Normal labour Flashcards
Stages of fetal passage through pelvis in labour
Engagement and descent
Internal rotation to OA
Crowning
Restitution
External rotation
Delivery of anterior shoulder
Delivery of posterior shoulder
1st stage of labour
Latent phase = period for cervix to full efface and dilate to 3cm
Active phase = 3cm to 10cm
Braxton-hicks
Mild, irregular, non progressive contractions from 30 weeks
Normal progression rate
2cm every 4 hours
2nd stage
From full dilatation to baby being born
Active 2nd stage = when mother starts expulsive efforts
Caput
swelling of fetal skull - normal if its central
Moulding
overlapping of fetal skull bones
Management of baby immediately after delivery
Double clamp cord and cut after 2-3 mins (when it stops pulsating)
Assess baby using APGAR score at 1,5 and 10 mins
Active management of 3rd stage - what is it, SE
Use of oxytocin (given as anterior shoulder is born)
Early clamping and cutting of cord
Controlled cord traction using Brandt-Andrew’s technique
Side effects: N+V, headache
When should active management of 3rd stage always take place?
In event of haemorrhage, failure to deliver placenta within 1 hour, maternal desire to shorten 3rd stage
Care immediately after delivery for mother
Give oxytocin infusion if high risk of PPH
Skin to skin contact
Delay of 2nd stage - when to make diagnosis
Nulliparous - after 1 hour of pushing.
After 2 hours, consider CS
Multiparous - after 1 hour of pushing consider CS
Foetal monitoring during labour (normal delivery)
Auscultate for a full minute every 15 mins in 1st stage, every 5 mins in 2nd stage
CTG indications (maternal, fetal, intrapartum)
Maternal: previous CS, comorbidities, post-term pregnancy, PROM, induction or APH
Fetal: IUGR, prematurity, multiple, breech, oligohydraminos
Intrapartum indications: Oxytocin use, epidural, pyrexia
CTG interpretation
DR C BRAVADO
Determine risk
Contractions
Baseline rate
Accelerations
Variability
Decelerations
Overall impression
CTG normal values + what this means
Contractions - should be 3-4 in 10 mins
Baseline rate = 100-160
Variability 5-25 (shows good CNS perfusion)
Acceleration (15 beats over baseline for 15 seconds) - presence is good
Decelerations (15 beats below baseline for 15 seconds) - presence is bad. Late decels or atypical decels = bad
Causes of reduced variability
Fetal hypoxia
Sleep cycle
Drugs: benzos, methyldopa, magnesium sulphate
Prematurity
Heart block
Management of poor CTG
Left lateral side
Fluids
Fetal blood sample = if <7.2 pH = abnormal so deliver
Dawes Redmond criteria
At end of CTG - not to be used in labour
Maternal monitoring during labour
Use partogram
Assesses using maternal vital signs, liquor colour, FHR
Narcotic pain relief in labour - duration, SE
Pethidine + diamorphine: lasts 3-4 hours.
Can cause resp depression if birth within this time
Give with an antiemetic
Epidural pain relief - action, SE, cautions
Reduced maternal secretion of catecholamines
Good for controlling BP
Can give a patchy block, can get hypotension + decreased mobility
Postdural puncture headache
Epidural contraindications
Sepsis, infection at site of insertion, thrombocytopaenia, raised ICP, haemorrhage, CV instability
What precautions should be taken in IOL with previous CS + grand multiparas?
Risk of scar dehiscence
Use oxytocin first (not prostaglandins)
What is the incidence of induction, and rate of success at term?
10%, success = 60-80% at term
What is stabilising induction?
when presenting part isn’t engaged so is stabilised by an assistant to prevent cord prolapse. Should happen in theatre in case of cord prolapse
What is fetal fibronectin?
protein found in vaginal secretions during labour. Can be measured to assess whether preterm labour is real or not
How can you prevent preterm labour?
treat BV (Clindamycin), progesterone, cerclage, amnioreduction
What is the caution with syntometrine?
Increases BP
When should postnatal depression be screened for?
4-6 weeks + 3-4 months
