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GOSH > Normal labour > Flashcards

Normal labour Flashcards

1
Q

What are the key hormones that cause labour to start?

A

prostaglandins

oxytocin

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2
Q

What hormonal changes take place towards the end of pregnancy?

A

Increased concentrations of oestrogen

stimulates production and release of prostaglandins
+
promotes formation of oxytocin receptors = myometrium more sensitive to oxytocin

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3
Q

Why are oxytocin and prostaglandins important in end-stage pregnancy/labour?

A

Strong myometrial stimulants

Play a major role in cervical ripening

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4
Q

What changes occur in the myometrium towards the end of a pregnancy?

A

Stretching increases muscle excitability and contractility

gap junctions are formed (under influence of oestrogen) - enables transmission of electrochemical signals from cell to cell and a synchronized contraction wave

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5
Q

What changes occur in the cervix towards the end of a pregnancy?

A

Decrease in collagen
Increase in water content

  • allows cervix to soften, efface and dilate (ripen)
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6
Q

What is the definition of latent labour?

A

Period of time (not necessarily continuous):

Painful contractions

Some cervical change - effacement
dilation up to 4cm

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7
Q

What is recommended to women in latent labour?

A

Women usually cope well

Encouraged: stay hydrated, eat snacks, mobilise, rest, warm baths, massage, paracetamol analgesia

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8
Q

What are the features that indicate established labour?

A

Regular painful contractions

Progressive cervical dilation from 4 cm

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9
Q

What is recommended to women in established labour?

A

Continuous one-to-one care from a midwife

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10
Q

What are the different stages of (established) labour?

A

1st stage: Onset of established labour (4cm) to full dilation of the cervix (10cm)

2nd stage: from full dilation to birth of the baby

3rd stage: from birth of baby to expulsion of placenta and membranes

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11
Q

What is the first stage of labour?

A

Onset of established labour (4cm) to full dilation of the cervix (10cm)

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12
Q

What is the second stage of labour?

A

from full dilation to birth of the baby

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13
Q

What is the third stage of labour?

A

from birth of baby to expulsion of placenta and membranes

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14
Q

How is descent of the head measured?

How is this also known?

A

During vaginal examination

In relation to ischial spine of pelvis

AKA station of the head

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15
Q

What is a common station of the head in early labour?

A

-1

above the ischial spine

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16
Q

What is a common station of the head in second stage of labour?

A

+1

below the spines

17
Q

Other than PV exam, how else can one check the descent of the head?

A

Abdominal palpation (how many 5ths of babies head can be felt above pelvis)

Head above pubic bone - 5/5ths palpable

once cervix 10cm dilated - none of head is felt, 0/5ths palpable

18
Q

How can one help cervical dilation and descent of the head?

A

Mobilisation - walking and upright positions

19
Q

How can mobilising during the first stage of labour help the progression of labour?

A

Reduces:
Duration of labour
Risk of caesarean birth
Need for epidural

20
Q

How can the second stage of labour be divided further?

A

Passive

Active

21
Q

What is the passive 2nd stage of labour?

A

Full dilation of cervix

Prior to or in absence of involuntary expulsive contractions

22
Q

What is the active 2nd stage of labour?

A

Expulsive contractions or active maternal effort

Full dilation of cervix

23
Q

Other than urge to push, what other signs of stage 2 labour?

A

Anal dilation and perineum bulging

24
Q

How can you limit the risk of perineal damage during childbirth?

A

Anal pad - pressure on perineum

Ask mother to pause once head is out, as her to breath and give little pushes

25
Q

What is delayed cord clamping, how and why is it done?

A

delayed cord clamping: waiting for at least a minute before cutting cord - wait for cord to stop pulsating

reduces risk of anaemia in babies

26
Q

What are the two ways that the third stage of labour can be managed?

A

Active management

Physiological management

27
Q

What is active management of the third stage of labour?

A

Use of uterotonic drugs (syntometrine)

Deferred clamping and cutting of cord (>1 min)

Controlled cord traction (apply counter-pressure, just above the pubic bone to guard the uterus and apply gentle downwards traction of the cord)

28
Q

What are the benefits of active management of third stage of labour?

A

Reduced risk of postpartum haemorrhage

Shortens length of the third stage

29
Q

What are the drawbacks of uterotonic drugs?

A

increase amount of nausea and vomiting

30
Q

How would you physiologically manage a woman in the third stage of labour?

A

No routine use of uterotonic drugs

No clamping of cord until pulsation has ceased

Delivery of placenta by maternal effort

31
Q

Where should a woman give birth?

A

Mother’s choice:

low risk women: midwifery unit is equally as safe as obstetric unit

Home birth safe for multis, but slightly higher risk in primips

32
Q

What should women be advised re. food and drink during labour?

A

Drink throughout

Light meals when desired (unless having opiates or increasing chance of GA)

33
Q

What should women be advised re. bladder careering labour?

A

Encourage women to pass urine regularly

May need catheter if unable to pass urine (eg. epidural)

34
Q

What observations would you need to for someone in normal labour?

A

vital signs

urine analysis

vaginal loss - liquor (say colour), fresh blood

contractions

35
Q

What would you watch for in a woman who’s membranes have ruptured?

A

Meconium or blood-staining liquor

Could indicate an antepartum haemorrhage

36
Q

What are some non-pharmacological pain relief methods used in labour?

A

massage
relaxation and breathing
water
mobilisation

37
Q

What are some pharmacological pain relief methods used in labour?

A

Paracetamol

Nitrous oxide (gas and air)

opiates (diamorphine)

epidural

38
Q

What foetal monitoring is done in low-risk women?

A

intermittent auscultation of fatal heart using doppler US or pinard stethoscope

39
Q

What foetal monitoring is done in high-risk women?

A

continuous fetal monitoring using a cardiotocograph (CTG)

GOSH (33 decks)

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