Normal Labour Flashcards
What occurs in labour?
The foetus, membranes, umbilical cord and placenta are expelled from the uterus
What is a birth plan?
A record of what the woman would like to happen during labour and after birth
Which hormones play a role in the onset of labour?
Oestrogen
Oxytocin
What is the role of oestrogen in labour?
Causes uterus contraction through prostaglandin production
What occurs in Ferguson’s reflex?
The head pushing on the cervix sends messages to the pituitary to release oxytocin causing increased contraction
When is the rupture of membranes useful?
Towards term - initiates labour
Give some cervical changes that occur during labour
Decrease in collagen fibre alignment/strength
Decreased firmness
What 5 criteria are assessed in Bishop’s score?
Position Consistency Effacement Dilatation Station in pelvis
What is the purpose of Bishop’s score?
To determine if it is safe to induce labour
What are the two phases of the first stage of labour?
Latent and active
What occurs during the latent phase?
Mild irregular uterine contractions with cervix shortening and softening
What occurs in the active phase?
Contractions getting stronger
Slow descent of presenting part
What indicates the start of the second stage of labour?
Complete dilatation of the cervix
When is the second stage considered prolonged?
Nulliparous - exceeding 3 hours with regional analgesia or 2 hours without
Multiparous - exceeding 2 hours with regional analgesia or 1 hour without
What occurs in the third stage of labour?
Delivery of baby to expulsion of placenta/foetal membranes
What is the average duration for the third stage of labour?
10 minutes
What are Braxton-Hicks contractions?
Tightening of the uterine muscles that can be confused for labour
Which hormone controls true labour contractions?
Oxytocin
In true labour contractions, the length of time between contractions increases and duration of contractions decreases. True/false?
False - length of time between contraction decreases and duration increases
What are the three key factors in labour? (Three P’s)
Power
Passage
Passenger
What is the normal timing for contractions?
Up to 3-4 in 10 mins
What are the three main types of female pelvis?
Gynaecoid
Anthropoid
Android
What is the normal foetal position during labour?
Longitudinal lie with cephalic presentation and occipito-anterior position
What can be palpated to determine foetal position on vaginal examination?
Fontanelles
Give some analgesia options that may be considered during labour
Paracetamol/co-codamol TENS Entonox Diamorphine Epidural Remifentanyl
What are the 7 cardinal movements of labour?
Engagement Descent Flexion Internal rotation Crowning & extension Restituition & external rotation Expulsion
What occurs in engagement?
The widest diameter of the presenting part passes below the plane of the pelvic inlet
How can engagement be felt on palpation?
By palpating the foetal head in the abdomen - 3/5ths should have entered the pelvis
How often should vaginal examinations be carried out in normal labour?
4 hourly
What occurs in crowning?
There is appearance of a large segment of the foetal head at the introitus
What is the purpose of delayed cord clamping?
To increase the red blood cells an infant receives at birth by 50%
What is the current recommendation for skin to skin after birth?
Uninterrupted SSC for 1 hour after birth
What three signs indicate completion of the third stage?
Uterus contraction and hardening
Umbilical cord lengthens permanently
Gush of blood
What can be done to manage the third stage of labour?
Syntometerine (prophylaxis)
Oxytocin
What is a normal blood loss seen in labour?
Less than 500ml
How is haemostasis achieved in pregnancy?
Thrombosis of torn blood vessels
Contraction of uterine muscle to strangulate blood vessels
What is puerperium and how long does it last?
The return of tissues to a non-pregnant state - lasts 6 weeks
Give some uterine changes that occur in puerperium
Involution
Fundal height falls
Endometrium regenerates
