Normal labour Flashcards
Labour
Process in which the fetus, placenta and membranes are expelled via the placenta
When does labour occur?
spontaneously at term (37-42weeks) with fetus presenting vertex
SVD
spontaneous vaginal birth
2 key physiological changes for labour
cervix softens - changing from support to the birth canal
myometrial tone changes to allow coordinated contractions
Hormonal changes that occur for labour
progesterone down
oxytocin and prostaglandins up to allow labour to initiate
Latent first stage of labour
intermittent, irregular, painful contractions
cervical effacement and dilation up to 4cm
established first stage of labour
regular, painful contractions that result in cervical effacement and dilation from 4cm
When is the 1st stage of labour complete?
cervix fully dilated - 10cm
1st stage length for primigravida
about 8 hours but no more than 18
1st stage length for multigravida
about 5 hours but no more than 12
Anticipated progress for the first stage of labour
0.5-1cm/hour
What is the 2nd stage of labour?
from full cervical dilation to the birth of the baby
passive second stage
full cervix dilation before/in absence of involuntary expulsive contractions
Plan of passive second stage
1 hour of passive 2nd stage to allow further fetal descent
Active 2nd stage
presenting part is visible
expulsive contractions - full cervix dilation
active maternal effort - full dilation but no expulsive contractions
2nd stage for primigravida
birth within 2 hours
2nd stage for multigravida
birth within 1 hour
What is stage 3?
time from birth of baby to the expulsion of placenta and membranes
3 points for active management of stage 3
uterotonic drugs
deferred clamping and cutting of cord
controlled cord traction after signs of separation of placenta
3 points for physiological management of stage 3
no routine use of uterotonic drugs
no clamping of cord until pulsation stops
placental delivery by maternal effort
When to diagnose a prolonged stage 3?
30 mins - active
60 mins - physiological
obs taken for progress and monitoring
blood pressure, temp, RR, pulse, O2 sats, urine output and urinalysis
Abdominal exam findings
fetal lie, presentation, attitude, position, engagement
Vagina exam findings
presentation, engagement, position, cervical effacement and dilation, membranes
Liquor findings
colour, volume and smell - after spontaneous or artificial rupture of membranes
How to auscultate fetal heart
intermittent - doppler or pinards
continuous - CTG
CTG
cardiotocograph
Intermittent fetal heart auscultation times in 1st and 2nd stage
1st - every 15 mins
2nd - every 5 mins
When palpating uterine muscle contractions what is expected?
3-4 every 10 minutes
lasting 40-60s and moderate to strong
External signs which may be seen
rhomboid michaelis or anal cleft line
What would you document your findings of monitoring in labour on? When?
partogram
when established labour confirmed
3 fetal lie
oblique - transverse - longitudinal
5 presentations
face-brow-breech-vertex-shoulder
How is the position of the fetus determined?
in relation to posterior fontanelle
mechanism of labour (explain video)
descent flexion internal rotation of head crowning and extension of head restitution internal rotation of shoulders external rotation of head lateral flexion
Analgesia in labour
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
