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Normal Labour Flashcards

1
Q

Definition of Labour

A

The process by which the foetus, placenta and membranes are expelled via the birth canal

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2
Q

Term of labour occurs at how many weeks gestation?

A

37-42 weeks

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3
Q

The 3 key physiological changes that occur to allow for expansion of the foetus

A
  1. Cervix softens
  2. Myometrial tone changes to allow for coordinated contractions
  3. Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate
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4
Q

Cervix changes for expulsion of the foetus

A 
From supportive role to birth canal 
Softens
Effaces
Thins out (paper thin)
Moves forward from being quite posterior
Dilate
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5
Q

How many stages of labour are there?

A

3

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6
Q

Substages of Stage 1 of Labour

A

Latent stage

Established stage

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7
Q

What does the latent stage of stage 1 involve?

A

Intermittent, often irregular painful contractions which bring about some cervical effacement and dilatation up to 4cm

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8
Q

Does everyone experience the first latent stage?

A

No

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9
Q

What does the established first stage 1 involve?

A

Regular, painful contractions that result in progressive effacement and cervical dilatation from 4cm (WHO says 5cm)

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10
Q

How long does the established stage last in primigravida mothers?

A

On average 8 hours

Unlikely to last longer than 18 hours

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11
Q

How long does the established stage last in multigravida mothers?

A

On average 5 hours

Unlikely to last over 2 hours

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12
Q

Where do the uterine contractions start?

A

The fundus of the uterus

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13
Q

How does the cervix dilate?

A

Uterine contractions move across
This exerts pressure on the foetal pole which encourages flexion and a well applied presenting part
Which in turn puts pressure on the cervix to thin and dilate

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14
Q

Anticipated progress of cervix dilation

A

0.5-1.0cm per hour

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15
Q

How often do you do a vaginal exam during labour?

A

every 4 hours

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16
Q

The cervix is fully dilated at….

A

10cm

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17
Q

When is the established first stage of labour complete?

A

When the cervix is fully dilated at 10cm

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18
Q

Substages of the second stage of labour

A

Passive stage

Active stage

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19
Q

Definition of Stage II of Labour

A

From full cervical dilatation to the birth of the baby

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20
Q

Passive Second stage of Labour involves

A

Finding of full dilatation of the cervix before or in the absence of involuntary expulsive contractions

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21
Q

What may women want to do in the passive second stage of labour?

A

May want to move around/change position

This means the baby is about to descend

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22
Q

How does the passive stage last?

A

1 hour to allow further foetal descent

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23
Q

The active second stage of labour involves

A

Active maternal effort (expulsive contractions) following confirmation of full dilatation of the cervix in the absence of expulsive contractions

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24
Q

Which substage of the second stage of labour is the presenting part visible?

A

Active stage

25
How long does the active stage of stage II of labour last in primigravida women?
Within two hours of the active stage commencing
26
How long does the active stage of II of labour last in multigravida women?
Within one hour of the active stage commencing
27
Definition of the Stage III of Labour
The time of birth of the baby to the expulsion of the placenta and membranes
28
What happens to the placenta as the baby is born?
It folds in on itself and is covered by the membranes
29
What can happen to the membranes in the third stage of labour?
Can rupture spontaneously | Can be ruptured artificially e.g. by a hook
30
Two types of management for stage III
Active management | Physiological management
31
Active management of stage III involves
Routine use of uterotonic drugs Deferred clamping and cutting of the cord Controlled cord traction after signs of separation of the placenta
32
Physiological management of Stage III involves
No clamping of the cord until pulsating has stopped No use of uterotonic drugs Delivery of placenta by maternal effort
33
How long does it take to diagnose a prolonged third stage of labour?
In active management = within 30 mins of birth | In physiological management = within 60 mins of birth
34
MOEWS
Modified obstetric early warning score
35
Progress and monitoring of labour done by
``` MOEWS BP HR Temp Respirations, O2 sats urine output and urinalysis abdominal palpation (PRIOR TO VE) Vaginal examination Monitoring of liquor (colour, smell, volume) once rupture of membranes has occurred Auscultation of foetal heart Palpation of uterine muscle contractions External signs e.g. Rhomboid of Michaelis and Anal cleft line ```
36
Before what does abdominal palpation ALWAYS have to be done
Vaginal Examination
37
What does abdominal palpation look at?
``` Foetal lie presentation altitude denominator position engagement ```
38
What does vaginal exam look at?
``` Presentation engagement station position cervical effacement and dilatation presence/absence of membranes ```
39
How to auscultate the foetal heart
Intermittedly with hand held doppler pinards continuously with CIG (cardiotocograph)
40
How often to intermittendly monitor the babys heart
1st stage of labour = every 15 mins 2nd stage of labour = every 5 mins Active phase = try after every contraction
41
If the baby's heart increases from baseline, this means....
Infection
42
If the baby's heart decreases from baseline, this means.....
Stress
43
How many contractions are normal?
3-4 every 10 mins, lasting 40-60 seconds | Moderate to strong in strength
44
What is the Rhomboid of Michaelis?
The baby puts pressure on the lower sacrum and you can see this - its easier to see in slimmer women
45
What is the anal cleft line?
Purple line that appears in the second stage due to the pressure (from a reddish colour)
46
Different possible presentations of the foetus
``` Face Brow Vertex Breach Shoulder ```
47
Position in normal labour is the position in relation to the
Occiput (posterior fontanelle)
48
The mechanism of labour and changes of the position of the body
1. Descent and flexion 2. Internal rotation of the head 3. Crowning and extension of the head 4. Restitution (turns) 5. Internal rotation of the shoulders 6. External rotation of the head 7. Lateral flexion
49
Position of normal labour
LOA or ROA
50
Lie of normal labour
Longitudinal lie
51
Presentation of normal labour
Vertex and cephalic presentation
52
Denominator in normal labour is the....
Occiput
53
Which bone is meant to be the presenting part of the foetus?
Anterior parietal bone
54
Analgesics used in labour
``` Breathing, massage, paracetamol dihydrocodeine Water Entonox (nitrous oxide + oxygen inhaled) Opoids (morphine, diamorphine, pethidine) Epidural Reminifentanil patient controlled analgesia Maternal position and mobility Continous midwifery Birthing balls, baths and pools ```
55
Mechanisms of labour
``` Engagement Descent Flexion Internal rotation Extension Restitution and external rotation Expulsion ```
56
Indications for C section
``` Absaloute CPD Placenta praevia grades 3 / 4 Pre eclampsia Post maturity IUGR Foetal distress in labour / prolapsed cord Failure to progress in labour Malpresentations; brow Placental abruption if foetal distress Vaginal infection e.g. active herpes Cervical cancer ```
57
Serious complications of C sections
``` Emergency hysterectomy Need for further surgery at a later date Thromboembolic disease ITU admission Bladder or ureteric injury Death 1 in 12 000 Future pregnancies - Increased risk of uterine rupture - increased risk of antepartum stillbirth - increased risk of pregancies with placenta praevia and placenta accreta ```
58
Frequent complications of C sections
Persistent wound and abdo discomfort in 1st few months Increased risk of C section in subsequent pregnancies Readmission to hosp Haemorrhage Infection Foetal lacerations 1 - 2 babies per 100

Reproduction Physiology (13 decks)

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