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Obstetrics > Normal Birth and Assessment > Flashcards

Normal Birth and Assessment Flashcards

1
Q

Latent Stage of Labour

A
  • Cervix starts to thin and dilate
  • Irregular uterine activity
  • Can last a few days
  • Finished when first stage is established
  • Can be a very long stage
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2
Q

First Stage of Labour

A
  • Regular contraction 3-4 in 10 contractions
  • Contractions lasting at least a minute to 90 seconds
  • Continued effacement (thinning) of cervix
  • Dliation of the cervix to at least 4-5cm
  • Cervix dilates 1cm per hour on average
  • Ends when cervix is fully dilated
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3
Q

Second Stage of Labour

A
  • Cervix is fully dilated
  • Baby descends through vaginal canal
  • Contractions sometimes slow down
  • Hide and seek (going back and forward) leading to crowning is very common
  • Ideally completes within two hours to include 1 hour for passive descent and hour 1 of pushing
  • Birth of baby
  • Delayed cord clamping of at least 60 seconds if baby and mum are okay
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4
Q

Third Stage of Labour

A
  • From the birth of the baby to full expulsion of placenta and membranes
  • Can take up to an hour for placenta to deliver
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5
Q

General JRCALC Guidelines

A
  • Consider conveying if no visible progress after 10 minutes
  • If the placenta has not delivered in 20 minutes make a time critical transfer
  • Prepare the NLS area on hard surface and open maternity pack
  • Prepare area eg towels, close windows, warm room
  • Give entonox where required
  • If they are actively bleeding DURING labour then convey as soon as possible
  • Constant pain and bleeding is a massive red fleg even if mild
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6
Q

What’s in the Maternity Pack?

A
  • Prompt cards
  • NLS guidelines cards
  • Simple instructions for shoulder dystocia, prolapse ect
  • Towel
  • Wrapping towel
  • Gauze swabs
  • Waterproof towel
  • Two pads
  • Cord clamps
  • Cord scissors
  • Hat
  • Wristbands
  • Nappy
  • Placenta bag
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7
Q

Good things to know/do about the Baby

A
  • Might not cry immediately
  • Babies are very slippery
  • Dry the baby while maintaining skin to skin where possible
  • Put hat on and keep on
  • Vernix (white stuff) is normal and doesn’t need to be wiped off
  • Assess; tone, breathing, perfusion, heart rate
  • Assess for intervention
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8
Q

Benefits of Skin to Skin

A
  • Regulates HR, BP and temperature
  • Improves baby oxygen saturations
  • Boosts milk supply
  • Reduces blood loss in women
  • Builds baby’s immunity to infections
  • Decreases stress in mother and baby through release of oxytocin and inhibition of cortisol
  • Great for bonding and attachment
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9
Q

What to do with the Cord

A
  • Allow the cord to stop pulsating (minimum of 60 seconds) and then clamp, delaying is always better
  • No medical need to clamp/cut if no resus needed
  • Cut BETWEEN the clamps (very important to stop blood lost)
  • About 15cm from the umbilicus and 3cm apart
  • If twins, two clamps on the second twin
  • Delayed clamping can improve Hb levels, optimise cerebral oxygenations, increase stem cell volume, decreases cord infections, decreases need for transfusion
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10
Q

Safely Delivering the Placenta

A
  • Can take up to an hour to be birthed, DO NOT pull the cord
  • Encourage emptying the bladder and upright positioning
  • Sometimes a push can deliver it
  • Deliver directly into a carrier bag and take to hospital
  • Try to collect as many parts and bits as possible
  • Assess blood loss in home prior to department for an EBL
  • Patient can get a vasovagal response from the placenta being delivered/sat in the vaginal canal
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11
Q

Assessing the Sac

A
  • If the amniotic membranes are visible do not rupture the sac while the baby is in utero
  • In the majority of births the sac will rupture during labour before birth but if preterm may not rupture and may be visible for some time.
  • Artificially rupturing sacs pre birth can only be done by a midwife or obstetrician. When ruptured artificially it can progress the labour rapidly leading to complications eg cord prolapse
  • If the entire baby is born in the sac, firmly pinch the sac to tear open the sac, carefully use scissors if doesn’t work. Note the colour of the fluid.
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12
Q

What is Foetal Presentation

A

the foetal part that presents out the pelvic inlet/vagina

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13
Q

What is Foetal Position

A

positioning of the whole body prenatally - usually and ideally the foetus is head down, facing the mums back with the head toward the pelvis with limbs bent and drawn up into itself. Limbs can be in a different place with back arched backwards, or whole body rotated to a certain degree (rotating like a kebab)

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14
Q

What is Foetal Lie

A

how turned the baby is in relation to the mother eg longitudinal (up or down), transverse (lying sideways), oblique (between the two) (spinning like a microwave)

