Management of labour Flashcards
what is labour?
The process of uterine contractions and cervical dilatation that allows the uterus to deliever a viable foetus
How often do you want the contractions to be before they come on the labour ward?
At least every five minutes
what are theories for the initiaiton of labour?
- progesterone withdrawal
- neuronal stimulation from cervical pressure
why could progesterone drop cause labour?
progesterone is a strong smooth muscle relaxant
what is the first stage of labour?
The period between onset of regular painful contractions to full cervical dilatation
what is the second stage o flabour?
From full cervical dilatation to delivery of a foetus
what is the third stage of labour?
From delivery of the foetus to delivery of the placenta and membranes
how long is the second stage of labour normally in a nulliparous women?
one hour
how long is the second stage of labour normally in a multiparous lady?
half an hour
how big do you want the cervix by the end of the first stage of labour?
10cm
what is the normal progress in the second stage of labour?
1cm an hour
what stage of labour is considered the most dangerous?
third
what is the first stage of labour split into?
latent phase
active phase
what is the latent stage?
the duration for the cervic to be effaced at 3cm long.
how long is the latent stage of labour?
nullipara: 6-8 hours
multipara: 4-6 hours
why does the cervix become soft in the latent stage?
Prostaglandin release act as vasodilators allowing water in
There is also actviation of MMP’s which break down collagen
what is the normal rate of progress in the active phase?
1cm/hr
what events are reported on a partogram?
- 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
what is the alert line on a partogram?
Drawn at a rate of 1cm/hour from admission cervical dilatation in the active phase.
what is the action line?
A line drawn 2 or 3 cm to the right and parallel to the alerty line
If labour is to the right of the normal line how can it be augmented?
- rupture the amniotic membranes if they haven’t already as this helps the head descent and releases PG’s
- consider using oxytocin
what are the 3 P’s of causes of slow labour?
P- passage
P-passenger
P-power
why can ‘passage’ be a cause of slow labour?
- inadequate pelvis to fit for example short, previous injury or trauma
why can ‘passenger’ be a cause of slow labour?
- large foetus
- abnormal prseentation
why can ‘power’ be a cause of slow labour?
- inadequate uterine contractions
what is the most common cause of slow labour?
Not enough power: inadequate uterine contractions
what is the standard management for active phase?
- reassurance by giving one to one support
- hydration
- pain relief
what extra management can be added to the standard care in a slow active phase?
- artificial membrane rupture
- use of oxytocin
- foetal surveillance
- monitoring labour progress and mothers conditions
how do staff check the mothers hydration through out the active phase?
checking the urine for ketones as a marker
what is an eppsiotomy?
A cut to prevent tears in the 8 o clock direction
why do you not do an epsiotomy straight down?
damage to the anal sphincter
what is seen in the mother in the second stage of labour?
vulval bulging
anal dilatation
increased resp rate
can’t sit still
what is the ferguson reflex and when is it present?
In the second stage of labour and is the urge to push
what positions do you want the baby?
- as it passes through the pelvic inlet which it’s face to the side and chin tucked in
- after passing the pelvis moves it’s head forward through the vagina facing the bed
what is given to help the third stage of labour?
IM syntometrine
when is IM syntometrine given for the third stage of labour?
once the anterior shoulder has been delievered
As the doctor where do you want your hands in the third stage of labour?
Left on the pubis synphisis to guard the anterior wall of uterus
how should you deliver the third stage of labour?
wait to see cord lengthening then gently pull to see if the placenta has detached
what should be done after the placenta has been delivered?
it should be checked for completeness
what dose of oxytocin should be given in labour?
2-4MU//min and then slowly increase
what are risks of using oxytocin throughout labour?
- hyperstimulation
- foetal distress
- uterine rupture
- ADH effect and water intoxication
what are complications of a slow labour?
- maternal dehydration and exhaustion
- maternal and foetal infection
- foetal distress
- operative delivery
- uterine rupture
- postpartum haemorrhage
- increased morbidity
- fistula
what are indications of dystocia?
- failure of the cervix to dilate
- failure of the head to descend
- increased caput andmoulding.
what help can be given in a prolonged second stage?
- forceps
= ventous
= analgesia
what is given for the 3rd stage at the point the anterior shoulder is delievered?
IM syntometrine
what are possible complications of the third stage of labour?
- retained placenta
- postpartum haemorrhage
- perineal trauma via tears
- perineal haematoma
- uterine inversion
