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T yr ravi and rita > Management of labour > Flashcards

Management of labour Flashcards

1
Q

what is labour?

A

The process of uterine contractions and cervical dilatation that allows the uterus to deliever a viable foetus

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2
Q

How often do you want the contractions to be before they come on the labour ward?

A

At least every five minutes

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3
Q

what are theories for the initiaiton of labour?

A
  • progesterone withdrawal

- neuronal stimulation from cervical pressure

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4
Q

why could progesterone drop cause labour?

A

progesterone is a strong smooth muscle relaxant

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5
Q

what is the first stage of labour?

A

The period between onset of regular painful contractions to full cervical dilatation

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6
Q

what is the second stage o flabour?

A

From full cervical dilatation to delivery of a foetus

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7
Q

what is the third stage of labour?

A

From delivery of the foetus to delivery of the placenta and membranes

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8
Q

how long is the second stage of labour normally in a nulliparous women?

A

one hour

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9
Q

how long is the second stage of labour normally in a multiparous lady?

A

half an hour

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10
Q

how big do you want the cervix by the end of the first stage of labour?

A

10cm

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11
Q

what is the normal progress in the second stage of labour?

A

1cm an hour

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12
Q

what stage of labour is considered the most dangerous?

A

third

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13
Q

what is the first stage of labour split into?

A

latent phase

active phase

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14
Q

what is the latent stage?

A

the duration for the cervic to be effaced at 3cm long.

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15
Q

how long is the latent stage of labour?

A

nullipara: 6-8 hours
multipara: 4-6 hours

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16
Q

why does the cervix become soft in the latent stage?

A

Prostaglandin release act as vasodilators allowing water in

There is also actviation of MMP’s which break down collagen

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17
Q

what is the normal rate of progress in the active phase?

A

1cm/hr

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18
Q

what events are reported on a partogram?

A
  • rate of cervical dilatation
  • descent of the head
  • contraction frequency and duration
  • foetal heart rate and colour
  • caput and moulding
  • maternal pulse, BP, temp, UO
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19
Q

what is the alert line on a partogram?

A

Drawn at a rate of 1cm/hour from admission cervical dilatation in the active phase.

20
Q

what is the action line?

A

A line drawn 2 or 3 cm to the right and parallel to the alerty line

21
Q

If labour is to the right of the normal line how can it be augmented?

A
  • rupture the amniotic membranes if they haven’t already as this helps the head descent and releases PG’s
  • consider using oxytocin
22
Q

what are the 3 P’s of causes of slow labour?

A

P- passage
P-passenger
P-power

23
Q

why can ‘passage’ be a cause of slow labour?

A
  • inadequate pelvis to fit for example short, previous injury or trauma
24
Q

why can ‘passenger’ be a cause of slow labour?

A
  • large foetus

- abnormal prseentation

25
Q

why can ‘power’ be a cause of slow labour?

A
  • inadequate uterine contractions
26
Q

what is the most common cause of slow labour?

A

Not enough power: inadequate uterine contractions

27
Q

what is the standard management for active phase?

A
  • reassurance by giving one to one support
  • hydration
  • pain relief
28
Q

what extra management can be added to the standard care in a slow active phase?

A
  • artificial membrane rupture
  • use of oxytocin
  • foetal surveillance
  • monitoring labour progress and mothers conditions
29
Q

how do staff check the mothers hydration through out the active phase?

A

checking the urine for ketones as a marker

30
Q

what is an eppsiotomy?

A

A cut to prevent tears in the 8 o clock direction

31
Q

why do you not do an epsiotomy straight down?

A

damage to the anal sphincter

32
Q

what is seen in the mother in the second stage of labour?

A

vulval bulging
anal dilatation
increased resp rate
can’t sit still

33
Q

what is the ferguson reflex and when is it present?

A

In the second stage of labour and is the urge to push

34
Q

what positions do you want the baby?

A
  1. as it passes through the pelvic inlet which it’s face to the side and chin tucked in
  2. after passing the pelvis moves it’s head forward through the vagina facing the bed
35
Q

what is given to help the third stage of labour?

A

IM syntometrine

36
Q

when is IM syntometrine given for the third stage of labour?

A

once the anterior shoulder has been delievered

37
Q

As the doctor where do you want your hands in the third stage of labour?

A

Left on the pubis synphisis to guard the anterior wall of uterus

38
Q

how should you deliver the third stage of labour?

A

wait to see cord lengthening then gently pull to see if the placenta has detached

39
Q

what should be done after the placenta has been delivered?

A

it should be checked for completeness

40
Q

what dose of oxytocin should be given in labour?

A

2-4MU//min and then slowly increase

41
Q

what are risks of using oxytocin throughout labour?

A
  • hyperstimulation
  • foetal distress
  • uterine rupture
  • ADH effect and water intoxication
42
Q

what are complications of a slow labour?

A
  • maternal dehydration and exhaustion
  • maternal and foetal infection
  • foetal distress
  • operative delivery
  • uterine rupture
  • postpartum haemorrhage
  • increased morbidity
  • fistula
43
Q

what are indications of dystocia?

A
  • failure of the cervix to dilate
  • failure of the head to descend
  • increased caput andmoulding.
44
Q

what help can be given in a prolonged second stage?

A
  • forceps
    = ventous
    = analgesia
45
Q

what is given for the 3rd stage at the point the anterior shoulder is delievered?

A

IM syntometrine

46
Q

what are possible complications of the third stage of labour?

A
  • retained placenta
  • postpartum haemorrhage
  • perineal trauma via tears
  • perineal haematoma
  • uterine inversion

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