Labour and Birthing Flashcards
Normal Labour
Occurs spontaneously 37-42 weeks gestation Singleton Cephalic presentation Regular contractions resulting in cervical dilation No intervention Can last 4-24hrs
Second Stage
Full dilatation to birth of baby
Strong contractions, 2-4mins apart lasting 60-90sec
Full dilation to 10cm
Urge to push
Advancement of the presenting part to birth of the baby
1-2hrs in duration
Third Stage
From birth of baby to birth of placenta
Up to 1hr physiologically
Oxytocic is given usually
Estimate blood loss
Pre-labour Rupture of Membranes (PROM)
10% of pregnancies
Diagnosis difficult - history, examination and Amnisure
Check for infection
NO VE
Reasonable to induce them the next day or send home and wait up to 96hrs
Pre-term Pre-labour Rupture of Membranes (PPROM)
23-36+6 weeks
RF - PHx PPROM, infection, smoking, APH, polyhydramnios, multiple pregnancy
Give antibiotics (erythromycin) and steroids
Wait to at least 34 weeks to deliver if no signs of infection
Pre-viable PPROM
<24 weeks
Causes include iatrogenic (amniocentesis) and spontaneous (infection, cervical incompetence, abruption).
Fetal complications include death, severe prematurity, sepsis, pulmonary hypoplasia and skeletal deformities
Pain relief options in labour
and their side effects
Non-pharmacological - hot water, massage, positioning, music, rocking, medicine ball
Nitrous oxide gas (S/E: dizziness, dry mouth, nausea)
Pethidine IM (S/E: maternal and fetal sedation, risk of sciatic nerve injury)
Epidural/spinal anaesthetic (S/E: anaesthetist, paralysis, infection, loss of motor function, IV access, catheter, maternal hypotension, increased chance of needing syntocinin)
Indications for Induction of labour
Maternal health (DM, PET) Distressed baby >41 weeks PROM Prolonged first stage (cervix dilating <1cm/hr)
Methods of inducing labour
Membrane sweep (can be done at 39-40 weeks)
ARM
Prostaglandins if cervix is unfavourable
Oxytocin if cervix is favourable
Indications for instrumental delivery
Maternal exhaustion Inability to push (e.g. due to epidural) Prolonged 2nd stage Fetal distress Twins - for the second twin
Forceps complications
Maternal - injury to vaginal wall, requires episiotomy, fecal incontinence, infection, dyspareuria
Fetal - may leave mark on the babies face however this will fade, facial nerve palsy, cephalhaematoma, subconjunctiva haemorrhage, skull fracture
Forceps requirements
Confirmed ROM Fully dilated cervix Presenting part below the ischial spines Adequate analgesia Empty bladder (catheter) Cephalic presentation No obvious cephalic-pelvis disproportion Position of fetus is known
Ventouse Contraindications
Bleeding disorder Predisposition to fracture (e.g. OI) Fetal head above ischial spines Significant prematurity (<34 weeks) Face presentation
Looking for fetal distress in labour
Liquor
Fetal heart rate
CTG
Fetal scalp blood sampling