Labour: Normal and Abnormal Flashcards
Summary of Mx of first stage of labour
From Dx labour to full dilatation of cervix 1 to 1 midwife Obs + anaes as required Monitor well being 4hrly PV exam (or as indicated) Partogram Pain relief Hydration and light diet
Dx labour
regular painful contractions
Latent phase of labour
usually silent gradual cervical effacement
days/weeks
encourage mobilisation
Do not admit
Stand up
antacids if opiate analgesia
malpresentation: slower first stage and slow dilatation of cervix, may not go into labour at all
PV exams in First stage````
every 4h to determine if in active labour More if concerns about progress or well being normal prog: 1cm/2h Record descending part
Mx of Second stage of labour
First sign: urge to push Full dilatation confirmed PV Expulsive reflex Discourage (semi)supine Increase monitoring Regional anaesthesia means Dx often made on PV
Prolonged second stage of labour
Nulip. 3+ hrs from onset of second stage Multip. 2+ hrs since active second stage ARM if membranes intact Consider oxytocin Review every 15-30m If having epidural allow extra hour
Descent and delivery of the Head
watch the perineum
Between contractions elastic tone will push head back into pelvis
when the head no longer recedes: crowning
Once crowning
Delivery is imminent
Guard perineum
discourage bearing down take rapid slow breaths
Immediate care of the neonate
Should breathe within a couple seconds No need for immediate clamping Dependent holding to drain resp. mucous Skin-skin (bonding and uterine cont.) Dry and cover Bf within 1hr Routine measurements Vit K first dose asap
Apgar performed
1m after cord clamping and again at 5min
Routine neonatal measurements
HC, birthweight, temperature
Managment of Third stage of labour
usually takes 5-10min
can be active or physiological
Active third stage Mx
All women recommended
10 IU oxytocin IM at birth of anterior shoulder or immediately after delivery (before cord clamped)
Use controlled cord traction to remove placenta (98% effective) if no bleed try again in 10min``
When to clamp cord
1-5min
Signs of placetal seperation
gush of blood
cord lengthening
Uterus rise or become round
Cx of third stage of labour
uterine inverion but is rare
Physiological Mx of 3rd stage labour
Maternal effort controls delivery
heavier bleeding
if haem. OR placenta undel, after 60min recommend active Mx
After completing third stage of labour
inspect placenta for missing cotyledons or succenturiate lobe
(if sus. examination under anaesthetic and MROP arranged)
Induction of labour indications:
- Prevention of prolonged preg (uncomp. 41-42w, if declined 2/wk USS+CTG)
- PTL/ROM (avoid before 34w)
- Prev C-sec
- Maternal req. (exceptional circumstances around 40w)
- Breech (not recom. consider if ECV if declined and declines c-sec)
- IUGR (if sev. c-sec)
- IUD (if ROM, infection or bleed, mifepristone then misoprostol)
- DO NOT CARRY OUT INDUCTION FOR Macrosomia
When to consider prostin/propress in cases where you might want to induce labour
PPROM
prev. c sec ( will increase risk of rupture and emergency c-sec
Methods of inducing labour
membrane sweep (offered prior to formal induction NOT official inducing labour Prostin or propress ARM, Syntocinion, mechanical (not first line)
When to offer membrane sweep
before formal induc
40-41wk (41 for parous F)
additional sweep if labour doesn’t start
Prostin or propress
PV PgE2 preferred induction method PO (2 dose 6hrs aprt), gel, pessary(2 dose 6hrs apart) (1 dose/24hr) RiskL uterine hyperstim (if IUD misoprostol and mifepristone)
Summary of induction of labour
- propress (24hr)
- Prostin if insuf. 6hrly
3, ARM
4, Syntocinon
c-sec if all else fails
if fully dilated offer instrumental delivery
when to NOT induce
foetal head high (cord prolapse risk)
