Normal labour Flashcards

1
Q

Labour

A

Process in which the fetus, placenta and membranes are expelled via the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When does labour occur?

A

spontaneously at term (37-42weeks) with fetus presenting vertex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SVD

A

spontaneous vaginal birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

2 key physiological changes for labour

A

cervix softens - changing from support to the birth canal

myometrial tone changes to allow coordinated contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hormonal changes that occur for labour

A

progesterone down

oxytocin and prostaglandins up to allow labour to initiate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Latent first stage of labour

A

intermittent, irregular, painful contractions

cervical effacement and dilation up to 4cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

established first stage of labour

A

regular, painful contractions that result in cervical effacement and dilation from 4cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is the 1st stage of labour complete?

A

cervix fully dilated - 10cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

1st stage length for primigravida

A

about 8 hours but no more than 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

1st stage length for multigravida

A

about 5 hours but no more than 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anticipated progress for the first stage of labour

A

0.5-1cm/hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the 2nd stage of labour?

A

from full cervical dilation to the birth of the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

passive second stage

A

full cervix dilation before/in absence of involuntary expulsive contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Plan of passive second stage

A

1 hour of passive 2nd stage to allow further fetal descent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Active 2nd stage

A

presenting part is visible
expulsive contractions - full cervix dilation
active maternal effort - full dilation but no expulsive contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

2nd stage for primigravida

A

birth within 2 hours

17
Q

2nd stage for multigravida

A

birth within 1 hour

18
Q

What is stage 3?

A

time from birth of baby to the expulsion of placenta and membranes

19
Q

3 points for active management of stage 3

A

uterotonic drugs
deferred clamping and cutting of cord
controlled cord traction after signs of separation of placenta

20
Q

3 points for physiological management of stage 3

A

no routine use of uterotonic drugs
no clamping of cord until pulsation stops
placental delivery by maternal effort

21
Q

When to diagnose a prolonged stage 3?

A

30 mins - active

60 mins - physiological

22
Q

obs taken for progress and monitoring

A

blood pressure, temp, RR, pulse, O2 sats, urine output and urinalysis

23
Q

Abdominal exam findings

A

fetal lie, presentation, attitude, position, engagement

24
Q

Vagina exam findings

A

presentation, engagement, position, cervical effacement and dilation, membranes

25
Q

Liquor findings

A

colour, volume and smell - after spontaneous or artificial rupture of membranes

26
Q

How to auscultate fetal heart

A

intermittent - doppler or pinards

continuous - CTG

27
Q

CTG

A

cardiotocograph

28
Q

Intermittent fetal heart auscultation times in 1st and 2nd stage

A

1st - every 15 mins

2nd - every 5 mins

29
Q

When palpating uterine muscle contractions what is expected?

A

3-4 every 10 minutes

lasting 40-60s and moderate to strong

30
Q

External signs which may be seen

A

rhomboid michaelis or anal cleft line

31
Q

What would you document your findings of monitoring in labour on? When?

A

partogram

when established labour confirmed

32
Q

3 fetal lie

A

oblique - transverse - longitudinal

33
Q

5 presentations

A

face-brow-breech-vertex-shoulder

34
Q

How is the position of the fetus determined?

A

in relation to posterior fontanelle

35
Q

mechanism of labour (explain video)

A
descent 
flexion 
internal rotation of head 
crowning and extension of head 
restitution 
internal rotation of shoulders 
external rotation of head 
lateral flexion
36
Q

Analgesia in labour

A

water - birthing pool and equipment
breathing, TENS, massage, paracetamol, dihydrocodeine
Entonox - Inhaled NO and O2
opiods eg morphine
epidural
maternal position and mobility
remifentanil patient controlled analgesia