Labour and Birthing Flashcards
The baby needs to do what series of movements in order to complete the second stage of labour
- Engagment (may occur in the first stage)
- Flexion
- Internal rotation
- Extension/birht of head
- Restitution
- Explusion
The ______ diameter is the smallest part of the pelvic inlet
The ______ diameter is the smallest part of the pelvic cavity
The ______ diameter is the smallest part of the pelvic Outlet
The transverse diameter is the smallest part of the pelvic inlet
The anterioposterior diameter is the smallest part of the pelvic cavity
The anterioposterior diameter is the smallest part of the pelvic Outlet
The First stage of labour includes
Onset of contractions and cervical effacment (from prostaglandin release)
- Latent Phase: effacement and some descent, contractions can be irregular. ~10-12hrs
- Active phase: ~1cm/hr dilitation (<0.5cm/hr concerning)
Usually the mucus show and SROM will occur in
The first stage of labour
What are the four markers of labour
- Regular painful contractions
- Show
- Cervical dilitations
- Rupture of membranes
Why does the baby flex its head?
Because the suboccipito bregmatic diameter is then the presenting part, and this is the smallest
What entails an admission assessment for a woman in labour
- time of onset, frequency and durations of contractions
- Any vaginal loss (show, SROM, blood)
- Obs taken
- ?urinalysis
- Fetal presentation, lie, descent determined and fetal size (fundal height) assessed.
- Low Risk: fetal HR auscltated during and after a contraction
- High risk: continuous CTG monitoring
- Palpate materal HR during to differentiate pulses
- VE performed after placenta praevia and PPROM are excluded.
When performing a vaginal exam, what is the midwife looking at in terms of the Bishop Score?
A score used to gauge whether induction of labour is required
- Position of cervix: usually more anterior as labour progresses
- Effacement of the Cervix: should be soft from PG release
- Consistency of cervix:
- Dilitation of cervix
- Station of the presenting part
They also look at the colour of liquor
If the cervix is dilated, what else will a midwife be feeling for during a vagination examination
- The fetal presenting part
- caput and/or molding of the head
- position of the fetal head
Why should you avoid a supine (flat) position during labour
The uterus can fall back onto the IVC, decreasing venous return to the heart
Nutrition and fluid intake in pregnancy?
>6hours: due to gastric stasis, exertion of labour and poor fuid absorbtion can lead to dehyrdration. Acidosis and ketosis can follow, uterine SM function deteriorates → labour dystocia
If labour is >6hrs and delivery is not imminent, give IV fluids
If maternal tachycardia and fever are noted, what investigations are required
Urgent dx and treatment is required as every degree rise doubles the fetal metabolic requirements. Give parental ABs and deliver if amnionitis is suspected
- FBC + blood cultures
- MSU
- Examination of the heart, lungs, loins
- vaginal swabs
Clear indications for a vaginal examination are (as this is painful and shouldn’t be done without reason)
- Assessment of progress
- amniotomy to augment labour
- to confirm full dilitation
- fetal scalp electrode palcement
- Fetal blood sampling
Usually done four-hourly, and therefore a 2cm increase during active labour would be expected. Any slowing, especially in a multiparous women is critical.
Normal fetal Heart record
Rate:
Band width:
Rate: 110-160
Band width: 6-25
No decelerations
What can fetal tachycardia be due to
- maternal fever
- fetal infection
- Hypoxia
- prematurity
- intense fetal activity
What can you potneitally do to fix variable decelerations?
Change maternal position
Late Decelerations are due to?
What can you do?
fetal hypoxia, and 50% of these fetuses will be acidotic.
Take a fetal pH or lactate measurement.
Delivery may be required
Variability (5-10bpm) that is reduced for >40 minutes in a term fetus indicates?
CNS dysfuntion secondary to fetal hypoxaemia
When should you give antibiotics during labour?
What antibiotic should you use?
Intrapartum anitbiotics should be give if the woman has tested positive for Group B Strep on antenatal vaginal swabs.
IV penicillin
Non pharmacological pain relief during labour?
Relaxation, breathing, water immersion, heat packs, transcutaneous electrical nerve stimulation (TENS)
Pharmacological pain relief during labour
Inhaled NO, IV opiods, PCA, epidural
Antenatal indications for continuous CTG monitoring
- SIgns of fetal distress
- Growth Restriction
- Pre/post erm fetus
- Multiple pregnancy
- Maternal disease (PET, HTN, diabetes)
- BMI>40
- Age >42
- Previous c section
In labour indications to start continuous CTG
- haemorrhage
- induced labour
- liquor: absent, reduced, blood stained, meconium stained
- Malpresentation
- Bleeding or fever
- anaethesia
- prolonged labour
Indications for an episiotomy?
- Bleeding: suggests vaginal skin tearing prior to complete crowing
- Fetal distress
- Failure to progress in the second stage with head in the perineum
- Shoulder dystocia
- Forceps deliveries
Where should an episiotomy be
mediolateral as this is associated with less 3rd and 2nd degree tears
What do you need to consider when delivering the shoulders?
That careful delivery of the anterior shoulder will protect the brachial plexus. THe anterior shoulder + arm must be in view prior to delivering the posterior shoulder.
In a third and fourth degree tear, after repair has occured what else should be done/given
- Prophylactic antibiotics
- Laxatives
- Pelvic floor exercises
- FU in 6 weeks with gynaecology clinc
What is given during the seond stage to minimise the risk of PPH in the third stage, and when exactly is it given.
When should you not give this?
IM syndometrine or IV syntocin is given during the delivery of the anterior shoulder which has been shown to decrease the risk of PPH by ensuring complete delivery of the placenta.
Contraindicated in HTN and cardiac disease
When and how do you start controlled cord traction (CCT)
Once you see signs of placental seperation: gush of blood, lengthening of the cord, uterine contraction
- One hand on pubic symphis
- Other hand posteriorally tractions the cord
- Maternal explusion effort also aids
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What things are you lookng for on examination of the placenta following the third stage
- Missing coytledons: raw depressed area
- indicates evacuation of uterus
- Torn vessels
- ?succenturiate (accessory) lobe could’ve been left behind
Normal types of placenta versus abnormal
Normal: Cord in centre, membranes at edge
Battledore: cord inserted towards the edge
Velamentous: thin, wide, cord inserted at edge
Circumvallate: associated with APH
Succenturiate: has an accessory lobe
