Normal labour Flashcards
What is the 1st stage of labour?
Latent/early phase - cervical effacement and dilation up to 4cm
Active/established phase - dilation from 4cm to fully dilated (10cm), painful regular contractions
What rate of dilation is acceptable for active 1st stage?
0.5cm/h (2cm every 4h)
Frequency of contractions during active/established 1st stage should be what?
3-4/10 mins, lasting up to 1 min
What is the 2nd stage of labour?
full cervical dilation to delivery of baby
- passive stage - seen particularly in epidural (1-2h passive stage recommended)
- active stage - maternal pushing
What is the 3rd stage of labour?
delivery of placenta and membranes
How long should a physiological 3rd stage take?
up to 1 hour
When are uterotonics for active 3rd stage used?
as anterior shoulder is born
Which uterotonics should be used for active management of the 3rd stage?
- syntometrine (oxytocin + ergometrine maleate IM) if not CI
- syntocinon (oxytocin) IM - NICE recommend this, fewer SEs and CIs
What are the CIs to syntometrine and why?
Can precipitate MI
- pre-eclampsia
- severe HTN
- severe liver or renal impairment
- severe heart disease
What are early decelerations?
- downward spike of >15bpm for >15s
- mimic the shape of the contraction
- caused by head compression
What are late decelerations?
- downward spike of >15bpm for >15s
- reach their lowest point after the peak of the contraction has passed
- sign of acidosis
FBS pH ranges
Normal (repeat every hour if CTG remains abnormal): >/= 7.25
Borderline (repeat 30 mins if CTG remains abnormal): 7.20-7.25
Abnormal (immediate delivery): <7.20
When to expect birth, suspect and diagnose delay in 2nd stage of labour
Nulliparous:
- expect birth within 3h of pushing
- suspect delay after 1h
- diagnose delay after 2h
Multiparous:
- expect birth within 2h of pushing
- suspect delay after 30mins
- diagnosed delay after 1h
When is entonox used in labour?
throughout
When is pudendal nerve block used in labour?
instrumental delivery (not sufficient for rotational forceps)
When is local anaesthetic (lidocaine) used in labour?
before episiotomy at delivery, before suturing vaginal tears
Monitoring after epidural insertion
- monitor BP every 5 mins for 20 mins
- CTG monitoring
When is combined spinal epidural anaesthesia (CSE) used in labour?
- for quick pain relief (spinal) with option of prolonging anaesthesia (epidural)
- e.g. for C-section that might take longer than usual (e.g. prev. difficult surgery, placentae praevia)
When is spinal anaesthesia used in labour?
for most LSCS
