Labour Flashcards
What is the name given to contractions that happen throughout pregnancy but doesn’t mean labour is occurring?
Braxton Hicks contractions
The first stage of labour:
Latent phase:
- Describe the contractions
- Cervical effacement - what is it?
- How much does the cervix dilate up to?
- What is the bloody show?
Acute phase:
- Describe the contractions
- How much does the cervix dilate up to?
- What is the rate of cervical dilation?
Gradually more intense contractions
Thins softens and becomes shorter by pulling in the uterus
Up to 3cm
Regular myometrial contractions
Up to 10 cm
Rate of 1cm/hour
The first stage of labour:
Monitoring during the active phase of labour:
DON’T FORGET THIS IS DONE BY MIDWIVES
What is checked every 15 minutes?
What is checked every 30 minutes?
What is checked every hour?
What is checked every 4 hours?
Where is all this recorded in? - P
Auscultation of fetal HR for 1 minute after contractions
Frequency of contractions, which should be 3-4 minutes apart
Check maternal HR
Check maternal BP and temperature
Examine vagina
Check urine for ketones and protein
Partogram
The first stage of labour:
What is a poor progression of labour suggested by?
3Ps causing this:
- Power - what does this mean?
- Passenger - what does this mean?
- Passage - what does this mean?
<2cm dilation in 4 hours
Uterine weakness - the commonest cause
Size
Position
Presentation of the baby
Pelvic problem
The first stage of labour:
Vaginal exam during labour:
- What do you feel at the top of the babies head?
- What else should be checked?
- What if present would be an obstetric emergency?
Fontanelles (3 sides = posterior, 4 sides = anterior)
Cervical effacement and dilatation
Head station
Liquor
Palpable cord
The second stage of labour:
What does this mean?
Stage 1 - the baby enters pelvis OT:
- What does OT mean?
- Why does this happen?
Stage 2 - the baby internally rotates OA and crowns:
- What does OT mean?
- Why does this happen?
Stage 3 - head pops out and shoulders delivered:
- Restitution - what is it?
- What shoulder is delivered first?
- What could the midwife or attendant do to help the delivery of this shoulder?
Stage 4 - Rest of baby born:
- What shoulder is delivered next, followed by the rest of the body?
Fetal descent through the vagina and expulsion, as the mother has urge to push
Occipito-transverse
Occipito-anterior
The head rotates externally to its direction at the onset of labour
Anterior shoulder
Posterior shoulder
The second stage of labour:
Monitoring:
DON’T FORGET THIS IS DONE BY MIDWIVES
What is checked every 5 minutes?
What is checked every 30 minutes?
What is checked every hour?
What is checked every 4 hours?
Where is all this recorded in? - P
Fetal HR - auscultation
Contraction frequency
Maternal BP, HR and vaginal exam]
Maternal temperature
Partogram
The second stage of labour:
Management:
- How long should passive (uterine) pushing be allowed before active pushing?
- What position should be used?
- What does a water birth reduce the rate of?
1 hour
Whatever is comfortable for the woman
Tears and less need for episiotomies
The third stage of labour:
What is it?
Physiological management:
- What should stop before the cord is cut?
- Why does this type have a higher risk of PPH?
Active management:
- How long should be allowed before double clamping and cutting cord?
- What 2 drugs can be given to help with placental delivery? - O, S
- Route?
- Why do you hold on to the uterus with your left hand on the abdomen during controlled cord traction?
Delivery of placenta
1 minute
Oxytocin
Syntometrine (Ergometrine)
IM
To prevent the inversion of the uterus
The third stage of labour:
What type of scoring can be done for baby?
What can be given to baby to reduce risk of bleeding?
APGAR score - look at paeds
Vit K 1mg IM
