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Repro AM > Normal labour > Flashcards

Normal labour Flashcards

1
Q

When does “normal labour” occur?

A

37-42 weeks

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2
Q

What initiates labour?

A

Paracrine and autocrine signals generated by fatal, maternal and placental factors

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3
Q

What are the key physiological changes in the initiation of labour?

A

Cervix softens
Myometrial tone changes to allow for coordinated contractions
Progesterone decreases while oxytocin and prostaglandins increase to allow for labour to initiate

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4
Q

What are the 2 parts of stage 1 labour?

A

Latent

Established

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5
Q

What happens in latent first stage labour?

A

Intermittent, often irregular, painful contractions which bring about some cervocal effacement and dilation up to 4cm

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6
Q

What happens in established firs stage?

A

Regular painful contractions that result in progressive effacement and cervical dilation from 4-10cm

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7
Q

How long does stage 1 labour take in primigravida?

A

Average 8 hours

Should be No more than 18

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8
Q

How long does stage 1 labour take in multigravida?

A

Average 5 hours

Should be no more than 12 hours

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9
Q

What is the anticipated progress in stage 1 labour?

A

0.5-1cm per hour

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10
Q

What is stage 2 labour?

A

From full cervical dilatation to birth

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11
Q

What are the 2 stages of stage 2 labour?

A

Passive

Active

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12
Q

When is the passive phase of stage 2?

A

Full cervical dilation but before expulsive contraction

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13
Q

How long should passive stage 2 be allowed for?

A

About 1 hour

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14
Q

What is the active phase of stage 2?

A

Presenting part of baby is visible

Expulsive contractions with fully dilated cervix

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15
Q

How long does stage 2 last for in primigravida?

A

Birth expected within 2 hours f active stage commencing

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16
Q

How long does stage 2 last for in multigravida?

A

Birth expected within 1 hour of active stage commencing

17
Q

What is stage 3?

A

From time baby is born until expulsion of placenta and membranes

18
Q

What are the 2 type of management of stage 3?

A

Active management

Physiological management

19
Q

When is active management of stage 3 used?

A

Long labour

Induced labour etc

20
Q

What does active management of stage 3 involve?

A

Routine use of uterotonic drugs
Deferred clamping and cutting of cord
Controlled cord traction after signs of separation of placenta

21
Q

What does physiological management of stage 3 involve?

A

Delivery of placenta by maternal effort

22
Q

How long does stage 3 take?

A

Up to 30 mins with active management or 60 mins with physiological management

23
Q

How is labour monitored?

A 
MEWS
Abdo exam
Vaginal exam
Monitor liquor
Fetal heart
Palpation of uterine contractions
External signs
24
Q

What is monitored for MEWS?

A 
BP
Pulse
Temp
Respirations
Oxygen saturation
Urine output
Urinalysis
25
Q

What is palpated for in abdomen?

A 
Fetal lie
Presentation
Attitude
Denominator
Position
Engagement
26
Q

What is the position of th foetus monitored in relation to?

A

Occiput- posterior fontanelle

27
Q

What is monitored via vaginal exam?

A 
Presentation
Engagement and station
Position
Cervical effacement and dilation
Presence/absecnce of membranes
28
Q

What is monitored in liquor?

A

Colour
Smell
Volume

29
Q

What is the normal colour of amniotic fluid?

A

Clear to very light straw colour

30
Q

What can be present in the amniotic fluid?

A

Blood

Foetal faeces

31
Q

How often is fatal heart rate monitored?

A

Every 15 mins in first stage

Every 5 mins in second stage

32
Q

What are “normal” uterine contractions?

A

3-4 per 10 mins

Lasting approx 40-60 seconds each

33
Q

What are external signs we look for?

A

Rhomboid of Michaelis

Anal cleft line

34
Q

What analgesia in used in labour?

A 
Breating, massage, water
TENS
Paracetemol, dihrdrocodeine
Entenox
Opiods- morphine, dimorphic, pethidine
Remifentani patient controlled analgesia
Epidural

Repro AM (27 decks)

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