Labour Flashcards
At what rate should cervical dilation occur after reaching 4cm?
Nulliparous: >1 - 1.2 cm per hour
Multiparous: >1.5 cm per hour
What does APGAR stand for?
A - appearance
P - pulse
G - grimace
A - activity
R - respiration
When are APGAR scores calculated?
What is good vs bad?
1 min after birth
5 minutes after birth
Good: 7-10
Bad <7
What scores 0 - 2 for each APGAR?
A - appearance
P - pulse
G - grimace
A - activity
R - respiration
What happens in Stage 1 of Labour?
Latent phase
Positive feedback loop of prostaglandins → contractions → stretch → oxytocin → prostaglandins and contractions (irregular→regular)
Active phase
3-4cm dilated, cervix now dilates to 10cm
Can see crowning
What does oestrogen do to prepare body for labour?
Increases oxytocin receptors on uterus
What does Progesterone do to ready body for birth?
Relaxes smooth muscle:
- increases breast lobules (create milk)
- Maintains uterine lining
- Inhibits uterine contractions during pregnancy
Describe what is happening in this stage of labour
Stage 1:
- Fetal distress → ACTH release by baby brain
- → cortisol release
- → placenta:
- inhibits progesterone ↓
- inhibits oestrogen ↓
- stimulates prostaglandins ↑↑↑
- Prostaglandins → uterine contractions → stretch receptors
- signal to hypothalamus to produce oxytocin
- stored in posterior pituitary
- Released Oxytocin causes
- Increased ↑↑ uterine contractions directly
- Increased ↑↑ prostaglandins via placenta
Failure to Progress - how long should each be in a nulliparous vs multiparous woman?
- Stage 1 - intitial/latent (up to 4cm dilated)
- Stage 1 - active (rate of dilatation)
Nulliparous:
- <20 hr
- >1 - 1.2 cm per hour
Multiparous:
- <14 hr
- >1.5 cm per hour
What does green or smelly “waters” indicate?
Meconium = the first poo from baby. Sign of distress, and risk of meconium aspiration
What are the cardinal stages of labour?
- Descent
- Flexion
- Internal Rotation
- Extension
- Restitution (external rotation)
- Expulsion
What 2 “leaks” often occur before labour begins?
- Bloody show
- Amniotic sac rupture (waters breaking)
What about the fetus affects the process of labour / birth?
- Fetal SIZE
- Fetal ATTITUDE
- Fetal LIE
- Fetal PRESENTATION
What is considered
Early term
full term
post-term
Early term is considered 37+0 weeks through 38+6 weeks,
full term is 39+0 weeks through 40+6 weeks
late term is 41+0 weeks through 41+6 weeks
post-term is 42+0 weeks and beyond.
When should you be considered for VTE risk after giving birth?
- have a very long labour (more than 24 hours)
- have had a caesarean section
- lose a lot of blood after you have had your baby
- receive a blood transfusion.
When should you consider a ventouse delivery?
- abnormal fetal HR in second stage (with or without abnormal scalp pH)
- Maternal exhaustion (has to have some push left)
- Failure to progress 2nd stage
Which is the optimal position for baby to deliver in?
Occipitoanterior (OA) - left, right or straight
when should you consider instrumental delivery?
- Fetal compromise
- Maternal health concerns re long second stage e.g. heart failure, myasthenia gravis
-
Failure to progress:
- Nulliparous women – lack of continuing progress for 3 hours (total of active and passive second-stage labour) 17 with regional anaesthesia, or 2 hours without regional anaesthesia
- Multiparous women – lack of continuing progress for 2 hours (total of active and passive second-stage labour)17 with regional anaesthesia, or 1 hour without regional anaesthesia
- Maternal fatigue/exhaustion
what are the 2 stages of second phase of labour?
Passive: fully dilated but no urges to push
Active: expulsive contractions (making you want to push) with the finding of full dilatation of the cervix, or active maternal effort with full dilatation but without contractions
When might instrumental delivery not work?
Higher rates of failure are associated with:
- maternal body mass index over 30
- estimated fetal weight over 4000 g or clinically big baby
- occipito-posterior position
- mid-cavity delivery or when 1/5th of the head palpable per abdomen
What are risk factors for needing operative delivery?
Operative vaginal delivery is more common in:
Primiparous women
Supine and lithotomy positions
Epidural anaesthesia
Why might a longer passive stage be encouraged before instrumental delivery?
If a primip with an epidural then evidence shows that delaying pushing for 1-2 hours has a lower risk of mid-cavity or rotational operations
What is the accronym to interpret CTGs?
DR - Define Risk
C - Contractions
BRa - Baseline rate
V - Variability
A - Accelerations
D - Decelerations
O - overall assessment
What are the complications of a caesarean section in the second stage of labour?
Maternal morbidity: uterine/cervical/high vaginal injury, postpartum haemorrhage, blood transfusion, sepsis, admission to intensive care, and length of stay.
Neonatal morbidity: admission to neonatal intensive care.
