Labour Flashcards
What is the green pathway?
Midwife lead care
Healthy women with a normal pregnancy and no significant complicating social factors
What is the red pathway and what women go down this route?
Obstetric lead care
For women with significant medical/ obstetric/ social risks
- Age
- Diabetes, high BMI, epilepsy, heart conditions
- Previous pregnancy complications- stillbirth or neonatal death, severe preeclampsia
- Alcohol or drug misuse, significant mental health issues
What is the Ferguson Reflex?
Neuroendocrine reflex that compromises the self-sustaining cycle of uterine contractions initiated by pressure at the cervix or vaginal walls
Example of positive feedback
In terms of the onset of labour, what is the role of Progesterone?
Keeps the uterus settled
Prevents the formation of gap junctions and hinders the contractability of myocytes
In terms of the onset of labour, what is the role of Oestrogen?
Makes the uterus contract
Promotes prostaglandin production
In terms of the onset of labour, what is the role of Oxytocin?
Initiates and sustains contractions
Oxytocin acts on decidual tissue to promote prostaglandin release
Synthesised directly in decidual and extraembryonic fetal tissues and in the placenta
What is cervical ripening?
Where the cervic changes from firm and closed, to soft and thin
What is the Bishop’s score used to determine?
If its safe to induce labour
Score of 8 or more is considered favourable
What are the 5 elements of the Bishops Score?
Position
Consistency
Effacement
Dilitation
Station in Pelvis
What are the 3 stages of labour?
-
First Stage
- Latent stage- up to 3-4cms dilation
- Active stage- 4-10cm dilated (full)
-
Second Stage
- Full dilitation to delivery of the baby
-
Third Stage
- Delivery of baby, expulsion of placenta and membranes
What occurs in the latent phase of stage 1?
Mild and irregular uterine contractions, the cervix softens and shortens.
Duration of the latent stage is varaible and can last an uncomfortable few days.
What occurs in the active phase of stage 1?
Slow desent of the baby
Contractions progressively become stronger and more rhythmic
Normal progress is around 1-2cm an hour
What is the normal length of time for Stage 2 of labour?
Nulliparous- considered prolonged if it exceeds 3 hours with regional analgesia or 2 hours without
Multiparous- prolonged if exceeds 2 hours with analgesia and 1 hour without
How long is the 3rd stage of labour?
Average duration is around 10 minutes
After an hour, preparation is made to remove the placenta under GA
What are Braxton Hicks contractions?
Tightening of the uterine muscles, thought to aid the body in preparation for birth
Can start as early as 6 weeks into the pregnancy, but more common in the third trimester
What hormone influences labour?
Oxytocin
What is true labour?
When the timing of the contractions become evenly spaced and the time between becomes increasingly shorter
Length of time the contraction lasts increases
What are the 3 Ps of labour?
- Power- uterine contractions
- Passage- maternal pelvis
- Passenger- fetus
What is the most sutiable pelvic shape for giving birth?
Gynaecoid
What is an Android pelvis and what group of women is it mostly seen in?
Android shaped pelvis has a triangular or heart-shaped inlet and is narrower at the front
Afro-Carribean women
Describe an anthropoid pelvis?
Oval shaped inlet with large anterio-posterior diameter and compartively smaller transverse diameter
What presentation is the best for a normal delivery?
Cephalic presentation
What are the analgesia options in childbirth?
- Paracetamol/ co-codamol
- TENS
- Entonox
- Diamorphine
- Epidural
- Remifentanyl
- Combined spinal/ epidural
What are the 7 cardinal movements of childbirth?
- Engagement
- Descent
- Flexion
- Internal Rotation
- Extension
- External Rotation
- Expulsion
When is the fetal head engaged?
When the widest diameter of the fetal head has entered the brim of the pelvis. Described as 3/5s of the head having entered and 2/5s still in the abdomen
In a normal labour, how often should vaginal examinations be carried out?
4 hourly
What indicated placental sepatation?
Uterus contracts, hardens and rises
Umbilical cord lengthens permenantly
Frequently there is a gush of blood in variable amounts
What is lochia?
The vaginal discharge after giving birth. Contains blood, mucus and uterine tissue
Typically continues for 4-6 weeks after child birth
What are the different types of lochia?
- Rubra- fresh red (3-4 days)
- Serosa- brownish, red and watery (4-14 days)
- Alba- yellow (10-20 days)
What are the borders of the vertex of the foetal skull?
Bound by the anterior and posterior fontanelles as well as the parietal eminences
In stage 1 of labour, when is delay of progression suspected?
Nulliparous- less than 2cm dilation in 4 hours
Parous- less than 2cm dilation in 4 hours or slow progressing
On a CTG, how is hypoxia characterised?
- loss of accelerations
- repetitive deeper and wider decelerations
- rising fetal baseline heart beat
- loss of variability
