Normal Labour Flashcards

1
Q

How is labour defined?

A
  • the physiological process in which a foetus is expelled from the uterus
  • it requires the presence of regular uterine contractions
  • these increase in frequency, intensity + duration
  • this leads to progressive cervical effacement + dilatation

labour = regular contractions + cervical effacement / dilatation

other features (e.g. waters breaking) do NOT indicate labour

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2
Q

When does labour + delivery typically occur?

A

between 37 and 42 weeks gestation

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3
Q

Why is the position of the baby important during labour?

A
  • the head pushes against the cervix, causing it to stretch
  • stretching of the cervix sends nerve impulses to the brain
  • the brain stimulates the pituitary gland to release oxytocin
  • oxytocin causes the uterus to contract

if the baby is not in the correct position, the head is unable to cause the cervix to stretch

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4
Q

What are the 2 phases of labour?

A
  • latent phase
  • established phase

the established phase is further divided into 3 stages

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5
Q

What happens during the latent phase of labour?

A
  • there may be some painful contractions, but these are irregular
  • there may be some cervical effacement and dilation up to 4cm
  • this phase can last from hours up to a week

during this phase women are encouraged to mobilise, use paracetamol and stay hydrated

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6
Q

What is meant by the established phase of labour?

A
  • there are regular painful cervical contractions
  • there is progressive cervical dilatation from 4cm
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7
Q

How can established labour be divided into 3 stages?

A

first stage:

  • from the onset of labour (4cm dilation / true contractions) until 10cm dilation

second stage:

  • from 10cm dilation to delivery of the baby

third stage:

  • from delivery of the baby until delivery of the placenta
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8
Q

What is the first stage of labour?

A
  • this begins when the cervix reaches 4cm dilation and true contractions begin
  • there is cervical dilatation (up to 10cm) and effacement

effacement = cervix becomes thinner

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9
Q

What is meant by cervical effacement?

A
  • also referred to as “ripening”
  • the cervix becomes softer, thinner and shorter

it is assessed via a digital examination

  • finger inserted into the cervical os to assess how dilated / effaced the cervix is
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10
Q

What is meant by the “show”?

A
  • there is a mucus plug in the cervix that prevents bacteria from entering the uterus during pregnancy
  • this falls out during the first stage of labour
  • this creates space for the baby to pass through

this appears as a single blob of pinkish / white jelly which can be blood-tinged

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11
Q

What are the signs of the onset of labour?

A
  • show (mucus plug from the cervix)
  • rupture of membranes
  • regular, painful contractions
  • dilation of the cervix on examination
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12
Q

What are the criteria for diagnosing the latent and established first stage of labour?

A

latent stage:

  • painful contractions
  • effacement + dilation of the cervix up to 4cm

established phase:

  • REGULAR, painful contractions
  • dilation of the cervix from 4cm onwards
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13
Q

What are Braxton-Hicks contractions?

A
  • occassional irregular contractions of the uterus
  • felt during the 2nd or 3rd trimester
  • there is temporary and irregular tightening / mild cramping in the abdomen

they are sometimes called “false labour pains” and can be described to feel like menstrual cramps

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14
Q

How are Braxton-Hicks contractions related to labour?

A
  • these contractions are NOT true contractions and DO NOT indicate the onset of labour
  • they do not progress
  • they do not become regular

staying hydrated / relaxed can reduce these contractions

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15
Q

During vaginal examination in labour, what else is assessed?

A

descent of the head

  • this is assessed in relation to the ischial spines of the pelvis
  • it is called the “station of the head”
  • in early labour, the station is often -1
  • the station becomes +1 during the second stage (below the ischial spines)
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16
Q

Other than by vaginal examination, how can descent of the head be assessed?

A

abdominal palpation

  • it is described by how many 5ths of the baby’s head can be felt above the pelvis
17
Q

When describing descent of the head, what is meant by 5/5 and 0/5?

A

5/5th palpable:

  • all of the head is above the pubic bone
  • all 5 fifths can be palpated

0/5th palpable:

  • all of the head is below the pubic brim and cannot be palpated
  • once the cervix is 10cm dilated, usually none of the head is felt
18
Q

What are women encouraged to do during the first stage of labour?

A
  • walk and remain in an upright position
  • this has been seen to reduce the duration of labour, need for C-section and epidural
19
Q

How can the second stage of labour be divided into 2 stages?

A

passive stage:

  • the cervix is fully dilated to 10cm
  • there is an absence of contractions

active stage:

  • there are expulsive contractions / active maternal effort alongside full dilation of the cervix
20
Q

Why does the passive stage of the second stage of labour occur?

A
  • once the cervix is dilated to 10cm, the head moves down the pelvis and applies pressure to the pelvic floor
  • pressure on the pelvic floor produces the urge to push
  • it can take time for this urge to occur when the head is still high
21
Q

What are the 2 approaches to the third stage of labour?

A
  • physiological management
  • active management
22
Q

What is meant by physiological management in the third stage of labour?

A
  • the placenta is delivered via maternal effort alone
  • uterotonic drugs are not used
  • there is no cord traction
23
Q

What is meant by active management of the third stage?

A
  • there is assistance in delivery of the placenta
  • IM oxytocin is given to encourage the uterus to contract
  • traction is applied to the umbilical cord to guide the placenta out
24
Q

Who is offered active management of the third stage and why?

A
  • it is offered to all women routinely to reduce the risk of postpartum haemorrhage
  • it will be initiated if there is haemorrhage

OR

  • a > 60 min delay in delivery of the placenta
25
Q

What is the major side effect of active management of the third stage?

A

N&V

26
Q

How is active management of the third stage initiated?

A
  • an IM dose of oxytocin (10 IU) is given
  • this is given immediately after delivery of the baby
  • other uterotonic drugs - such as syntometrine - can be used
27
Q

When should the cord be clamped in active management of the third stage?

A
  • the cord should be clamped + cut within 5 mins of birth
  • there should be a delay of 1-3 mins between delivery and clamping to allow blood to flow to the baby
  • (unless baby requires resuscitation)

delay is important in prevention of neonatal anaemia

28
Q

How is controlled cord traction acheived?

A
  • the abdomen is palpated to assess for a uterine contraction
  • traction is applied DURING contractions
  • it should be stopped if there is resistance
  • at the same time, the other hand presses the uterus upwards (in the opposite direction) to prevent prolapse

the aim is to deliver the placenta in one piece

29
Q

What should be done following active management of the third stage?

A
  • massage the uterus until it is contracted and firm
  • examine the placenta to ensure it is complete and no tissue remains in the uterus
30
Q

What are the 3 important things to monitor in the mother?

A
  1. contractions
  2. vaginal loss
  3. vital signs
31
Q

Why is it important to monitor contractions?

A
  • frequency, strength and length of contractions gives a good indication of progress in labour
  • 4-5 contractions in 10mins are needed to progress in labour
32
Q

Why is it important to monitor vaginal loss?

A
  • spontaneous rupture of the membranes (SROM) can occur at any point in labour (and before)
  • once ruptured, observe for meconium or heavy blood staining
  • this could indicate antepartum haemorrhage
33
Q

How is the foetus monitored during labour?

A

low risk women:

  • intermittent auscultation of the foetal heart
  • via Doppler USS or Pinard stethoscope

high risk women:

  • continuous monitoring via cardiotocograph (CTG)