervix
How does moulding happen?
- sutures of baby’s skull are not flexible at birth
- so skull bones can overlap - make the skull smaller
- normal in childbirth
On the partogram, there are 2 lines to show cervical dilation. What are they called?
alert line
action line
What is the alert line?
drawn at a rate of 1cm/hour
What is the action line?
line drawn 2-3cm to right of alert line (parallel to alert line)
When is the first point plotted on the alert line?
when the mother first reaches active phase of labour
i. e.
- if a woman admits herself into the hospital with 5cm dilatation of the cervix, the first plot will be done on the 5cm mark on the alert line
How often do you take readings of cervical dilation?
every 1-4 hours
What does the alert and action line mean?
if points are plotted on the alert line, means the progression to labour is fine
- if plotting goes to the right of action line, then labour is seen as slow and need action to be taken
What are causes of slow labour?
PASSAGE- pelvis not big enough for baby to come through
PASSENGER- the foetus might be fat or exit of cervix is suboptimal diameter (foteus may be the wrong way round)
POWER- uterine contractions are not enough
What is seen when admitting a woman in labour?
- assessment
- check if pregnancy is high or low risk - definitive diagnosis of labour
- this can be hard bc you need to keep observing - discuss action plan with mother that needs to be adhered to
- consult with consultant when required
How do you manage a slow latent phase?
- reassure mother that this is normal
- keep mother nourished, hydrated and offer pain relief
- keep an eye on mother and foetus through appropriate surveillance (e.g. foetal heart sounds)
- allow labour to progress naturally
- actively manage mother and foetus if there are any complications
What are the complications of slow labour?
- Maternal dehydration or exhaustion
- Maternal and foetal infection
- Foetal distress
- Operative delivery ie a caesarian section
- Uterine rupture
- Haemorrhage ie bleeding after the delivery
- Increased maternal and foetal morbidity
- Increased chance of a vesicovaginal fistula
What is a vesicovaginal fistula?
- when prolonged labour
- baby pushes vesicovaginal wall for too long
(wall vetween vagina and bladder) - so tissue loses its blood supply
- becomes necrotic
- leaves a hole
- urine then leaks from the bladder into the vagina
