Normal & Abnormal Labour/Antenatal Care Flashcards
What happens during the first stage of labour?
What is the progression?
Cervix dilation from 4cm to 10cm
Progression of 0.5 cm per hour
What happens during the second stage of labour?
How long does it last?
This is from full dilation of cervix (10cm) until delivery of the baby
Should last 2-3 hours
What happens during the third stage of labour?
How long does it last?
From delivery of the baby until delivery of the placenta
Should last up to 1 hour
What are the 8 cardinal movements of labour as they happen during birth?
- head floating before engagement
- engagement - descent, flexion
- further descent, internal rotation
- complete rotation, beginning extension
- complete extension
- restitution (external rotation)
- delivery of anterior shoulder
- delivery of posterior shoulder
What are the 7 cardinal movements of labour in order?
- Engagement
- Descent
- Flexion
- Internal rotation
- Extension
- External rotation (restitution)
- Expulsion
Every Day Fine Infants Enter Eager and Excited
What is meant by the cardinal movements of labour?
changes in the position of the foetus’s head during its passage in labor
What are the 3 P’s that describe the causes of abnormal pregnancy?
- passenger
- power
- passage
What can go wrong with each of the 3 P’s?
- passenger - the size, position or distress
- power - inadequate contractions
- passage - pelvic dimensions
What are the 3 types of forceps used in assisted pregnancy?
- neville-barns
- keillands
- ventouse
What is a breech delivery?
When the baby’s bum or legs present first
What is the difference between a cephalic and transverse presentation?
Cephalic presentation is the ideal position for birth - the baby’s head is presenting
Transverse presentation is when the baby is lying with its head to either side
What is the definition of pain?
An unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage
What is the definition of pain relating to the woman in labour?
Whatever the experiencing person says it is, existing whenever she says it does
What are the 2 main non-pharmacological pain reliefs?
- water birth
2. transcutaneous electrical nerve stimulation (TENS)
What are the pharmacological ways of giving pain relief?
- oral
- inhalation
- injection
What are the regional ways of giving pain relief?
- epidural
- spinal
- combined epispinal
What are the stages in the analgesic ladder?
- non-opioid such as paracetamol, aspirin or NSAID
- add an opioid for mild-moderate pain such as codeine or tramadol
- add opioid for moderate to severe pain - morphine, fentanyl
What pain relief methods are used in early pregnancy?
- simple analgesia - paracetamol and codeine
- TENS
- water and heat
- meditation and relaxation techniques
What non-pharmacological analgesia methods are used during late pregnancy and early labour?
- TENS
- warm water - bath or water birth
- support from birth partner or midwife
- reassurance
What are the first line pharmacological methods used in late pregnancy and early labour?
- paracetamol
2. weak opioids - codeine
What analgesic medication must NOT be used in pregnancy?
Why?
Ibuprofen
It causes premature closure of the ductus arteriosus
What inhalation agents are used as analgesia in advancing labour?
- nitrous oxide
This is known as ‘entonox’ or ‘gas and air’
What are the side effects of nitrous oxide?
dizziness, nausea and amnesia
What pharmacological analgesia is used in advancing labour?
- opioids
This is mainly diamorphine
Pethidine used to be used (except in epilepsy)
What are the side effects of diamorphine?
- sedation
- nausea and vomiting
- respiratory depression
What pain relief is used in advanced labour?
- lumbar epidural
- spinal
- combined spinal and epidural
What are the local techniques used in advanced labour?
- perineal infiltration
2. pudendal block - local anaesthetic
What is the difference in the positions that epidural and spinal anaesthesia is injected?
Epidural goes in the epidural space
(posterior to dura matter)
Spinal goes in the subarachinoid space containing CSF
(anterior to dura matter)
When is general anaesthetic used in pregnancy?
Only in emergency situations
This is usually an emergency Caesarean section where mother/baby is in serious danger
Why is general anaesthetic only used in emergency situations?
It involves the mother being unconscious at birth
This means the baby may be affected
What is antenatal care?
The care that women receive from healthcare professionals during pregnancy
What is the purpose of antenatal care?
To ensure the health and wellbeing of both mum and baby
It provides useful information to help women have a healthy pregnancy
What is involved in antenatal care?
A series of appointments with a midwife, or sometimes an obstetrician
Routine ultrasound scans
What are the 3 principles of good antenatal care?
