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Yr3 Reproductive > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

Define normal labour?

A

Spontaneous labour at term (37-42 weeks) with fetus in vertex position resulting in a Spontaneous Vaginal Birth (SVD)

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2
Q

What physiological changes must occur for labour to initiate?

A
  • Cervix softens
  • Myometrial tone changes to allow for coordinated contractions
  • Progesterone decrease/ Oxytocin & Prostaglandins increase
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3
Q

How many stages of labour are there?

A

3

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4
Q

What are the parts of Stage 1 of labour?

A

Latent first stage

Established first stage

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5
Q

What occurs during the latent first stage of labour?

A

Intermittent painful contractions leading to up to 4cm of dilatation

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6
Q

What occurs during the Established first stage of labour?

A

Regular Painful contraction producing progressive cervical effacement and 10cm dilatation

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7
Q

How long does the first stage last?

A

Established first stage lasts an average 8 hours primagravida and 5 multigravida

Progresses at 0.5-1cm per hour

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8
Q

What occurs during stage 2 of labour?

A

Phase from full cervical dilation to birth of baby

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9
Q

What occurs in the Passive 2nd stage of labour?

A

This is the stage after your fully dilated but before Involuntary Expulsive Contractions occur

Allow 1 hour for the fetus to descend

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10
Q

What occurs in the Active Second stage of Labour?

A

Expulsive contractions with full dilatation = Active 2nd stage

The presenting part of fetus is visible and active maternal effort is required

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11
Q

How long does the Active second stage of labour take?

A

Average 2 hours for primagravida and 1 for multigravida

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12
Q

What occurs during the 3rd stage of labour?

A

Expulsion of the placenta and membranes

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13
Q

What are the different ways we can handle the 3rd stage of labour?

A
  • Active Management

- Physiological management

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14
Q

Whats involved in Active management of the 3rd stage?

A
  • Uterotonic drugs
  • Deferrend clamping and cutting of cord
  • Controlled cord traction

Physiological means no drugs, don’t clamp till it stops pulsating and deliver placenta by maternal effort alone

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15
Q

How long does the 3rd stage take?

A

Prolonged Third Stage is a diagnosis made after 30 minutes of active management or 60 minutes of physiological management

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16
Q

We use a partogram once established labour has been confirmed to monitor the labours progress.
What tests/measurments would this include?

A
  • Abdominal Palpation
  • Vaginal Exam
  • Monitoring colour, smell & volume of liquor
  • Fetal Heart rate
  • Palpate Uterine muscle contractions
  • External signs
  • BP/Pulse/Temp/RR/O2Sat/Urine output/Urinalysis
17
Q

What does abdominal palpation tell us about the labour?

A 
Fetal Lie
Presentation
Attitude
Denominator
Position
Engagement
18
Q

Define Fetal Lie

A 
Axis of foetus to mother.
Either Longitudinal (same axis as mom) or transverse (lying sideways) or Oblique
19
Q

Define Fetal Presentation

A

The part of the foetus that is foremost in the birth canal

20
Q

Define Fetal Attitude

A

Foetus’s posture

i.e. back concave, straight or convex and head tilted forward or back

21
Q

Define Fetal Position

A

orientation of the foetus. Determined by which way the occiput (post fontanelle is facing)

1) anterior vs posterior vs transverse
2) and left vs right

22
Q

Define foetal Engagement

A

Degree to which the baby’s presenting part (head in vertex) has entered the pelvic inlet

23
Q

What can be found on vaginal exam?

A

Fotal presentation, engagement & position

Cervical effacement and dilatation

Presence/absence of membranes

24
Q

How do we auscultate the foetal heart?

A

Intermittently with Hand held doppler or pinard

OR Continuously with Cardiotocograph (CTG)

25
Q

How often should be auscultate the foetal heart if doing it intermittently?

A

Every 15 minutes in first stage and 5 minutes in 2nd stage

26
Q

How often/long do you hope for when palpating uterine muscle contractions?

A

3-4 every 10 minutes lasting 40-60seconds each

And moderate to strong not weak

27
Q

What are some external signs of labour?

A

Rhomboid of Michaelis

Anal Cleft line

28
Q

What are the parts of the actual mechanism of labour?

A

Descent
Flexion (of head)
Internal rotation of head (so facing downward)
Crowning & extension of head
Shoulders rotate internally
Head gets out and rotates to face sideways (restitution)
Lateral flexion to deliver shoulders (Ant first then Post)

29
Q

What forms of analgesia can women get during labour?

A
  • Entonox
  • Opioids
  • Epidural
  • Breathing & massage
  • TENS
  • Paracetamol and Dihydrocodeine
  • Remifentanil Patient controlled Analgesia
30
Q

What is entonox?

A

Inhalation Nitrous Oxide and oxygen

Aka gas and air

Yr3 Reproductive (40 decks)

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