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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

What stimulates uterine contraction?

A

Increase in intraellular calcium (by prostaglandins and oxytocin) stimulate uterine contraction

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2
Q

What are signs of labour

A
  • Show - mucus plug in cervix comes away (may still be weeks until pregnancy)
  • SRM (Spontaneous Rupture of Membrane) - rupture of amniotic sac (water breaking)
  • Regular contraction
  • Effacement and dilation of cervix: 1-2cm to 10 cm
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3
Q

How i s labour confirmed

A
  • Regular painful uterine contractions (thinning of cervix)
  • Effeacemetn and dilation of cervix (vaginal examination)
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4
Q

Average length of labour in primiparous

A

12-24 hours

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5
Q

Average length of labour in multiparous

A

6-12 hours

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6
Q

Brief overview of stages of labour

A
  • Dilatation period (6-12hours)
    • Onset to full dilatation of cervix
    • Approximately 1/2cm per hour
      • Latent stage- up to 4 cm
      • Active phase- up to 10cm
  • Expulsion period (30-120minutes)
    • Full dilatation to birth of baby
  • After birth period (10-30minutes)
    • Birth to delivery of placenta
    • If slow, IM syntometrine (ergometrine + oxytocin) after 30 minutes or brandt-andrews
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7
Q

Care of mother in labour

A
  • Supportive/resuscitation
    • Temperature- check every 4 hours
    • Pulse- hourly check
    • BP- hourly check
    • Urinalysis
    • Progress of labour- below
    • Diet + Fluids
    • Analgesia
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8
Q

Care of foetus during labour

A
  • Amniotic fluid appearance (meconium)
    • May indicate foetal distress
  • FHR
    • Over shoulder
    • Intermittent/continuous
    • Every 15minutes for 1st stage + listen for full minute
  • Foetal blood scalp pH (if abnormal FHR)
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9
Q

How is foetal engagement measured?

A

Estimated using the palm width of the five fingers of the hand. If five fingers are needed to cover the head above the pelvic brim, it is five-fifths palpable, and if no head is palapbale, it is zero fifths

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10
Q

When does foetal engagement occur?

A
  • Nulliparous - 37 weeks beyond
  • Multiparous - may not occur until labour
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11
Q

Where is the foetal engagement measured from?

A

Pubic symphysis

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12
Q

What is the following foetal position?

A

Right occiput transverse

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13
Q

What is the following foetal position?

A

Right occiput anterior

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14
Q

What is the following foetal position?

A

Occiput anterior

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15
Q

What is the following foetal position?

A

Left occiput anterior

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16
Q

What is the following foetal position?

A

Left occiput transverse

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17
Q

What is the following foetal position?

A

Left occiput posterior

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18
Q

What is the following foetal position?

A

Occiput posterior

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19
Q

What is the following foetal position?

A

Right occiput posterior

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20
Q

What are the boundaries of the pelvic inlet?

A
  • Anterior - upper boerder of pubic symphysis
  • Laterally - Ileopectineal line
  • Posterior - sacral promontory
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21
Q

What are the boundaries of the pelvic outlet?

A
  • Anterior - pubic arch
  • Posterolaterally - sacrotuberous ligaments and ischial tuberosities
  • Posterior - coccyx
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22
Q

What are the cardinal movements of labour?

A
  1. Transverse engagement
  2. Descent and flexion
  3. internal rotation to OA
  4. Crowning - extension
  5. Restitution - OA to LOT/ROT

Mneumonic = Every Descent Female I Corwn Rules Lovingly

  • Engaement
  • Descent
  • Flexion
  • Internal rotation
  • Corwn
  • Restitution
  • Lateral flexion
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23
Q

What is the sequence of passage through the pelvus for a normal vertex delivery?

A
  1. Cardinal movements of labour
  2. External rotation of shoulders
  3. Delivery of the anterior shoulder
  4. Delivery of posterior shoulder
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24
Q

What are the phases of the first stage of labour?

A
  • Latent phase
  • Active phase
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25
Q

What is the latent phase of the first stage of labour?

A

The period taken for the cervix to completely efface and dilate up to 3cm

26
Q

What is meant by the term effacement?

A

Shortening of the cervix

27
Q

What is the active phase of the first stage of labour?

A

Dilation of the cervix from 3cm to 10 cm

28
Q

What are braxton hicks contractions?

A

Mild, often irrgular, non-progressive contraction that may occur from 30 weeks gestation (more common after 36 weeks) and may be confused with labour

29
Q

How do braxton hicks contractions differ from labour contractions?

A

They are non-progressive and less painful

30
Q

What is meant by the station of the baby?

A

Relation of the presenting part to the ischial spine. If the presenting part is level with the ischial spine, the station is 0

31
Q

What is the difference between station and engagement?

