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Mariam Reproductive System > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

What is ‘normal labour’?

A

Is where foetus, placenta and membranes are expelled via birth canal and is:

  • Spontaneous
  • 37-42 weeks gestation
  • Foetus presenting by the vertex
  • Results in a spontaneous vaginal birth
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2
Q

What weeks of gestation for birth is considered normal?

A
  • 37-42 weeks gestation
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3
Q

What initiates labour?

A

It is not known what initiates labour, but its caused by interplay between paracrine and autocrine signals from maternal, foetus and placenta

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4
Q

What key physiological changes occur that allow expulsion of foetus?

A
  • Cervix softens
  • Myometrial tone changes to allow for coordinated contractions
  • Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate
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5
Q

What are the 3 stages of labour?

A
  • First stage
    • Split into
      • Latent phase
        • Can be longest part of labour, irregular contractions, cervical changes and dilation up to 4cm
      • Active phase
        • Length varies from 8-12 hours, regular and painful contractions, cervix is 4-10cm
      • Transition
        • Cervix is 8-10cm, physical changes such as shaking, vomiting or need to empty bowels
  • Second stage
    • From full dilation to birth of baby
    • Passive second stage of labour
      • Assessed woman is fully dilated, but no involuntary contractions
    • Active second stage of labour
      • Is expulsive contractions or maternal efforts have been encouraged
    • Length is from 2-3 hours depending on if woman is nulliparous or multiparous
  • Third stage
    • From birth of baby to expulsion of placenta and membranes
    • Can be managed physiologically or actively
      • Physiologically being where expulsion is done by maternal effort, no cord clamping
      • Active uses medication and cord clamping
    • Timing is generally up to an hour
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6
Q

What can the first stage of labour be split into?

A
  • Latent phase
    • Can be longest part of labour, irregular contractions, cervical changes and dilation up to 4cm
  • Active phase
    • Length varies from 8-12 hours, regular and painful contractions, cervix is 4-10cm
  • Transition
    • Cervix is 8-10cm, physical changes such as shaking, vomiting or need to empty bowels
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7
Q

When is the second stage of labour?

A
  • From full dilation to birth of baby
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8
Q

What are the 2 stages of the second stage of labour?

A
  • Passive second stage of labour
    • Assessed woman is fully dilated, but no involuntary contractions
  • Active second stage of labour
    • Is expulsive contractions or maternal efforts have been encouraged
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9
Q

When is the third stage of labour?

A
  • From birth of baby to expulsion of placenta and membranes
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10
Q

What are the different forms of management for the third stage of labour?

A
  • Can be managed physiologically or actively
    • Physiologically being where expulsion is done by maternal effort, no cord clamping
    • Active uses medication and cord clamping
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11
Q

What is the timing for the first, second and third stages of labour?

A

1st - longest part of labours, can be excess of 12 hours

2nd - 2 to 3 hours

3rd - up to 1 hour

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12
Q

Describe the steps in the mechanism of labour?

A
  1. Engagement and descent
  2. Flexion
  3. Internal rotation of the head
  4. Crowning and extension of the head
  5. Restitution
  6. Internal rotation of head and external rotation of head
  7. Lateral flexion of shoulders
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13
Q

What are the different foetal lies?

A

Cephalic

Breech

Transverse

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14
Q

What are the different foetal presentations?

A

Face

Brow

Vertex

Breech

Shoulder

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15
Q

What are the different foetal positions?

A
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16
Q

What is the normal foetal heart rate?

A

Normal foetal heartrate is 110-160bpm, with good variability (>5bpm) and accelerations (15bpm)

17
Q

How is the woman monitored during labour?

A
  • Maternal observations
  • Abdominal palpation
  • Vaginal examination
  • Monitoring of liquor
  • Palpation of contractions
  • External signs such as Rhomboid of Michealis and anal cleft line
18
Q

How is the baby monitored during labour?

A

Depending on woman’s risk assessment monitoring of foetus’ heart is through intermittent auscultation or continuous monitoring:

  • Intermittent auscultation with pinards stethoscope or a handheld Doppler
  • Continuous monitoring done with cardiotocograph
19
Q

What are different forms of pharmacological and non-pharmacological support during labour?

A
  • Maternal position and mobility
  • Breathing and hypnobirthing techniques
  • Massage
  • Aromatherapy
  • TENS
  • Oral analgesia
  • Water
  • Entonox
  • Opiods
  • Remifentacil
  • Epidural
20
Q

What are some pain relief options in labour?

A
  • Non-pharmacological
    • Birthing ball
    • Birthing pool
    • TENS machine
    • Hyponobirth
    • Aromatherapy
  • Simple drug therapies
    • Entonox
      • Administration – inhale
      • Advantages – safe, widely used, you control the breathing, quick acting, wears off in minutes
      • Side effects – dizziness, dry mouth, nausea
    • Diamorphine
      • Administration – IM
      • Duration – works within 30 minutes and lasts 4 hours
      • Side effects – nausea, sleepy, slow breathing
  • Advanced techniques
    • Remifentanil PCA
      • Strong morphine like pain medication that is short acting
      • Administration – IV
      • Duration – takes 1 minute to have effect
      • Advantages – control it yourself by pushing button
      • Side effects – slow breathing. Drowsy, nausea, itchiness
    • Epidural
      • Duration – 20 minutes to start working
      • Advantages – button gives extra medicine which you control
      • Side effects – slow down pushing phase, risk of forceps, hypotension, itching, fever, headache
21
Q

For entonox:

  • administration
  • advantages
  • side effects
A
  • Administration – inhale
  • Advantages – safe, widely used, you control the breathing, quick acting, wears off in minutes
  • Side effects – dizziness, dry mouth, nausea
22
Q

For diamorphine:

  • administration
  • duration
  • side effects
A
  • Administration – IM
  • Duration – works within 30 minutes and lasts 4 hours
  • Side effects – nausea, sleepy, slow breathing
23
Q

What is remifentanil PCA?

A
24
Q

For remifentanil PCA:

  • administration
  • duration
  • advantages
  • side effects
A
  • Administration – IV
  • Duration – takes 1 minute to have effect
  • Advantages – control it yourself by pushing button
  • Side effects – slow breathing. Drowsy, nausea, itchiness
25
Q

For epidural:

  • duration
  • advantages
  • side effects
A
  • Duration – 20 minutes to start working
  • Advantages – button gives extra medicine which you control
  • Side effects – slow down pushing phase, risk of forceps, hypotension, itching, fever, headache

Mariam Reproductive System (35 decks)

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