Labour Flashcards
what happens during the first stage of labour?
early latent phase and an active phase
onset of regular painful contractions and cervical changes
…until full dilation and cervix is not palpable.
what happens in the early latent phase?
cervix becomes effaced, shortens in length and dilates up to 4cm
what happens in an active phase?
the cervix dilates from 4cm to full dilatation
what happens in the 2nd phase of labour?
full dilatation to delivery of the fetus
what happens in the 3rd phase of labours?
time between delivery of the fetus and delivery of the placenta
considered normal up to 30mins
what are the signs to indicate the separation of the placenta and membranes?
uterus contracts, hardens and rises
umbilical cord lengthens permanently
gush of blood variable in amount
placenta and membranes appears at introitus
when do you move from physiological management to active management for placental expulsion?
if there is excessive bleeding
failure to deliver the placenta within one hour
patient’s desire to shorten 3rd stage
when is delay in the 3rd stage diagnoses?
60 minutes of physiological management
30 minutes of active management
how much is the cervix expected to dilate in 4 hours during labour?
more than or equal to 2cm
what are uterotonic drugs?
uterine stimulants are medications given to cause a woman’s uterus to contract, or to increase the frequency and intensity of contractions
what are some examples of uterotonic drugs?
oxytocin
syntometrine (ergometrine and oxytocin)
what are Braxton Hicks contractions?
contractions which are believed to be the uterine muscles preparing for labour
the initiation of labour involves what changes to progesterone, oestrogen and prostaglandin action?
progesterone withdrawal
increases in oestrogen and prostaglandin action
what hormone initiates and sustains contractions?
oxytocin
what are the 7 cardinal movements?
engagement descent flexion internal rotation extension external rotation expulsion
how many women will achieve a normal delivery?
60% normal delivery
25% caesarean section
15% forceps
what are situations of abnormal labour?
malpresentation malposition (OP / OT) too early (<37wks) too late (>42wks) too painful too quick (<2hrs) too long fetal distress
what are the 3 Ps of labour?
power
passages
passenger
what problems can their be with power?
inadequate contractions either in the strength or frequency of contractions
what problems can there be with passages?
trauma
shape
cephalopelvic disproportion
what problems can there be with passenger?
big baby
malposition causing a relative cephalo-pelvis disproportion
in labour there is a vaginal examination every 4 hours to assess what?
cervical dilatation
descent of presenting part
signs of obstruction
what are some different types of forceps?
outlet forceps
mid-cavity/low-cavity forceps
rotational forceps
what forceps are used for Wrigley’s forcep?
outlet forceps
what forceps are used for Neville-Barnes, Andersons & simpsons?
Mid-cavity/low-cavity forceps
what forceps are used for Kielland’s forceps
rotational forceps
what are the requirements for forceps delivery?
FORCEPS Fully dilated cervix Occipitoanterior position Ruptured membranes Cephalic presentation Engaged presenting part Pain relief Sphincter empty
what are the indications for operative vaginal delivery?
failure to progress to 2nd stage of labour
fetal distress
maternal exhaustion
what are the advantages of caesarean section?
avoid tears and so long-term urinary/faecal incontinence
no injury to cervix/high vaginal areas
less chance of neonatal trauma
disadvantages of caesarean section?
major surgery so risk of haemorrhage, infection, visceral injury, venous thromboembolism
longer hospital stay & recovery
what are the three potential injuries with ventouse delivery?
caput succedaneum
cephalohaematoma
subgaleal haemorrhage
when does induction of labour occur?
when the risk to mother or baby of continuing pregnancy exceeds the risks of inducing labour
what are indications for induction?
prolonged pregnancy (>42wks) pre-eclampsia placental insufficiency & IUGR antepartum haemorrhage rhesus diabetes mellitus chronic renal disease
what does the Bishop score look at?
dilatation effacement station consistency cervix position
what are some methods of induction?
stripping of membranes / sweep
AROM
what is a partogram?
graphic representation of maternal and fetal data during labour and often started as soon as woman is admitted to the delivery suite
what is labour pain due to?
compression of para-cervical nerves and myometrial hypoxia during cotnractions
what types of analgesia are available in labour?
narcotic analgesia (morphine, pethidine, remifentanil) inhalation (entonox) TENS Epidural Spinal Pudendal nerve block
what is the mnemonic for looking at CTGs?
DR C BRAVADO
what is DR C BRAVADO?
DR - define risk C - contractions BRA - baseline rate V - variability A - accelerations D - decelerations O - overall impression/diagnosis
how many contractions do you expect in labour?
3-5 every 10 minutes
how much should a fetal baseline heart rate be?
110 - 160 beats per minute
where does normal fetal pH lie?
7.25 - 7.35
what are the 4Hs and 4Ts of maternal collapse?
Hypovolaemia
Hypoxia
Hypo/hyperkalaemia
Hypothermia
Thromboembolism
Toxicity
Tension pneumothorax
Tamponade