- information is given in a form that is easy to understand and is accessible
- it is based on current available evidence
- women’s decisions should be respected, even when this is contrary to the views of the healthcare professional
Upon presenting to the GP with a pregnancy, what advice should be given?
- take folic acid and vitamin D supplements
- nutrition, diet and food hygiene advice
- stop smoking, drinking and taking recreational drugs
When is the first dating scan performed?
Within 8-14 weeks of pregnancy
What is the purpose of the dating scan?
- giving an estimated due date
2. screening for possible abnormalities undertaken along with specific blood tests
What is the anatomy scan and when does it take place?
It checks the physical development of the baby and looks for any physical abnormalities
Occurs at 18-20/26 weeks
How many antenatal appointments are offered to pregnant women?
First time parents are offered up to 10 appointments
If it is not the first child, it is around 7
Under certain conditions, such as medical conditions, there may be more
When do antenatal appointments become more frequent?
From around 24 weeks of pregnancy
What is performed during later antenatal visits?
- check urine and blood pressure
- palpate to check baby’s position
- check the baby’s growth
- listen to the baby’s heartbeat
How is the baby’s growth checked?
By measuring the distance from the top of the womb to the pubic bone
(symphasis-fundal height)
What is involved in the post-natal check?
When does this occur?
Occurs 6 weeks after delivery with a GP to ensure women are recovering
It is a good time to discuss contraception
What are the risk factors that must be determined in a high-risk antenatal visit?
- complications in a previous pregnancy/delivery - e.g. pre-eclampsia or premature delivery
- current treatment for a chronic disease such as diabetes or hypertension
- previous baby with an abnormality in the family- e.g. spina bifida
- family history of inherited disease
If a pregnancy is deemed ‘high-risk’, how does antenatal care differ to normal?
- more hospital appointments and USS
- consultant-obstetrician led care
- hospital as place of birth
- may be delivered before 40 weeks by induction or C-section
Why is it important to find out about pre-existing maternal disease?
Pre-existing maternal disease can have an adverse effect on pregnancy
Pregnancy can have an adverse effect on pre-exisiting maternal disease
Which region has the highest rate of maternal mortality?
Sub-Saharan africa
What is a stillbirth?
A baby that is born dead after 24 completed weeks of pregnancy
What is the difference between a stillbirth and a miscarriage?
If the baby dies before 24 completed weeks, this is a miscarriage
How many stillbirths are there in the UK?
> 3,600 stillbirths every year in UK
1 in every 200 babies
What is the extra USS provided to high risk pregnancies?
Growth USS
This checks to see if the baby is growing appropriately and occurs at 28 and 34 weeks
What is the definition of ‘screening’?
A process of identifying apparently healthy individuals who may be at increased risk of a disease or condition
Why do ethics play a large role in screening?
Ethics has an important role in evaluating potential benefit vs. harm and whether to offer the test
In the antenatal period, what conditions are regularly offered to be screened for?
- infectious diseases - HIV, Hep B, syphilis and rubella
- rhesus negative
- haemoglobinopathies
- foetal abnormalities
What haemoglobinopathies are screened for?
This identifies carriers of sickle cell disease and thalassaemia
When does rhesus disease occur?
When the mother has rhesus negative blood and the baby has rhesus positive blood
What happens during delivery when a RhD- mother gives birth to a RhD+ foetus?
Antigens from the foetus enter the mother’s blood
The mother produces anti-Rh antibodies
What happens if a woman carrying anti-Rh antibodies becomes pregnant with another RhD+ foetus?
The anti-Rh antibodies will cross the placenta
This causes damage to foetal red blood cells
What treatment is offered to RhD- women?
Anti-D at 28-30 weeks
Another Anti-D is given after delivery is the baby is Rh+
How does the Anti-D treatment work?
It neutralises foetal RhD+ antigens
This prevents creation of antibodies by the mother
What are the 2 screening tests for foetal anomalies?
- down’s syndrome screening
2. anomaly scan
When is Down’s syndrome screening performed?
It is an opt-in test
If chosen, it is performed in the first trimester at the dating scan
What is involved in the Down’s syndrome “combined screening”?
- nuchal translucency scan
- blood test for:
human chorionic gonadotrophin (hCG)
pregnancy-associated plasma protein A (PAPP-A)
