normal labour Flashcards
function PGE labour
increase contractions
function oxytocin labour
increase contractions, excitability + PGE production
cervical changes labour
cervical softening (increased hyaluniric acid) // cervical ripening (decreased collagen)
monitoring in labour
FHR CTG // contractions 30 mins // pulse 60 mins // BP, temp, ketones and proteins 4 hours
3 Ps of labour
power (contrications), passage (shape of pelvis), passenger (feotal lie and presentation)
normal presenting fetus
cephalic lie, occipit-anterior // flexed head
what are braxton hicks contractions
3rd trimester, irregular and painless ‘contractions’
what are the 3 stages of labour
1 = until fully dilates // 2 = passage of baby / 3 = delivery of placenta
stage 1 labour latent phase + rate
0-3cm (takes about 6 hours)
stage 1 labour active phase + rate
3cm to fully dilated (1cm/hr)
how long should stage 1 take in primigravida mums
10-16 hours
usual presentation of fetus in stage 1
vertex (head enters pelvis in occipito-lateral)
what is passive second stage
abscence of pushing
what is active second stage
active process of maternal pushing (less painful than 1st stage)
when is stage 2 too long in nullparous women
> 2 hours (>3 in epidural)
when is stage 2 too long in multiparous women
> 1 hour (2> in epidural)
what are the 7 cardinal movements of labour
1) engagement (baby head tranverse in pelvis) –> 2) descent (baby through birth canal) –> 3) flexion –> 4) internal rotation (now AP) –> 5) crowning and extension –> 6) retitution and external rotation –> 7) expulsion
how long does stage 3 of labour last
5-10 mins (up to half an hour)
signs stage 3 is complete
uterus hardens and risens // umbilical cord lengthens // gush of blood
benefits of delayed cord clamping
more haemoglobin and blood volume to baby
how is a CTG read
DR C BRAVADO (risk , contractions, rate, accelerations, decelerations, overall)
normal foetal heart rate
100-160
causes foetal bradycardia
fetal vagal tone // maternal BB
causes foetal bradycardia
pyrexia, infection, hypoxia, prematura
how many contractions should be in 10 mintes
3-4 // too few = not progressing // too many = hyperstimulation
normal baseline variabilities CTG
5-15
causes loss of variability
premature, hypoxia, epidural, sleeping baby (worry if >90mins)
accelerations in a CTG
increase in heart rate >15bmp for >15 seconds after each contraction
what is an early deceleration
reduced heart rate that coincides with start of contraction and goes back to normal once contraction finishes (usually not harmful)
what is a late decel CTG
a deceleration of HR that lags behind start of contraction and takes 30 seconds to fix itself (sign of ditress)
what are variable decels
independent of contractions (cord compression)
indications for IOL
prolonged pregnancy (1-2 weeks past date) // PPROM // diabetes, pre-eclampsia, cholestasis // intrauterine death
what is bishops score
asses need for induction
components of bishops score
position // consistency // effacement // dilation // station
what bishop score indicates need for inducing labour
<5
what bishop score indicates spontaneous labour
> 8
1st method for IOL
membrane sweep (informal method, can be done by midwife)
medications used for IOL
vaginal PGE2, oral PGE1 (misoprotsol), oxytonin
procedural methods IOL
amniotomy (break waters) // cervical ripening balloon
what bishops score indicates medical method for IOL
<6 = vaginal PGE or oral misoprotsol
what bishops score indicates procedural method for IOL
> 6 = amniotomy or IV oxytocin
biggest complication IOL
uterine hyperstimulation
symptoms of uterine hyperstimulation
fetal hypoxia or acidaemia // uterine rupture
mx uterine hyperstimulation
remove vaginal PGE, stop oxytocin
non-medical mx for pain in labour
TENS or etenox (50% NO + 50% air)
opiates used in labour
Pethidine or diamorphine (may cause neonatal distress)
where is an epidural inserted + what meds are administered
L3-4 // Levobupivacaine/ bupivacaine + fentanyl
risks epidural
slow labour, fetal bradycardia + distress // maternal hypotension, headache, atonic bladder
analgesia for c section
spinal - LA + opioid to subarachnoid space
