Normal Delivery & Puerperium Flashcards
The foetal head is described as being engaged when the widest part has passed what anatomical landmark?
Pelvic inlet
The descent of the foetus during labour can be assessed using what terminology?
Stations
As the foetal head descends in labour, what position is it usually in?
Occiput-transverse
Descent of the foetus in labour is most effective when the head is in what position?
Flexion
In labour, at the level of the pelvic outlet, the foetus makes what cardinal movement to end up in what position?
Internal rotation to be occiput-anterior
What term is used to describe the appearance of a large segment of the foetal head at the introitus?
Crowning
Which cardinal movement of the foetus occurs as it is crowning?
Extension
At restitution, after the foetal head has been delivered, what cardinal movement occurs?
External rotation
After the head, what is usually the next part of the foetus to deliver in labour?
Anterior shoulder
What are the three main factors influencing labour?
Power, passenger, passage
Up to how many uterine contractions in 10 minutes would be considered normal in labour?
3-4
What is the normal foetal lie at labour?
Longitudinal
What is the normal foetal presentation at labour?
Cephalic
What is the normal foetal position at labour?
Occiput-anterior
What part of the foetus should present first in labour?
Vertex
Which hormone is responsible for inhibiting uterine contractions throughout pregnancy?
Progesterone
Which hormone stimulates the production of uterotonic substances such as oxytocin and prostaglandinds which trigger uterine contractions?
Oestrogen
Describe the beginning and end points of the first stage of labour?
The onset of contractions until the cervix is fully dilated and effaced
The latent phase of the first stage of labour lasts until the cervix is dilated how far?
4cm
The active phase of the first stage of labour lasts until the cervix is dilated how far?
10cm
Describe the beginning and end points of the second stage of labour?
From the cervix being 10cm dilated to the delivery of the baby
Describe the beginning and end points of the third stage of labour?
From the delivery of the baby to the delivery of the placenta and membranes
Describe the contractions which occur in the latent phase of the first stage of labour?
Mild and irregular
Describe Braxton-Hicks contractions?
Relatively painless contractions which do not increase in intensity or frequency
Describe the contractions which occur in the active phase of the first stage of labour?
Painful and regular
True labour contractions occur under the influence of which hormone?
Oxytocin
During the active phase of the first stage of labour, how often are women offered a vaginal examination?
Every 4 hours
A dilatation of how many centimetres per hour suggests normal progress in the active phase of the first stage of labour?
1-2cm
What is the minimum dilation required to state that adequate progress is being made in the active phase of the first stage of labour?
2cm every 4 hours
Are women advised to eat and drink during the active phase of the first stage of labour?
Yes
Describe when the second stage of labour would be considered prolonged in a nulliparous woman?
Lasting > 2 hours without regional anaesthesia or > 3 hours with regional anaesthesia
Describe when the second stage of labour would be considered prolonged in a multiparous woman?
Lasting > 1 hour without regional anaesthesia or > 2 hours with regional anaesthesia
A prolonged second stage of labour increases the risk of what complications?
PPH and maternal infection
What are the three main elements of active management of the third stage of labour?
Uterotonic drugs, controlled cord traction and cord clamping
Providing there is no immediate risk to the life of the mother or newborn, cord clamping should be delayed for how long?
3 minutes, or until pulsation ceases
What are some signs of placental separation, which would suggest that it is the appropriate time to begin active management of the third stage of labour?
Sudden gush of blood and lengthening of the umbilical cord
What is Syntometrine?
5IU of oxytocin with 500mcg of ergometrine
How can oxytocin be given in the active management of the third stage of labour?
It is given IM- either as 10IU alone, or as Syntometrine
Both oxytocin alone and as Syntometrine are equally effective at preventing haemorrhage > 1000ml. Which is better at preventing smaller haemorrhages, but comes with a risk of nausea and vomiting?
Syntometrine
What is the reason for active management of the third stage of labour?
To reduce the risk of PPH
What is the average duration of the third stage of labour?
10 minutes
Describe what would be considered as a normal duration of the third stage of labour, with both expectant and active management?
30 minutes with active management, 1 hour with expectant management
What is the current recommendation for skin-skin contact after delivery?
1 hour of uninterrupted skin to skin following delivery
What is a normal amount of blood to lose during labour?
< 500mls
How is the foetal heart rate monitored during labour in low risk pregnancies?
Intermittent auscultation
How is the foetal heart rate monitored during labour in high risk pregnancies?
CTG
How often must intermittent auscultation be performed in the active phase of the first stage of labour?
For 1 minute immediately after a contraction, and at least every 15 minutes
How often must intermittent auscultation be performed in the second stage of labour?
For 1 minute immediately after a contraction, and at least every 5 minutes
What would be considered a normal baseline rate on CTG?
100-160 bpm
What would be considered a normal baseline variability on CTG?
5-25 bpm
What is an acceleration on a CTG?
An increase in heart rate > 15bpm for > 15 seconds
When should accelerations on a CTG generally occur?
Alongside the uterine contractions
Is an acceleration on a CTG normal?
Yes
What is a deceleration on a CTG?
A decrease in foetal heart rate of > 15bpm for > 15 seconds
Early decelerations on a CTG are considered to be normal. When do these occur?
They start at the beginning of a contraction and recover when they contraction stops
An abnormal CTG is an indication for what management?
Immediate delivery
A late deceleration on CTG begins at the peak of a uterine contraction and recovers after the contraction ends. This is a sign of what?
Foetal distress
A variable deceleration on CTG is a rapid fall in baseline foetal heart rate with a variable recovery phase and no relation to uterine contractions. This can be a sign of what complication?
Cord compression
What are some complications of Entonox use, which resolve upon stopping it?
Light headedness and nausea
How are opioids given as pain relief in labour?
IM
At what birthing site would opioid analgesia be contraindicated?
Pool delivery
What other medication must always be given alongside opioids for analgesia in labour?
Anti-emetic
What are some potential complications of using opioids for pain relief in labour?
Maternal and foetal drowsiness and respiratory depression
Where would the catheter be inserted into for giving an epidural or spinal anaesthetic?
L3/4
What medication is injected in both epidural and spinal anaesthesia?
Opioid and local anaesthetic
What monitoring is required in women who are using epidural or spinal anaesthesia in labour?
CTG and blood pressure monitoring
What scoring system is used to determine whether or not to induce labour? What score would suggest that labour is unlikely to start on its own without induction?
Bishop’s score, < 5
What method of induction of labour is offered to women at antenatal visits from 40 weeks?
Membrane sweep
What medical management is first line for induction of labour?
Synthetic prostaglandins
What is the main complication of the use of synthetic prostaglandins when inducing labour? How can this be resolved?
Uterine hyperstimulation- use tocolytic drugs e.g. terbutaline
When may vaginal prostaglandins be contraindicated as a method of induction of labour? In these cases, what method should be used instead?
If the woman has had a previous C-section- use artificial rupture of membranes instead
What defines the puerperium?
The 6 week period following delivery
What is the general name for discharge which occurs in the puerperium?
Lochia
How soon after delivery should the fundal height return to a pelvic level? If this does not occur, what complication may this be a sign of?
Within 2 weeks; if this does not occur it could be a sign of retained products and infection
In non-breastfeeding women, when does menstruation usually occur following delivery?
8 weeks
When do midwife visits occur after delivery?
Day 1, 5 and 10
What additional test is carried out by the midwife on day 5 following delivery?
Neonatal screening
How soon after delivery should a check up be carried out by the GP?
6-8 weeks
Breastfeeding women can use all forms of contraception except for what?
The combined oral contraceptive pill
