normal labour Flashcards
what is normal labour
painful regular uterine contractions with cervical effacement, dilation and descent of the presenting part
what is stage 1 labour split into
latent and established phase
what happens in the latent phase stage 1
before 3-4cm dilated.
what happens in active phase stage 1
> 4cm dilated up to 10cm
length of stage 1 in primip
8-18h
length of stage 1 in multip
5-12h
what should be monitored in stage 1
temperature and bp 4hourly, pulse hourly, observe contractions every 30 mins. listen to FHR every 15 mins for 1 min after contraction
rate of dilations
after 4cm - 0.5cm/hr
when does the second stage begin
when the cervix is dilated to 10cm - through to delivery of the fetus
what are the stages of the 2nd stage
passive and active
what happens in passive phase of 2nd stage
cervix fully dilated but no desire to push
what happens in the active phase of 2nd stage
full dilatation and expulsive contractions. baby can be seen
what should be monitored in stage 2
pulse and bp hourly, temp 4 hourly, contractions every half hour. listen to FHR every 5 mins for 1 min after contraction
how long does stage 2 last in primp and multip
3h - primip, 2h- multip
what is the 3rd stage labour
delivery of the placenta
what size does uterus contract to after birth
what happens in stage 3
uterus contracts to
what can be used as the anterior shoulder is delivered
ergometrine + oxytocin (syntometrine)
what does using syntometrine do to third stage
decreases the time to 5 min and decr incidence PPH
when is syntometrine contraindicated
pre eclampsia, hypertension, liver/renal impairment/ heart disease, hypercholesterolaemia. as can precipitate myocardial infarction
if BP hasn’t been measured and want to use a drug during labour what can you use
oxytocin
what hormones trigger onset of labour
prostaglandins and oxytocin- uterine contractions and cervical softening
what is a show
plug of cervical mucus and some blood as membranes strip from the os
what is rupturing of membranes
rupture of amniotic sac
why is vaginal exam performed
fetal engagement, cervical effacement, dilatation
what part of skull should be felt anteriorly
posterior fontanelle
what can be used to measure progress of labour in first stage
Bishops score
what is the bishops score based on
cervical length, dilatation, consistency, position of cervix, station of presenting part
when is the active phase in score of Bishops score
> 11
which stage is hypoxia more common
2nd stage - fetal blood reduces and anaerobic resp with each contraction
active management stage 3 to reduce risk PPH
IM oxytocin as babies shoulder is delivered, cord traction with uterine stabilisation, early cord clamping
what should be done if there is retained placenta
manual removal
