Labour and delivery Flashcards
Stages of labour
Stage 1: From onset of labour until 10 cm cervical dilation
Stage 2: from 10cm cervical dilatation until the delivery of the baby
Stage 3: from delivery of the baby until delivery of the placenta
Stages of first stage of labour
Latent - 0-3cm, irregular contractions
Active - 3-7 cm dilation, regular contractions
Transition - 7-10 cm, strong regular contractions
What are Braxton-hick’s contractions
Occasional irregular contractions of the uterus - felt during the second and third trimester. They are not true contractions and do not indicate onset of labour
Signs of onset of labour
Rupture of membranes
Regular, painful contractions
Dilating cervix on examination
What does PROM mean?
Amniotic sac has ruptured before onset of labour
What does P-PROM mean?
The amniotic sac has ruptured before onset of labour and before 37 weeks gestation
What does prolonged rupture of membranes mean?
The amniotic sac ruptures more than 18 hours before delivery
How do you classify pre-term?
Under 28 weeks - extreme preterm
28-31 - very preterm
32-37 - moderate to late preterm
Prophylaxis of pre-term labour
Vaginal progesterone - decreases activity of the myometrium and prevents cervix remodelling in preparation for delivery
Cervical cerclage - involves putting in a stitch in the cervix to add support and keep it closed. The stitch is removed when the woman goes into labour or reaches term.
Preterm Prelabour Rupture of Membranes - Diagnosis and management
Diagnosis - on speculum examination - pooling of amniotic fluid in the vagina
Management - prophylactic antibiotics to prevent chorioamnionitis.
Preterm labour with intact membranes - diagnosis and management
speculum examination to diagnose.
Management - foetal monitoring (CTG), tocolysis with nifedipine to suppress labour
Maternal corticosteroids - to reduce neonatal morbidity and mortality
IV Magnesium sulphate - can be given before 34 weeks and helps protect baby’s brain
Delayed cord clamping
What is the bishops score?
Used to determine whether to induce labour.
A score of 8 or more predicts a successful induction of labour
Options for induction of labour
Membrane sweep
Vaginal prostaglandins to stimulate the cervix and cause onset of labour
Cervical ripening balloon
Artificial rupture of membranes with oxytocin infusion
Oral mifepristone and misoprostol
NICE:
if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol
mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion
Five key features on a CTG
Contractions
Baseline rate
Variability
Accelerations
Decelerations
What do decelerations indicate?
Drop in foetal HR in response to hypoxia.
Causes of decelerations: VEAL CHOP
Variable decelerations –> Cord compression
Early decelerations –> Head compression
Accelerations –> Okay!
Late decelerations –> Placental Insufficiency
What are early decelerations?
Gradual dips and recoveries in HR that correspond to uterine contractions. These are normal and not pathological.
What are late decelerations?
Gradual fall in HR after uterine contractions. Caused by hypoxia
What are variable decelerations?
Abrupt decelerations unrelated to uterine contractions. Falls of more than 15 bpm of baseline
What are prolonged decelerations?
Last between 2-10 minutes with a drop of more than 15bpm of baseline. Often indicates umbilical compression causing foetal hypoxia.
Management of foetal hypoxia
Rule of 3s
3 minutes - call for help
6 minutes - move to theatre
9 minutes - prepare for delivery
12 minutes - delivery the baby (delivery by 15 minutes)
