Labour Flashcards
What are some of the risks for preterm labour?
Acute illness Low BMI PROM Multiple pregnancy Polyhydramnios Cervical surgery / short cervix / incompetence Smoking Uterine abnormalities
What are some of the indications for continuous foetal monitoring during labour?
Prematurity
Meconium stained liquor
Decelerations heard on sonicaid
Oxytocin use
What should a foetal heart rate be baseline?
110-160
Define labour:
Regular uterine contractions with progressive cervical change
Occurs in 3 stages
How many deliveries are induced?
1/5 (20%)
What are some of the indications that may lead t the induction of labour?
Gestation >41 weeks Large for dates baby Gestational diabetes Pre eclampsia IUGR Intrauterine death Maternal request Premature rupture of membranes
When is a ventouse delivery contrainidcated?
In a malpresentation of the foetus presenting face first vaginally.
What abnormal foetal lie carries an increased risk of cord prolapse?
Transverse lie
Especially in PROM
What are some of the foetal outcomes in cord prolapse?
Hypoxia
Cerebral palsy
Hypoxic encephalopathy
Death
What can occur to the cord if it prolapses?
Vasospasms or compression, leading to reduced blood flow to the foetus
What is the management for cord prolapse?
Immediate call for help
Deliver ASAP either vaginally or c section depending on stage of descent etc
What is the most common foetal malpresentation?
Breech
What are the 3 types of breech?
Footling
Complete
Frank breech
How is prolonged labour defined?
When the cervix is dilated <2cm after 4 hours of active labour.
What is a normal timeframe for the 3rd stage of labour?
Placental delivery tends to occur within 5-10 minutes after the baby is delivered, however anywhere up to 30 mins is normal.
In physiological management 60mins< would be considered delayed
what time frame is classified as delay of second stage labour in nulliparous and multiparous?
Nulliparous - 2 hours
Multiparous - 1 hour
When should the cord be clamped?
Once it has stopped pulsating - anytime up to 3 minutes is appropriate.
What are the 3 classic signs that the placenta has detached and the membrane?
Umbilical cord permanently lengthens
Uterus contracts, hardens and rises
Gush of blood (variable in amount)
What are some of the complications of active management for 3rd stage?
Nausea and vomiting
Haemorrhage
Increased risk of needing blood transfusion
What are some reasons for active management instead of physiological management of 3rd stage of labour?
Patient request
Excessive hemorrhage
Time >60 mins
How do we actively manage the third stage of labour?
Oxytocin or syntometrine infusion
Cord clamping and controlled
Bladder empyting
How do we medically induce labour?
Vagianl prostaglandins (PGE2) Oxytocin infusion
How do we surgically induce labour?
Membrane sweep
Artificial amniotomy (rupture of membranes)
Cervical balloon
WHat are some of the risks attached to inducing labouur?
Increased risk of surgical delivery Uterine hyperstimulation Failed induction Cord prolapse Uterine rupture (infections)
How should a cord prolapse be managed during labour?
Call for help immediately
Immediate delivery of baby (forceps if fully dilated or c section)
What are some of the risk factors for shoulder dystocia?
Large for dates Macrosomia DM Maternal BMI >30 IOL Prolonged first and second stage Forceps delivery Oxytocin
What are some of the risks to the foetus in shoulder dystocia?
Erb's palsy / Klumpke's palsy Cerebral palsy Hypoxic encephalopathy Brachial plexus injury of the newborn Death
What are some of the risks to the mother in shoulder dystocia?
Significant post partum haemorrhage
Tear / perineal trauma
Using the HELPERR mnemonic, describe how shoulder dystocia is managed?
H - call for Help
E - Evaluate for episiotomy
L - Legs (McRoberts maneuver)
P - Suprapubic Pressure
E - Enter manoeuvres (ie internal rotation of foetus anterior shoulder)
R - Remove posterior arm
R - Roll patient onto all fours and begin cycle
