Labour & Birth Flashcards
Describe an oblique lie
Baby is lying at a slight diagonal with buttocks or head just off centre of fundus
Describe a longitudinal lie
Baby is lengthways in line with the mother with either buttocks or head at fundus
Describe a transverse lie
Baby is lying across the mother with head and buttocks at the sides of the uterus
What are the THREE names for the different lie of the baby
Oblique
Longitudinal
Transverse
What are the SIX possible positions for a vertex presentation?
Left Occipitoanterior (LOA) Right Occipitoanterior (ROA) Left Occipitolateral (LOL) Right Occipitolateral (ROL) Left Occipitoposterior (LOP) Right Occipitoposterior (ROP)
Describe a left Occipitoanterior position
Occipital bone is located in the front left side of the mothers pelvis
Describe the right Occipitoanterior position
Occipital bone is located in the front right ride of the mothers pelvis
Describe the left Occipitolateral position
Occipital bone is located in the left side of the mothers pelvis
Describe the right Occipitolateral position
Occipital bone is located in the right side of the mothers pelvis
Describe the left Occipitoposterior position
Occipital bone is located in the back left of the mothers pelvis
Describe the right Occipitoposterior position
Occipital bone is located in the back right of the mothers pelvis
What are the names of the FIVE presenting parts and what are they?
Vertex - top of baby's head Brow - brow of baby's head Face - baby's face Breech - baby's legs or buttocks Shoulder - baby's shoulder
List ELEVEN possible complications of an Occipitoposterior position
- higher presenting part with wider diameters so takes longer to negotiate the pelvis
- early rupture of membranes increasing the risk of infection
- cord prolapse
- uncoordinated uterine action leading to prolonged labour
- urinary retention
- premature urge to push
- increased risk of trauma to vagina and pelvic floor
- increased risk of instrumental and/or operational delivery which may be associated with increased blood loss
- abnormal moulding which may result in an unsettled baby and increase the risk of intracranial haemorrhage
- lower apgar scores
- increased perinatal mortality and morbidity
What are the TEN possible complications of a breech presentation?
- early rupture of membranes with increased risk of infection
- uncoordinated contractions leading to prolonged labour
- increased risk of cord compression during first and second stage
- cord, foot, leg and arm prolapse
- early urge to push
- increased risk of operative delivery
- head undergoes compression and decompression increasing the risk of intracranial haemorrhage
- increased risk of trauma to the vagina and pelvic floor
- increased risk of birth asphyxia
- increased perinatal mortality and morbidity
What are the FIVE contraindications of a vaginal examination?
- bleeding
- placenta praevia
- preterm rupture of membranes
- preterm labour (initial VE should be undertaken by an obstetrician
- no consent from the woman
What are the SEVEN reasons why a vaginal examination may be undertaken?
- confirm the onset of labour
- assess progress during labour
- identify the presentation and position
- perform an artificial rupture of the membranes
- apply a fetal scalp electrode
- exclude cord prolapse following spontaneous rupture of membranes
- confirm the onset of the second stage of labour
Describe the position, consistency, effacement and dilatation of the cervix prior to labour
Posterior / Central
Firm
Non-effaced
Cervical OS closed
Describe the position, consistency, effacement and dilatation of the cervix in early labour
Anterior
Softer
Fully or partially effaced
Fully or partially dilated
During a VE, what can be felt if it is a cephalic presentation?
Smooth, round and firm and sutures or fontanelles may be felt
During a VE, what can be felt if it is a breech presentation?
Feels soft and irregular, sacrum and anus may be felt
During a VE, what can be felt if it is a face presentation?
Feels soft and irregular, orbital ridges may be felt
During a VE, what can be felt if it is a cord presentation?
Pulsations can be palpated through the membranes
What does the posterior fontanelle feel like?
A small triangular shaped area with three sutures running from it
What does the anterior fontanelle feel like?
A larger diamond shaped area with four sutures running from it
What position would a right oblique sagittal suture indicate?
Right Occipitoposterior
OR
Left Occipitoanterior
What position would a left oblique sagittal suture indicate?
Right Occipitoanterior
OR
Left Occipitoposterior
List THIRTEEN potential risk factors for neonatal compromise
- maternal disease eg. Hypertension, diabetes mellitus
- maternal substance abuse
- previous poor obstetric or neonatal history eg stillbirth
- known malpresentation eg. Breech
- fetal abnormality
- prematurity
- prolonged rupture of membranes
- abnormalities of the fetal heartbeat indicative of fetal compromise
- fresh meconium within the amniotic fluid
- heavy maternal sedation
- precipitate delivery
- instrumental or operative delivery especially under general anaesthetic
- obstetric emergency eg. Prolapsed cord, ante partum haemorrhage, shoulder dystocia, eclampsia
What are the FOUR stages of asphyxia?
- hyperventilation
- primary apnoea
- gasping
- terminal apnoea
Describe the stages and process of neonatal resuscitation
DRYING - aids thermo regulation and provides tactile stimulation
ASSESS - check colour, tone, breathing, heart rate
AIRWAY - open the airway by putting head in a neutral position
BREATHING - five slow initial inflation breaths to inflate alveoli
REASSESS - check colour, tone, breathing, heart rate
BREATHING - ventilation, 30 breaths per minute (1 every 2 seconds)
REASSESS - after 30 breaths, check colour, tone, breathing, heart rate
CIRCULATION - 3 chest compressions to 1 ventilation breath
At what intervals following birth, is the Apgar assessment undertaken?