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15
Q

Examples of Foetal Lie

A
  • Cephalic (normal position) head down towards vagina, legs up
  • Breech - bottom or feet first
  • Transverse -
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16
Q

Different Placenta Positions and What they can Mean

A
  • Normal (fundal) - at the top
  • Anterior - front wall (can be a back to back deliver)
  • Posterior - back wall
  • Lateral - side wall
  • Low Lying - is towards to bottom but doesn’t cover the cervix, can see bleeding in these patients, have a much higher risk of PPH
  • Placenta Previa - covering the cervix (can cause bleeding, can correct itself, needs c section if there at term)
17
Q

Altered Cardiovascular System in Pregnancy

A
  • Heart rate increases 15-20 beats by the 3rd trimester
  • BP pressure drops slightly in 2nd trimester but is normal at term and is characteristically unreliable
  • Cardiac output increases by up to 40%
  • Blood volume increases as much as 48%
  • Physiological anaemia and iron deficiency is common
  • Due to weight, from 20 weeks there can be compression on the vena cava reducing venous return and lowering cardiac output by up to 40% when supine
  • A pregnant women can tolerate greater blood loss (35%) before showing signs of hypovolaemia due to shunting of blood away from the uterus/placenta to the mother
  • The foetus is an end organ therefore foetal distress can mean maternal hypovolaemia
18
Q

Altered Respiratory System in Pregnancy

A
  • Increase in breathing rate and effort as well as a decrease in vital capacity, as the foetus grows the diaphragm becomes splinted
  • Some SOB is common in pregnancy but be careful of additional oxygen requirements
  • Tubing is indicated in pregnant people due to increased risk of aspiration and regurgitation because of delayed gastric emptying
  • Add cricoid pressure when tubing and ventilating to reduce the risk of regurgitation
19
Q

Gastro Changes in Pregnancy

A
  • Increase in acidity of stomach contents due to a delay in gastric emptying
  • Neasuea and vomiting can occur between around 4-8 weeks anc can continue until around 14-16 weeks. In severe cases can continue and lead to rapid dehydration requiring hospital addmission
20
Q

Hormone Changes in Pregnancy

A
  • Increase in steroidal hormones
  • Increase in T3/T4
  • Increase in prolactin (makes milk)
  • Increase in oestrogen and progesterone
  • Increase in HCG (pregnancy hormone picked up on pregnancy tests)
21
Q

Renal Changes in Pregnancy

A
  • Increase blood flow to area
  • Increase in GFR
  • Increase in water and sodium absorption
  • Increase in protein secretion
22
Q

History Taking for Mum

A
  • Any abnormal PV bleeding?
  • Have you had any previous pregnancy complications? (meconium, pre-eclampsia, diabetes)
  • How many weeks (and days) pregnant are they?
  • Any pain? where? constant or episodic?
  • Time between contractions? Regular or not?
  • Do they have the urge to push? (if yes, then visually inspect)
  • Feeling unwell?
  • Unpleasant or offensive smell to discharge or urine?
  • Meconium in waters?
23
Q

History Taking for Baby

A
  • Does the baby have reduced/no foetal movements?
  • Any hyperactive movements? - can be a sign of foetal distress only if near term
24
Q

Obstetrics PMH

A
  • Known Group B streptococcus carriage or infection
  • Foetal growth restriction
  • Low lying placenta? (Increased risk of bleeding and PPH)
  • Baby has abnormal lie presentation eg breech, shoulder, back to front
  • Gestational diabetes?
  • Consider high BMI complications
25
Q

Assessing Fundus Height

A
  • This is helpful if the patient doesn’t know how many weeks pregnant they are so you can estimate if the baby needs resus/care (over 22)
  • A fundus at the level of the umbilicus means an approx. 22 weeks baby
  • By definition if the heigh is below the umbilicus and the foetus is delivered its unlikely to survive
26
Q

Assessing a Potential Primary Sruvey for Women in Labour

A

Massive External Haemorrhage - soaked clothing, blood on the floor, numbers of soaked pads/towels
Airway - as normal
Breathing - as normal
Circulation - as normal, gently palpate abdomen for internal bleeding (guarding, tenderness, firm)
Disability - as normal
Exposure - inspect vaginal opening, presenting part of baby? prolapsed loop of cord? broken waters? state of amniotic fluid (clear, blood stained, mecunium stained?) bulging perinium? perinium tear?
Environment - risk of hypothermia, clean surroundings, decide if time critical transfer or not

27
Q

What Classes as “Birth Imminent”?

A
  • Contractions are regular about 1-2 minutes apart
  • Have the urge to push
  • Crowning of the baby’s head or breech presentation

Remain on scene and request midwife or backup, prepare for birth and resus

Obstetrics (5 decks)

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