A

Station is relation of presenting part to the ischial spine, whereas engagement is the descent of the biparietal diameter through the pelvic brim. If the level of the ischial spine is level with the head, the head must be engaged

32
Q

Following the commencement of the second stage of labour, how long does it normally take for birth to take place in a nulliparous women?

A

3 hours

33
Q

What monitoring is done during labour?

A

Partograph

  • FHR every 15 minutes
  • Contraction assessment every 30 minutes
  • Maternal pulse every hour
  • BP, temp and urine every 4 hours
34
Q

What is the second stage of labour?

A

Time from full cervical dilatation until the baby is born

35
Q

Following the commencement of the second stage of labour, how long does it normally take for birth to take place in a multiparous woman?

A

Within 2 hours

36
Q

How long is allowed for passive descent before active pushing is commenced?

A

1-2 hours

37
Q

When does the active stage of the 2nd stage of labour commence?

A

When the mother begins to actively push

38
Q

How should the anterior shoulder be encouraged to be delivered?

A

Gentle traction guiding the head towards the perineum

39
Q

How can the posterior shoulder be encouraged to be delivered?

A

Gentle traction upwards and anteriorly

40
Q

How would you cut the umbilical cord?

A

Double-clamp and cut

41
Q

What can delaying clamping the umbilical cord cause?

A

Raised haemtocrit in the neonate. However, it is now common practice to delay cord clamping at least 2-5 minutes unless contraindicated

42
Q

How is the baby assessed once delivered?

A

Apgar scoring

43
Q

What is Apgar scoring?

A

Objective and subjective assessment of newborn

  • Activity
  • Pulse
  • Grimace
  • Appearance
  • Respiration

Lower score = worse condition

44
Q

What is the 3rd stage of labour?

A

Duration from delivery of the baby to the delivery of the placenta and membranes

45
Q

What are signs of the 3rd stage of labour?

A
  • Gushing of blood
  • Cord lengthening
  • Rising fundus
46
Q

What is involved in active management of the 3rd stage of labour?

A
  • Calmping and cutting of the cord
  • Controlled cord traction
  • Use uterotonics
47
Q

What utertotonics can be given for active management of the 3rd stage of labour?

A

Given as anterior shoulder is delivered

  • Syntometrine - combination of ergometrine and oxytocin
  • Oxytocin IM - syntocinon
48
Q

How would you apply controlled traction on the umbilical cord in the 3rd stage of labour?

A

Brandt-Andrew technique - Applied with right hand, whilst left hand suports the fundus

49
Q

What should be given prophylactically if there is a risk of PPH (e.g. multiple pregnancies)?

A

Oxytocin infusion

50
Q

What monitoring is done for the 2 hours following delivery?

A
  • Basic Observations
  • Uterine size and contractions
  • Signs of complication - fresh blood PV, painful vulval/vaginal/perineal swelling
51
Q

How is Syntometrine given?

A

IM

52
Q

How can oxytocin be delivered in the 3rd stage of labour?

A

IM or slow IV infusion

53
Q

When is ergometrine (and therefore syntometriene) contraindicated for use?

A
  • Pre-eclampsia
  • Hypertension
  • Cardiac conditions
54
Q

When is active management of 3rd stage indicated for?

A

In the event of:

  • Haemorrhage
  • Failure to deliver placenta within 1hr
  • Maternal desire to shorten 3rd stage
55
Q

What is involved in the physiological management of the 3rd stage of labour?

A
  • No syntometrine or oxytocin
  • Cord is allowed to stop pulsatinig before it is clamped and cut
  • Placenta delivered by maternal effort alone
56
Q

What are the advantages of active management of the 3rd stage of labour?

A
  • Decreases rates of large PPH
  • Decreases mean blood loss and postnatal anaemia
  • Decreases length of 3rd stage
  • Decreases need for blood transfusions
57
Q

What do you do delay cutting the cord for 30 seconds?

A

To increase haematocrit

58
Q

Signs of separation of placenta

A
  • Uterus contracts and relaxes
  • Slight bleeding
  • Cord lengthens
59
Q

Indications for forceps delivery

A
  • fetal distress in the second stage of labour
  • maternal distress in the second stage of labour
  • failure to progress in the second stage of labour
  • control of head in breech deliver
60
Q

Indicatios for caesarean section

A
  • absolute CPD
  • placenta praevia grades 3/4
  • pre-eclampsia
  • post-maturity
  • IUGR
  • fetal distress in labour/prolapsed cord
  • failure of labour to progress
  • malpresentations: brow
  • placental abruption: only if fetal distress; if dead deliver vaginally
  • vaginal infection e.g. active herpes
  • cervical cancer (disseminates cancer cells)
61
Q

Requirments for forceps delivery

A
  • Fully dilated ervix
  • Occipito-atnerior
  • Ruptured membranes
  • Cephalic presentation
  • Engaged
  • Pain relief - minimal perineal nerve block
  • Sphincter (bladder) empty

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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