Normal labour Flashcards
When does “normal labour” occur?
37-42 weeks
What initiates labour?
Paracrine and autocrine signals generated by fatal, maternal and placental factors
What are the key physiological changes in the initiation of labour?
Cervix softens
Myometrial tone changes to allow for coordinated contractions
Progesterone decreases while oxytocin and prostaglandins increase to allow for labour to initiate
What are the 2 parts of stage 1 labour?
Latent
Established
What happens in latent first stage labour?
Intermittent, often irregular, painful contractions which bring about some cervocal effacement and dilation up to 4cm
What happens in established firs stage?
Regular painful contractions that result in progressive effacement and cervical dilation from 4-10cm
How long does stage 1 labour take in primigravida?
Average 8 hours
Should be No more than 18
How long does stage 1 labour take in multigravida?
Average 5 hours
Should be no more than 12 hours
What is the anticipated progress in stage 1 labour?
0.5-1cm per hour
What is stage 2 labour?
From full cervical dilatation to birth
What are the 2 stages of stage 2 labour?
Passive
Active
When is the passive phase of stage 2?
Full cervical dilation but before expulsive contraction
How long should passive stage 2 be allowed for?
About 1 hour
What is the active phase of stage 2?
Presenting part of baby is visible
Expulsive contractions with fully dilated cervix
How long does stage 2 last for in primigravida?
Birth expected within 2 hours f active stage commencing
How long does stage 2 last for in multigravida?
Birth expected within 1 hour of active stage commencing
What is stage 3?
From time baby is born until expulsion of placenta and membranes
What are the 2 type of management of stage 3?
Active management
Physiological management
When is active management of stage 3 used?
Long labour
Induced labour etc
What does active management of stage 3 involve?
Routine use of uterotonic drugs
Deferred clamping and cutting of cord
Controlled cord traction after signs of separation of placenta
What does physiological management of stage 3 involve?
Delivery of placenta by maternal effort
How long does stage 3 take?
Up to 30 mins with active management or 60 mins with physiological management
How is labour monitored?
MEWS Abdo exam Vaginal exam Monitor liquor Fetal heart Palpation of uterine contractions External signs
What is monitored for MEWS?
BP Pulse Temp Respirations Oxygen saturation Urine output Urinalysis
What is palpated for in abdomen?
Fetal lie Presentation Attitude Denominator Position Engagement
What is the position of th foetus monitored in relation to?
Occiput- posterior fontanelle
What is monitored via vaginal exam?
Presentation Engagement and station Position Cervical effacement and dilation Presence/absecnce of membranes
What is monitored in liquor?
Colour
Smell
Volume
What is the normal colour of amniotic fluid?
Clear to very light straw colour
What can be present in the amniotic fluid?
Blood
Foetal faeces
How often is fatal heart rate monitored?
Every 15 mins in first stage
Every 5 mins in second stage
What are “normal” uterine contractions?
3-4 per 10 mins
Lasting approx 40-60 seconds each
What are external signs we look for?
Rhomboid of Michaelis
Anal cleft line
What analgesia in used in labour?
Breating, massage, water TENS Paracetemol, dihrdrocodeine Entenox Opiods- morphine, dimorphic, pethidine Remifentani patient controlled analgesia Epidural
