labour and delivery Flashcards
what is the first stage of labour
from the onset of labour (true contractions) until the cervix is fully dilated to 10cm
involves cervical dilation and effacement
diagnosing the onset of labour
show (mucus plug from the cervix)
rupture of membranes
regular, painful contractions
dilating cervix
prophylaxis of preterm labour
vaginal progesterone (women with a cervical length less than 25mm on vaginal ultrasound between 16 and 24 weeks)
cervical cerclage (cervical length less than 25 mm, previous premature birth)
what is preterm prelabour rupture of membranes
amniotic sac ruptures releasing amniotic fluid before the onset of labour and in preterm pregnancy
diagnosis of preterm prelabour rupture of membranes
speculum examination: pooling of amniotic fluid in the vagina
if in doubt:
- insulin- like growth factor binding protein-1
- placental alpha microglobin 1
management of preterm prelabour rupture of membranes
prophylactic antibodies (prevent chorioamnionitis)
induction of labour from 34 weeks
management of preterm labour with intact membranes
fetal monitoring
tocolysis with nifedipine
maternal corticosteroids
IV Mg sulphate
delayed cord clamping
indications for induction of labour
prolonged pregnancy (1-2 weeks after estimated date of delivery)
prelabour premature rupture of membranes when labour doesn’t start
maternal medical problems: diabetic mother > 38 weeks, pre-eclampsia, obsetric cholestasis
intrauterine fetal death
5 factors in bishop score
cervical position
cervical consistency
cervical effacement
cervical dilation
fetal station
interpretation of bishop score
< 5 indicates labour is unlikely to start without induction
> 8 indicates that the cervix is favourable
induction of labour management
< 6 =
- vaginal prostaglandins (dinoprostone) or oral misoprostol
- mechanical methods, balloon catheter in women high risk of hyperstimulation or previous section
> 6=
amniotomy and an IV oxytocin infusion
membrane sweep offered to nulliparous women 40-41 week antenatal visit, parous women 41 week. done prior to formal induction of labour
complication of induction of labour
uterine hyperstimulation
- prolonged and frequent uterine contractions that can cause fetal hypoxemia and acidemia and uterine rupture
management of uterine hyperstimulation
removing vaginal prostaglandin and stopping oxytocin infusion
consider tocolysis
indications for caesarean section
absolute cephalopelvic disproportion
placenta praevia grades 3/4
pre-eclampsia
post-maturity
IUGR
fetal distress in labour/prolapsed cord
failure of labour to progress
malpresentations: brow
placental abruption: only if fetal distress; if dead deliver vaginally
vaginal infection e.g. active herpes
cervical cancer (disseminates cancer cells)
categories of c-section
category 1: immediate threat to life of mother or baby
category 2: maternal or fetal compromise, delivery of baby within 75 minutes
category 3: delivery is required but mother and baby are stable
category 4: elective
contraindications for vaginal birth after caesarean section
previous uterine rupture
classical caesarean scar
risk factors for breech presentation
uterine malformations, fibroids
placenta praevia
polyhydramnios or oligohydramnios
fetal abnormality
prematurity
management of breech presentation
if < 36 weeks: may turn spontaneously
if still breech at 36 weeks:
- external cephalic version
- planned caesarean section
indications for forceps delivery
fetal distress in the second stage of labour
maternal distress in the second stage of labour
failure to progress in the second stage of labour
control of head in breech deliver
stage one of labour
onset of true labour to when the cervix is fully dilated
stage 2 of labour
from full dilation to delivery of fetus
stage 3 of labour
from delivery of fetus to when the placenta and membranes have been completely delivered
active management of the third stage of labour
IM oxytocin and controlled cord traction
