Labour and Delivery 1 Flashcards
What is the definition of labour?
painful uterine contractions accompanying dilation and effacement of cervix
process whereby fetus and placenta are expelled from the uterus, usually between 37 and 42 weeks
What is the first stage of labour?
Dilation period
initiation (when regular contractions start) to full cervical dilation
What is the second stage of labour?
full cervical to delivery of the fetus
What is the third stage of labour?
delivery of the fetus to delivery of the placenta
What is effacement?
Bulb shape of cervix flattens when contractions staring and full dilation of the cervix
What is the normal rate of dilation?
1-3cm per hour
How are patients monitored during labour?
vaginal exam every 4 hours - assess dilation and position of the head (distance from ischial spine)
maternal urine every 4 hours - if ketones give 10% dextrose IV
maternal BP and temp every 1/2 hour
Contractions every 15 mons
Fetal HR every 15 mins
What are the key components of an abdominal palpation?
Lie - longitudinal, transverse Attitude - posture, flexed, extended Presentation - cephalic/breech Position - left OA Engaging diameter Denominator = presenting part
What will occur in stage 2?
complete dilation - 10cm
mother will feel the urge to push using abdo muscles and Valsalva
What is the normal duration of stage 2 if a primip and a multip?
45-120 mins in a primip
15-45 mins in a multip
What is engagement?
largest part of the fetal head entering the pelvis
What is restitution?
head turning to face postero-laterally
What is external rotation?
shoulders turning for delivery
Describe stage 3
delivery of the placenta and membranes
bleeding control
uterus shrinks after delivery
placenta separates from the uterine wall
When is syntometrine given?
after head and anterior should delivered (otherwise risk of shoulder dystocia) to reduce the length of stage and risk of PPH
What is a post partum haemorrhage?
loss of >500mls blood after delivery
What are the causes of PPH?
trauma
tissue - placental retention
thrombin - coagulation disorders
tone - uterine atony (80% of PPH)
What are the RFs for PPH?
polyhydramnios
multiple gestations
prolonged labour
excess oxytocin
What are the two most important RFs to consider for DVT prophylaxis?
age >35
BMI >35 or weight over 90kg
What are the other RFs considered for DVT prophylaxis?
parity >4 varicose veins nephrotic syndrome sickle cell IBD pre-eclampsia infection labour >12 hours excess blood loss dehydration immobility forceps delivery
What are some examples of delivery complications?
arrest of descent nuchal cord ] fetal distress perineal lacerations shoulder dystocia
What is an episiotomy?
a cut in the perineum
What are the indications for an episiotomy?
perineal tear appears inevitable fetal distress pre-term delivery breech delivery forceps or ventouse delivery
What are the pros of an episiotomy?
easier to repair
decreased trauma to perineum
What are the side effects of an episiotomy?
pain
blood loss
breakdown of wound
dyspareunia - pain during intercourse
What is a 1st degree perineal laceration?
vaginal mucosa and perianal skin
What is a 2nd degree perineal laceration?
perianal muscles
What is a 3rd degree perineal laceration?
external anal sphincter
What is a 4th degree perineal laceration?
anterior rectal wall is involved
How common is shoulder dystocia?
0.2-2% of deliveries
40-50% in low birth weight
What are the RFs for shoulder dystocia?
fetal macrosomia
diabetes
prolonged second stage
What are the risks of shoulder dystocia?
maternal morbidity - PPH, 4th degree lacerations
neonatal morbidity - asphyxia, brachial plexus erb palsy, humerus or clavicle fracture
