Normal Labour Flashcards
what are the seven cardinal movements of labour?
> descent > flexion > internal rotation of the head > crowning and extension of the head > restitution > internal rotation of the shoulders > external rotation of the head > lateral flexion
what hormonal changes initiate labour?
> decrease in progesterone
increase in oxytocin
increase in prostaglandins
what are the key physiological changes that occur to initiate labour?
> hormones
myometrial changes
cervix softens
define normal labour
process at which the foetus, placenta and membranes are expelled from the birth canal.
it occur spontaneously at 37-42 wks
describe the latent 1st stage of labour
a period where there are intermittent irregular and painful contraction bringing about cervical effacement dilation up to 4cm
describe the established first stage of labour
regular painful contractions resulting in progressive effacement and cervical dilation from 4cm
how long would you expect stage 1 labour to last in primigravida?
about 8hrs no more than 18hrs
how long would you expect stage 1 labour to last in multigravida?
about 5 hrs no more than 12hrs
when is stage 1 labour complete?
when the cervix is dilated to 10cm
what is the anticipated progress in stage 1 labour?
0.5-1cm per hour
what does stage 2 labour involve?
from full cervical dilation to the birth of the baby
what does passive second stage labour involve?
foetal descent, there is a fully dilated cervix in absence of involuntary contractions
describe active second stage labour
> presenting part is visible
expulsive contractions with full dilation of the cervix
active maternal effort
how long should 2nd stage labour last in a primigravida woman?
2 hours of active stage 2
how long should 2nd stage labour last in multigravida women?
1hr of active stage 2
what is stage 3 labour?
time between the birth of the baby and the expulsion of the placenta and the membranes
what is prolonged stage 3 labour?
> not completed within 30mins if active management
> not completed within 60 mins of physiological management
what physiological management exists for 3rd stage labour?
> delivery of the placenta by maternal effort
no clamping until pulsation had stopped
to uterine tonic drugs
what active management is there for 3rd stage labour?
> controlled cord traction after signs of separation of the placenta from the uterine wall
deferred clamping and cord cutting
uterotonic drugs
what would you assess on abdominal palpation during labour?
> foetal life
presentation
position
engagement
what would you assess on vaginal examination during labour?
> presentation > position > engagement > dilation > cervical effacement > membrane presence
what would you assess in the liquor after membrane rupture?
> volume
smell
colour
how often would you assess foetal heart with a hand held doppler?
> every 5 mins in second stage
> every 15mins in first stage
how can you assess foetal heart?
> cardiotocography
> hand held doppler
describe uterine muscle contractions during labour
3-4 every 10 mins that last 40-60 seconds
what general investigations would you do to assess in labour?
> BP > pulse > temperature > respiration > o2 saturation > urine output > urinalysis
what analgesia options are available in pregnancy?
> epidural > continuous midwifery care > maternal position and mobilisation > remifentanil > opioids (morphine, diamorphine, pethicline) > entox > dihydrocodeine > paracetamol > massage > TENS > breathing
