Normal Labour Flashcards
Definition of normal labour?
Regular, painful contractions with cervical effacement and dilatation
Definition of first, second and third stages of labour? In which stage is mortality the highest?
First - onset of labour to full dilatation of cervix
Second - full dilatation to delivery of baby
Third - delivery of baby to delivery of placenta; highest mortality!
What are the 2 phases of the first stage of labour?
Latent - slow progress until 3cm dilated
Active - fast progress until 10cm dilated
Definition of spurious labour?
Regular, painful contractions w/o effacement/dilatation
Name 2 indications for AROM
Speed up progress of labour
Check colour/amount of amniotic fluid
What does the colour/amount of amniotic fluid tell you about the foetus?
If it’s hypoxic - hypoxic foetus releases meconium (turns colour brown), and oligohydramnios indicates the foetus is centralising blood supply
What are the 3 components to successful contractions?
Strong, long and frequent (usually 3-5/10 minutes)
Definition of foetal lie, presentation, attitude, position, and station
Lie - what way is the longest axis of the foetus relative to mother (transverse vs longitudinal)
Presentation - what part of foetus is presenting (vertex vs face vs breech)
Attitude - Degree of flexion/extension of foetus (usually flexed)
Position - Relationship of a part of foetus to the mother’s pelvis (in cephalic, defined as relation of foetal occiput to mother)
Station - how far above/below the ischial spines is the foetus (ischial spines chosen as landmark as this is usually where foetus becomes engaged)
Name 4 things we have regular observations of the mother for
Infection
Pre-eclampsia - BP and urinanalysis
Bleeding
Emotional wellbeing (pain)
Are we obliged to give analgesia to a mother during delivery? Why/why not?
No (depends on mother’s wishes) - there’s a perception that a certain amount of pain during childbirth is normal and desirable
Name 4 non-pharmacological and 4 pharmacological analgesics during delivery
Non-pharm: Massage, relaxation/breathing techniques, environmental changes, hot and cold packs, TENS
Pharm: NO gas, oral or IV opioids, neuraxial block (epidural/spinal), local block (pudendal block)
How often do we do foetal auscultation in the 1st and 2nd stages of labour?
1st - every 15 minutes in active phase
2nd - after every contraction
Give indications for continuous foetal monitoring
Pre-natal complications - HT, PE, bleed, IUGR, DM
Intrapartum risk factors - meconium/blood stained liquor, abnormal HR on auscultation
How quickly does the 1st stage of pregnancy usually take?
Roughly 1cm/hour, but can be more, especially if nullpara
Name 5 elements of the admission history of a woman in labour
PMx Past Obsx Review this pregnancy for complications Infection status (GBS, HIV/HBV/HCV) Blood group
Labour Hx - duration, show, ROM, bleeding
Birth/analgesia plan, antenatal education
Name 4 components of initial examination of a woman in labour
BP, urinanlysis (pre-eclampsia)
T (infection)
Signs of bleeding
Duration, frequency, intensity of contractions and pain control
How often are women examined during the first stage of labour? Name 4 components of the examination
Abdo exam every hour, vaginal every 4 hours. Document uterine contractions (strength, freq, intensity), cervical effacement, dilatation and station of presenting part
Name 1 SE of an epidural
Can prolong length of second stage of labour
How long does the second stage of labour usually take for a nullpara and multipara woman? What’s it called if it takes longer than this?
Nullpara - under 2 hours
Multipara - under 1 hour
Any longer = arrested descent
What are the 3 ways the foetal head descends through the pelvis
Moulding, flexion and rotation
Go through the normal movements of the foetal head (in cephalic presentation) and shoulders from beginning to end of delivery (including how to deliver the shoulders)
Head starts in OT position, as it allows the longest diameter of the head to match the longest diameter of the mum’s pelvic inlet (transverse)
Then internally rotates to become OA to navigate through ischial spines (longest diameter of ischial spines in AP direction)
Head extends to pass through vaginal canal
After head is out, it restitutes by externally rotating to become OT again, to allow shoulders to pass through pelvic inlet
Pull down on anterior shoulder, then elevate head to deliver posterior shoulder
Pull on shoulders for rest of body to deliver
What is the shortest diameter of the foetal head? How long is it?
Suboccipitobregmatic distance (9.5cm)
Name the 3 general things you should monitor during 2nd stage of labour
Mother - P, BP, T
Foetus - Auscultate after every contraction, amniotic fluid colour
Progress of labour
How long does stage 3 usually take?
5 - 10 minutes
Name 3 signs of placental separation in stage 3
Fresh show of blood
Lengthening of umbilical cord
Firm uterus
What are the 3 elements of active management of the third stage?
Prophylactic oxytocics
Controlled cord traction
Early cord clamping
Name 3 oxytocics commonly used (in order of strength). What is a C/I for using the strongest one?
Syntocinon - least strong
Syntometrine
Ergometrine - strongest; C/I if HT
What’s the definition of early cord clamping? 1 good and 1 bad thing about it?
Cord clamping between 30-60 seconds. Good - reduces risk of PPH. Bad - might reduce amount of blood going to baby = more likely to become iron deficient
What are the recommendations for food and fluid in the first stage of labour?
If at risk of C/S or GA, IV line and NBM. Otherwise, light diet early, clear fluids in late labour
Name 3 indications for antibiotics in 1st stage of labour
GBS +ve
Chorioamnionitis
Prolonged ROM
Endocarditis prophylaxis
