Normal Labour Flashcards
How is foetal engagement measured?
Estimated using the palm width of the five fingers of the hand. If five fingers are needed to cover the head above the pelvic brim, it is five-fifths palpable, and if no head is palapbale, it is zero fifths
When does foetal engagement occur?
- Nulliparous - 37 weeks beyond
- Multiparous - may not occur until labour
Where is the foetal engagement measured from?
Pubic symphysis
What is the following foetal position?
Right occiput transverse
What is the following foetal position?
Right occiput anterior
What is the following foetal position?
Occiput anterior
What is the following foetal position?
Left occiput anterior
What is the following foetal position?
Left occiput transverse
What is the following foetal position?
Left occiput posterior
What is the following foetal position?
Occiput posterior
What is the following foetal position?
Right occiput posterior
What are the boundaries of the pelvic inlet?
- Anterior - upper boerder of pubic symphysis
- Laterally - Ileopectineal line
- Posterior - sacral promontory
What are the boundaries of the pelvic outlet?
- Anterior - pubic arch
- Posterolaterally - sacrotuberous ligaments and ischial tuberosities
- Posterior - coccyx
What are the cardinal movements of labour?
- Transverse engagement
- Descent and flexion
- internal rotation to OA
- Crowning - extension
- Restitution - OA to LOT/ROT
What is the sequence of passage through the pelvus for a normal vertex delivery?
- Cardinal movements of labour
- External rotation of shoulders
- Delivery of the anterior shoulder
- Delivery of posterior shoulder
What are the phases of the first stage of labour?
- Latent phase
- Active phase
What is the latent phase of the first stage of labour?
The period taken for the cervix to completely efface and dilate up to 3cm
What is meant by the term effacement?
Shortening of the cervix
What is the active phase of the first stage of labour?
Dilation of the cervix from 3cm to 10 cm
What are braxton hicks contractions?
Mild, often irrgular, non-progressive contraction that may occur from 30 weeks gestation (more common after 36 weeks) and may be confused with labour
How do braxton hicks contractions differ from labour contractions?
They are non-progressive and less painful
What is meant by the station of the baby?
Relation of the presenting part to the ischial spine. If the presenting part is level with the ischial spine, the station is 0
What is the difference between station and engagement?
Station is relation of presenting part to the ischial spine, whereas engagement is the descent of the biparietal diameter through the pelvic brim. If the level of the ischial spine is level with the head, the head must be engaged
Following the commencement of the second stage of labour, how long does it normally take for birth to take place in a nulliparous women?
3 hours
What monitoring is done during labour?
Partograph
- FHR every 15 minutes
- Contraction assessment every 30 minutes
- Maternal pulse every hour
- BP, temp and urine every 4 hours
What is the second stage of labour?
Time from full cervical dilatation until the baby is born
Following the commencement of the second stage of labour, how long does it normally take for birth to take place in a multiparous woman?
Within 2 hours
How long is allowed for passive descent before active pushing is commenced?
1-2 hours
When does the active stage of the 2nd stage of labour commence?
When the mother begins to actively push
How should the anterior shoulder be encouraged to be delivered?
Gentle traction guiding the head towards the perineum
How can the posterior shoulder be encouraged to be delivered?
Gentle traction upwards and anteriorly
How would you cut the umbilical cord?
Double-clamp and cut
What can delaying clamping the umbilical cord cause?
Raised haemtocrit in the neonate. However, it is now common practice to delay cord clamping at least 2-5 minutes unless contraindicated
How is the baby assessed once delivered?
Apgar scoring
What is Apgar scoring?
Objective and subjective assessment of newborn
- Activity
- Pulse
- Grimace
- Appearance
- Respiration
Lower score = worse condition
What is the 3rd stage of labour?
Duration from delivery of the baby to the delivery of the placenta and membranes
What are signs of the 3rd stage of labour?
- Gushing of blood
- Cord lengthening
- Rising fundus
What is involved in active management of the 3rd stage of labour?
- Calmping and cutting of the cord
- Controlled cord traction
- Use uterotonics
What utertotonics can be given for active management of the 3rd stage of labour?
Given as anterior shoulder is delivered
- Syntometrine - combination of ergometrine and oxytocin
- Oxytocin IM - syntocinon
How would you apply controlled traction on the umbilical cord in the 3rd stage of labour?
Brandt-Andrew technique - Applied with right hand, whilst left hand suports the fundus
What should be given prophylactically if there is a risk of PPH (e.g. multiple pregnancies)?
Oxytocin infusion
What monitoring is done for the 2 hours following delivery?
- Basic Observations
- Uterine size and contractions
- Signs of complication - fresh blood PV, painful vulval/vaginal/perineal swelling
How is Syntometrine given?
IM
How can oxytocin be delivered in the 3rd stage of labour?
IM or slow IV infusion
When is ergometrine (and therefore syntometriene) contraindicated for use?
- Pre-eclampsia
- Hypertension
- Cardiac conditions
When is active management of 3rd stage indicated for?
In the event of:
- Haemorrhage
- Failure to deliver placenta within 1hr
- Maternal desire to shorten 3rd stage
What is involved in the physiological management of the 3rd stage of labour?
- No syntometrine or oxytocin
- Cord is allowed to stop pulsatinig before it is clamped and cut
- Placenta delivered by maternal effort alone
What are the advantages of active management of the 3rd stage of labour?
- Decreases rates of large PPH
- Decreases mean blood loss and postnatal anaemia
- Decreases length of 3rd stage
- Decreases need for blood transfusions