1 minute
5 minutes
10 minutes
What FIVE variables are assessed in the Apgar score?
- respiratory effort
- heart rate
- colour
- muscle tone
- reflex irritability
What are the ELEVEN things to be checked when undertaking an assessment of the newborn?
- Head
- Neck
- Arms
- Chest
- Abdomen
- Genitalia
- Legs
- Spine
- Skin
- Elimination
- Weight
What SIX points should be considered when undertaking a newborn assessment of the head?
- Check for any visual signs of trauma or moulding and feel along sutures and fontanelles
- Check the shape of the face for symmetry
- Check size and shape of eyes and pupil shape
- Check nostrils are not flaring (sign of respiratory illness)
- Check mouth for cleft lip and palate
- Check both ears are present and fully formed
What THREE points should be considered when undertaking a newborn assessment of the neck?
- Check for swelling
- Check mobility
- Feel along clavicles to ensure they are intact
What THREE points should be considered when undertaking a newborn assessment of the arms?
- Check both are the same length
- Count the number of fingers and check for webbing
- Check number of creases on the palms (a single crease only may indicate a chromosomal abnormality)
What TWO points should be considered when undertaking a newborn assessment of the chest?
- Check for symmetry of movement with respiration
- Check nipples and areolae are well formed and symmetrical
What TWO points should be considered when undertaking a newborn assessment of the abdomen?
- Gently palpate to ensure no abnormal swellings
- check umbilical cord to ensure no signs of haemorrhage
What TWO points should be considered when undertaking a newborn assessment of the genitalia?
- For boys; length of penis should be assessed and scrotum gently palpated to check for two testes
- For girls; vulva should be examined ensuring presence of clitoris and urethral and vaginal orifices
What TWO points should be considered when undertaking a newborn assessment of the legs?
- Assess symmetry, size, shape and posture
- Count number of toes and check for webbing
What TWO points should be considered when undertaking a newborn assessment of the spine?
- Check for any obvious abnormalities and swelling
- gently part the cleft of the buttocks and check for any dimples or sinuses and confirm presence of anal sphincter
What point should be considered when undertaking a newborn assessment of the skin?
Presence of any rashes or marks should be recorded
What point should be considered when undertaking a newborn assessment of elimination?
Passage of urine and meconium should be recorded
What point should be considered when undertaking a newborn assessment of the weight?
Weight should be taken either before or after newborn assessment and should be recorded in kilograms
List NINE non-pharmacological types of pain relief in labour
- support and a relaxed comfortable environment
- changing positions and keeping mobile
- massage
- hypno-birth
- aromatherapy
- acupuncture
- reflexology
- immersion in water
- transcutaneous electrical nerve stimulation
List THREE pharmacological types of pain relief in labour
- nitrous oxide (gas and air)
- morphine and diamorphine
- epidural
Name the THREE phases of the third stage of labour
Latent
Contraction/Detachment
Expulsive
Describe the latent phase of the third stage of labour
Extensive thickening of the myometrium which occurs during the 1st and 2nd stages of labour.
Thickening does not occur in the area beneath the placental site
Describe the contraction/detachment phase of the third stage of labour
Contraction and retraction cause the myometrium under the lower pole of the placenta to contract, reducing the surface area.
Shearing forces then cause the placenta to tear away from the spongy decidua layer.
The wave of separation passes upwards and the remaining placenta detaches.
At this point, maternal sinuses within the decidua are exposed so the oblique muscle fibres around the blood vessels contract to seal off the torn ends.
Describe the expulsion phase of the third stage of labour
The placenta descends into the lower uterine segment causing the membranes to detach from the uterine wall.
The placenta and membranes are then expelled by maternal effort.
The Schultze method is fetal side first and looks like an umbrella turned inside out.
The Matthews Duncan method is maternal side first, one one of the placenta out first and the rest follows sideways out of the vagina.
List and describe the THREE signs of placental separation
- Bleeding - 30-60ml of blood occurs when the placenta separates
- Lengthening of the cord - occurs when the placenta descends
- Uterus becomes high, round and hard - is below umbilicus when placenta is separating and at the umbilicus when placenta is descending
Name and describe the TWO types of management of the third stage
Expectant - delivery of the placenta without and medical intervention
Active - delivery of the placenta using oxytocic drugs
List THREE benefits of expectant management of the third stage of labour
- no medical intervention
- early skin to skin
- delayed cord clamping
List THREE benefits of active management of the third stage of labour
- reduced risk of PPH
- mother is not required to be active
- shorter 3rd stage
Name the THREE oxytocic drugs
- Syntocinon
- Ergometrine
- Syntometrine
What effect does Syntocinon have on the uterus?
Causes it to contract rhythmically and strongly
What effect does Ergometrine have on the uterus?
Causes non-physiological continuous spasm of the uterus and cervix
What effect does Syntometrine have on the uterus?
Causes the uterus to contract rhythmically and strongly with continuous spasm of the uterus and the cervix
Describe the processes involved with the initiation of labour (9 points)
In the last 3 weeks of pregnancy, CRH-binding proteins diminish
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Placental CRH is released
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Stimulation of fetal adrenal gland ——– Production of cortisol
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Increase of DHEAS Promotion of lung maturation
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Increase of maternal oestrogen levels
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Formation of oxytocin receptors, majority in the upper uterine segment
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Initiates contractions & facilitates the synchronisation of uterine activity
