Labour Flashcards
outline the three stages of labour
first - from nothing to full dilatation
second - delivery of the baby
third - delivery of the placenta
outline the latent and active phases of the first stage of labour
latent - from 0-4cm dilation, slow dilatation
active - from 4-10cm, faster usually 1cm per hour
what are the changes in contractions and the cervix during the first stage of labour
cervix shortens and softens
contractions become stronger, more frequent and regular
the first phase of labour should be no more than __ hours
18 in nulliparous women
what is the second phase of labour
from full dilation to delivery of the baby
how long should the second phase of labour last in nulliparous women
<2 hours if no analgesia
<3 hours if analgesia
how long should the second phase of labour last in multiparous women
<1 hour if no analgesia
<2 hours if no analgesia
describe the passive stage of second phase of labour
woman if fully dilated and feels head reaching the pelvic floor, feels desire to push
describe the active stage of second phase of labour
baby is visible, persistent involuntary contractions and active maternal effort in time with contractions
what is the third stage of labour
from the delivery of the foetus to the expulsion of the placenta and membranes
how long should the third stage of labour last
usually lasts around 10 minutes but should be no more than 30 minutes
if the third stage of labour exceeds 30 minutes, what are the next steps in management
give IM syntocinon and observe for further 30 minutes - 1 hour in total
what are the indications to switch from physiological to active management of the third stage of labour
active bleeding
failure to deliver placenta in 1 hour
patient desire
list some indications that the placenta may have separated from the uterus
uterus contracts, hardens and rises
umbilical cord lengthens permanently
gush of blood
placenta visible at introitus
list the 7 cardinal movements of the foetus in preparation for labour
engagement descent flexion internal rotation extension external rotation expulsion
list some causes of malpresentation
breech
transverse lie
shoulder
brow/face presentation
what is the correct presentation of a foetus in labour
cephalic presentation, longitudinal lie
presenting part = vertex
occipito-anterior
outline some causes of failure to progress during labour (3Ps)
power - inadequate or infrequent contractions
passages - abnormally shaped pelvis, trauma
passengers - big baby, malposition, cephalic-pelvic disproportion
what are some risk factors for foetal hypoxia
small for dates preterm antepartum haemorrhage pre-eclampsia at term diabetes epidural analgesia sepsis induction of labour
what are the two methods of assisted delivery
forceps delivery
ventouse/vacuum assisted
what is the aim of assisted delivery
use of instrument to facilitate same cardinal movements before birth
for forceps delivery, what features must be present
fully dilated OAP ruptured membranes cephalic presentation engaged presenting part
amniotic fluid embolism is one of the immediate complications of labour, how does it present
respiratory distress
hypoxia
hypotension
usually occurs within 30 mins of delivery
what are the indications of induction of labour
prolonged pregnancy >42 weeks pre-eclampsia at term diabetes in pregnancy IUGR but NOT macrosomia alone
what are the three methods of induction of labour
vaginal prostaglandins
amniotomy
membrane sweep
what are the options for anaesthesia in labour
spinal anaesthesia
epidural
pudendal anaesthesia
