Normal labour Flashcards by Sheryl O'Hare

The 3 P’s that are important in labour

Power - uterine contractions
Passage - maternal pelvis
Passenger - foetal position

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Power - uterine contractions

Normal contractions have a regular pattern and adequate resting “tone”
Upper segment of uterus contracts
Lower segment of uterus strewtches, dilates and relaxes

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Passage - maternal pelvis. Name 3 different pelvis shapes

Gynaecoid pelvis
Anthropoid pelvis
Android pelvis

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Passage - maternal pelvis. What is the most suitable female pelvis shape?

Gynaecoid pelvis

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Passenger - foetal position. What is the normal foetal position?

Longitudinal lie
Cephalic (vertex) presentation
Occipito-anterior (baby’s head facing the floor)

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Passenger - foetal position. How can you detect the position of the baby?

Feel for fontanelles on baby’s scalp

anterior: diamond shape
posterior: triangular shape

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At which stage in pregnancy are birth plans discussed?

7 months gestation

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Onset of labour

Change in oestrogen/progesterone ratio

Mechanical stretch of cervix

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Onset of labour - ferguson’s reflex

Baby’s head pushes against cervix. This sends a message to the pituitary gland to release oxytocin.
Oxytocin is released which pushes baby down more.

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What is the function of progesterone in labour?

Keeps the uterus settled

Hinders the contractibility of myocytes

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What is the function of oestrogen in labour?

Makes the uterus contract

Promotes prostaglandin formation

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What is the function of oxytocin in labour?

Initiates and sustains contractions

Promotes prostaglandin release

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Increased foetal cortisol production stimulates an increase in maternal ?????

estriol

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Onset of labour - cervical changes - which 5 parameters do you assess?

Effacement 
Dilatation
Firmness
Position
Level of presenting part / station

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Onset of labour - cervix gets more firm/soft?

Soft

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Rupture of membranes - definition

Amniotic sac bursts and waters break

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What is the function of liquor?

Nurtures and protects foetus.

Facilitates movement

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Rupture of membranes - timing

Pre-term
Pre-labour
First stage of labour 
Second stage of labour 
Born in a caul (born inside sac)

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At which “timing” does rupture of membranes most commonly occur?

First stage of labour

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What is Bishops score?

Determines the likelihood of a patient going into labour

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High bishops score means….

Patient is likely to go into labour themselves

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Low bishops score means…

Patient may require induction of labour

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Contractions that are typically felt in the 3rd trimester. The contractions are irregular and do not increase in frequency and intensity. What are they called?

Braxton Hicks Contractions

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Braxton hicks contractions are the same as true labour contractions. True or false?

False

braxton hicks contractions are false labour contractions
give women a false sensation that they are having real contractions

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What is the role of braxton hicks contractions?

Tighten uterine muslces to prepare the body for birth

True labour contractions occur due to the release of _____

Oxytocin | - as this stimulates the uterus to contract

The blood supply to the uterus is not impaired by contractions/ True or false?

False - it is impaired - every time the uterus contracts, the blood supply to the uterus is impaired

True labour contractions have an irregular rhythm. true or false?

False | - regular rhythm

True labour contractions become longer/shorter in length as labour progresses?

Longer | - max duration is 45 seconds

True labour contractions become more/less frequent as labour progresses?

How many contractions are normal in 10 min period?

3-5 contractions

More than 5 contractions in 10 mins is called

Hyperstimulation | - abnormal

Less than 3 contraction is

Not enough | - abnormal

True labour contractions become stronger/weaker as labour progresses?

Stronger

True labour contractions become more/less/unchanged painful as labour progresses?

What is the significance of the stretch of the cervix by the foetal head?

Increases uterus contractility. This causes further oxytocin release from the posterior pituitary gland. This causes release of prostaglandins, causing further uterus contractions

Which substance is required for a successful labour?

Oxytocin

How many stages of labour are there?

Stage 1 labour - latent phase

Up to 3-4cms dilation of cervix Mild, irregular uterine contractions Cervix shortens and softens Duration is variable

Stage 1 labour - active phase

4cm onwards to full dilation of cervix | Contractions become more rhythmic and stronger

What is full dilation of cervix?

