normal labour Flashcards
what happens in the latent first stage of labour?
0-3cm dilatation
what happens in the active stage of the first stage of labour?
3-10cm dilatation
how long does the active first stage of labour usually take?
12-15hrs in a primiparous- 0.5-1 cm/hr
- 7.5 hours in a multiparous - 1cm/hr
what are the 3 parameters of fetal orientation?
- lie- longitudinal, transverse or oblique
- presentation - cephalic or breech
- position - right/left occipitoanterior, ocipitoposterior, occipitotransverse
when do you start a partgogram plot?
when 3cm dilated
which observations do you do as part of the cartogram and how often?
- maternal HR and blood pressure every 30 mins
- temperature and urinalysis every hour
- contractions every hour- and their frequency in a 10 min window- expect 3-5 strong 1 min contractions in 10 minutes by the second stage
- PV exam every 4 hours-> checking cervical dilatation and how many fifths palatable the fetal head is
what are complications that can occur associated with the 3 Ps?
Passenger- fetal malpresentation - C section
Passage- fibroids/cervical stenosis- c section
Power- primary uterine inertia - try oxytocin, ARM-> 24 hrs try instrumental delivery if cervix is fully dilated and C section if cervix is not fully dilated
how long does the second stage of labour take in a primp and multi primp?
45-120min in primp
15-45 min in multi primp
what are the steps in second stage labour?
Darn! Every fool in Egypt eats raw eggs
Decent- The baby is pushed down into the pelvis in the left (or right) occipitotransverse position by uterine contractions and pressure of the amniotic fluid
- engagement - largest diameter of fetal head in largest diameter of maternal pelvis - the fetal head if 3/5ths palpable or less
- flexion - fundal dominance of uterus contracts to bring the head in contact with the pelvic floor - the neck then flexes to create a suboccipitobregmatic diameter of 9.5cm- this smaller diameter assists passage through the maternal pelvis
- internal rotation - the gutter shape of the pelvis along with regular contraction of the uterus turns the head of the baby 90degrees and into the left occipitoanterior position
- extension / crowing- the widest part of the fetal head successfully negotiates through the narrowest part of the maternal pelvis- the head can be seen in the vulva without retreating . The occiput then extends beyond the suprapubic arch allowing the head to extend
- external rotation (restitution) - the foetus rotates again so it is facing the mothers medial thigh and it can release its shoulders
- expulsion- healthcare worker assists with downward traction to release the anterior arm and then upward traction to release the posterior arm
how often is fetal heart rate monitored in the second stage of labour?
every 5 mins
what should you do once the head is born?
- check the cord is not around the neck - clamp and cut it immediately if it is tightly wound around the neck
- give oxytocin/ ergometrine to precipitate the third stage - usually 5 units IM
when should the APGAR score be checked for baby?
Appearance, pulse, grimace, activity and respiration should be checked at 1 and 5 mins
- score <7 prompts oxygen and call paediatrician
- give the baby vitamin K and examine for abnormalities
what to do if there is a cord prolapse?
- place mother in elbow and knee position and put pressure on the presenting part and rush to theatre for C-section
how is shoulder dystocia managed?
- tell mother not to push
- mcroberts manœuvre- flexion and abduction of the maternal hip and suprapubic pressure
what may be needed if baby is in occipitoposterior position?
face to pubes delivery using forceps or c section may be needed
