Labour & Parturition (Birth) Flashcards
How many Stages in Labour?
3 stages
Stage 1: Contraction and cervical changes
Stage 2 - Dilation and delivery of baby
Stage 3 - Delievery of baby to delievery of placenta and membrane
What happens before labour?
Vague cramps called Braxton Hicks - Irregular painless tightening of the uterus
What happens in stage 1 of labour?
stage 1 describes the onset of progressive contraction and cervical changes:
Split into two stages
Latent First Stage- Effacement (thinning of cervix) and dilation to 3cm
Active first stage - dilation from 3cm to 10cm (fully dilation)
What happen in stage 2 of labour?
Stage 2 describes from full dilation to delivery of baby
Split into two stages:
Passive Second stage - Head descends to pelvis
Active second stage - Mother bears down (pushes baby out)
Describe the mechanism is stage 2 of labour.
Stage 2 of Labour can be split further into 7 stages:
- Descent - Baby head into pelvis
- Flexion - baby head flexes (chin to chest)
- Internal rotation - baby occiput (back of head) rotates anteriorly to give normal occipto-anterior position. facing bum
- Extension - Baby’s Occiput contacts maternal pubic rami - extend sand crowns
- Restitution - Baby’s Occiput aligns with it shoulders
- External rotation - baby shoulders rotate into anterior-posterior position (perpendicular to mothers). At this point baby is delivered // aligned w/ shoulders and looking laterally at mom thigh
- Delivery of shoulder - anterior shoulder is delivered first from beneath the pubic ramus; head is slightly lifted to deliver posterior shoulder. Rest follows.
What happens in the third stage of labour?
Stage 3 describes the time from delivery of baby to delivery of placenta and membrane
this should occur within 30 minutes of delivery of the baby
Can be physiological / or oxytocin induced
What should coincide with onset of labour?
passage of operculum (mucus plug) and SROM spontaneous rupture of membrane
What is myometrial activation?
The myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells (also called uterine myocytes) but also of supporting stromal and vascular tissue. Its main function is to induce uterine contractions.
Myometrial activation (contractions) is precipitated by:
1- INcreased maternal oestrogen and decerased progesterone
2- Increased expression of CAPs contraction-associated proteins, oxytocin and prostaglandins
What are the initial assessments carried out when monitoring labour?
1- Take Hx / Assess RF/ Assess Pain
2- Observations - BP, RR, Urinalysis
3- Examiantion - Abdominal palpitations - Assess lie, presentation, engagement, contraction strengths
4- Vaginal examination - assess position, cervical effacement and dilation, presence or absence of membrane, caput or cranial molding
How is the progression of labour monitored?
Progression of foetal, maternal and labour wellbeing is recorded on a PARTOGRAM
with measurments of :
- PROGRESS : Cervical dilation, descent, contraction (frequency and duration)
- Foetal WELLBEING: HR, amniotic fluid
- Maternal WELLBEING: PULSE, bp, TEMP, Urinalysis
How is heart rate monitored during labour
heart rate can be monitered by intermittent auscultation with:
Doppler probe (low risk)
or
Cardiotocograph (high risk)
Whats a reassuring features of ctg cardiotocograph
baseline hr 110-160
Deceleration (drops of 15bpm for 15s) - ABSENT
Acceleration (increases of 15bpm for 15s) - PRESENT
Baseline Variability 5-25bpm
What are the non-reassuring features of ctg cardiotocograph
BP - 100-109
Acceleration - Absent
Decceleration - Present
Baqseline variability <5 for 30 mins / >25 mi for < 10 mins
What are the non Pharmacological analgesia methods used in labour
Breathing and relaxation techniques
Use of birth pool
What are Pharmacological analgesia intervention used for labour?
systemic -
Entonox (Gas & air 50:50 of NO & O2)
Intramuscular Opiods - Morphine
Localised:
Epidural - bupivacaine w/ Fentanyl - bolused into L3/L4 epidural space