10cm

Stage 2 labour

Full dilation of cervix (10cm) -> delivery of baby | Passage through the birth canal (we want this to be as short as possible)

Stage 2 labour - passage through the birth canal - nulliparous women

Passage through the birth canal is considered prolonged if it exceeds 3 hours with analgesia or exceeds 2 hours without analgesia

Stage 2 labour - passage through the birth canal - multiparous women

Passage through the birth canal is considered prolonged if it exceeds 2 hours with analgesia or exceeds 1 hour without analgesia

Stage 3 labour

Expulsion of placenta and foetal membranes

Stage 3 labour - average duration

5-10 mins after delivery of baby. | It is considered normal up to 30 mins post delivery

Stage 3 labour - active management if there is no expulsion of placenta and foetal membranes in adequate time frame

Prophylactic administration of syntometrine Oxytocin 10 units Cord clamping and cutting

Movements of labour - outline the 7 movements of the foetus during delivery

1. Engagement of head 2. Descent 3. Flexion of head 4. Internal rotation 5. Crowning and extension 6. Restitution and external rotation 7. Expulsion, anterior shoulder first

Movements of labour - engagement of head

Foetal head is engaged when the widest diameter of the foetal head has entered the brim of the pelvis - at this point 3/5ths of foetal head will have entered pelvis

Movements of labour - descent

Downward passage of the presenting part through the pelvis

Movements of labour - during descent, what is the foetal head position?

Occiput transverse position - this is the widest pelvic diameter available for the widest part of the baby's head

Movements of labour - flexion of foetal head

This occurs due to the shape of the bony pelvis and the resistance offered by the soft tissues

Movements of labour - internal rotation

Rotation of the presenting part from its original position (transverse) to anterior position as it passes through the pelvis

Movements of labour - crowning and extension

Once the foetus reaches the introits, you can see a large segment of the foetal head Delivery of the head should be managed carefully and slowly with hands guiding but not leading the exit to prevent rapid extension of tissues and tearing

Movements of labour - restitution and external rotation

Return of foetal head to normal anatomical position in relation to foetal torso

Movements of labour - expulsion

Delivery of rest of baby | Anterior shoulder first

What is a partogram? and what does it measure?

``` Graphic representation of the progress of labour. Measures - foetal heart - amniotic fluid - contractions - cervical dilatation - descent - obstruction - maternal obs ```

What is used to assess foetal heart?

CTG

Who needs CTG monitoring?

High risk pregnancy

CTG - what is the upper trace ?

Foetal HR

CTG - what is the lower trace ?

Uterine contraction pattern from mum

What is the CTG interpretation pneumonic?

DR C BRAVADO

CTG - Determine Risk

High or low ?

CTG - Contractions

Comment on frequency - how many in 10 mins? Unable to tell strength of contraction

CTG - Baseline RAte

Normal: 110-150bpm Tachycardia: >150 bpm Bradycardia: <110bpm

CTG - Variability

Jaggedness of the line around the baseline HR there should be lots of variability. If there is reduced variability - think hypoxia

CTG - Acceleration

Rise above the baseline Can be present or absent If present this is reassuring as when the uterus contracts, the foetal HR should increase

CTG - Decelerations

Early - normal and physiological in the pushing stage of labour due to head compression Late - BAD - this is a sign of foetal hypoxia

CTG - Overall impression

Is this reassuring or are you concerned?

Analgesia options during labour

``` Paracetamol Diamorphine Epidural anaesthesia TENS Entonox (gas and air) Remifentanyl ```

The umbilical cord should be clamped immediately. True or false?

False - delayed cord clamping is more beneficial. - immediate cord clamping reduces the RBCs an infant receives at birth

Skin to skin contact

For an hour immediately after birth

What are fontanelles?

Soft spot on baby head

What shape is the anterior fontanelle?

Diamond

When does the anterior fontanelle ossify?

Between 9 and 18 months

The posterior fontanelle is what shape?

Triangular

The occipitofrontal diameter is longer/shorter than the piparietal diameter?

Longer

At the mothers pelvic inlet, which diameter of the pelvis is wider? - transverse diameter - AP diameter

Transverse diameter

How should the foetus enter the pelvic cavity (what direction should the baby's head be in)

Baby's head should be transverse (facing either right of left)

When descending through the pelvic cavity, what should happen to the foetal head?

It should rotate and be in a flexed position

At the mothers pelvic outlet, which diameter is widest? - transverse diameter - AP diameter

AP diameter

The baby should leave the pelvic cavity in which position?

OA (occipitoanterior)

During delivery, the foetal head should be in flexion/extension?

Extension

What is a station?

The distance of the foetal head from the ischial spines

-ve station means what?

Head is superior to the ischial spines

+ve station means what?

Head is inferior to the ischial spines

Maternal nerve injuries during delivery - what can stretching cause?

Incontinence

Maternal nerve injuries during delivery - what can stirrups cause?

Common peroneal nerve damage (calf)

How can a baby get bells palsy during delivery ?

Due to forceps clamping around the head