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Reproductive System > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

Define normal labour?

A

Spontaneous labour at term (37-42 weeks) with fetus in vertex position resulting in a Spontaneous Vaginal Birth (SVD)

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2
Q

What physiological changes must occur for labour to initiate?

A
  • Cervix softens
  • Myometrial tone changes to allow for coordinated contractions
  • Progesterone decrease whilst Oxytocin and Prostaglandins increase
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3
Q

How many stages of labour are there?

A

3

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4
Q

What are the parts of Stage 1 of labour?

A

Latent first stage

Established first stage

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5
Q

What occurs during the latent first stage of labour?

A

Intermittent painful contractions leading to up to 4cm of dilatation

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6
Q

What occurs during the Established first stage of labour?

A

Regular Painful contraction producing progressive cervical effacement and 10cm dilatation

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7
Q

How long does the first stage last?

A

Established first stage lasts an average 8 hours primagravida and 5 multigravida

Progresses at 0.5-1cm per hour

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8
Q

What occurs during stage 2 of labour?

A

Phase from full cervical dilation to birth of baby

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9
Q

What occurs in the Passive 2nd stage of labour?

A

This is the stage after your fully dilated but before Involuntary Expulsive Contractions occur

Allow 1 hour for the fetus to descend

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10
Q

What occurs in the Active Second stage of Labour?

A

Expulsive contractions with full dilatation

The presenting part of fetus is visible and active maternal effort is required

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11
Q

How long does the Active phase of Stage 2 of labour take (difference between primagravida and multigravida)?

A

Average 2 hrs of Stage 2 starting for primagravida and 1hr for multigravida

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12
Q

What occurs during the 3rd stage of labour?

A

Expulsion of the placenta and membranes

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13
Q

What are the different ways we can handle the 3rd stage of labour?

A
  • Active Management

* Physiological management

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14
Q

Describe the active and physiological management options for stage 3

A
  • Uterotonic drugs
  • Deferrend clamping and cutting of cord
  • Controlled cord traction

Physiological means no drugs, don’t clamp till it stops pulsating and deliver placenta by maternal effort alone

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15
Q

When is prolonged third stage diagnosed?

A

After 30 minutes of birth with active management or within 60 minutes of birth with physiological management

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16
Q

We use a partogram once established labour has been confirmed to monitor the labours progress.
What tests/measurments would this include?

A
  • Abdominal Palpation
  • Vaginal Exam
  • Monitoring colour, smell and volume of liquor
  • Fetal Heart rate
  • Palpate Uterine muscle contractions
  • External signs
  • BP/Pulse/Temp/RR/O2Sat/Urine output/Urinalysis
17
Q

What does abdominal palpation tell us about the labour?

A 
Fetal Lie
Presentation
Attitude
Denominator
Position
Engagement
18
Q

Define Fetal Lie

A 
Axis of foetus to mother.
Either Longitudinal (same axis as mum) or transverse (lying sideways) or Oblique
19
Q

Define Fetal Presentation

A

The part of the foetus that is foremost in the birth canal

20
Q

Define Fetal Attitude

A

Foetus’s posture - way body is flexed

i.e. back concave, straight or convex and head tilted forward or back

21
Q

Define Fetal Position

A

Orientation of the foetus. Determined by which way the occiput (post fontanelle is facing)

1) Anterior vs posterior vs transverse
2) and left vs right

22
Q

Define foetal Engagement

A

Degree to which the baby’s presenting part (head in vertex) has entered the pelvic inlet

23
Q

What can be found on vaginal exam?

A

Foetal presentation, engagement and position

Cervical effacement and dilatation

Presence/absence of membranes

24
Q

How do we auscultate the foetal heart?

A

Intermittently with Hand held doppler or pinard

OR Continuously with Cardiotocograph (CTG)

25
Q

How often should be auscultate the foetal heart if doing it intermittently?

A

Every 15 minutes in first stage and 5 minutes in 2nd stage

26
Q

How often/long do you hope for when palpating uterine muscle contractions?

A

3-4 every 10mins lasting 40-60s each

And moderate to strong not weak

27
Q

What are some external signs of labour?

A

Rhomboid of Michaelis

Anal Cleft line

28
Q

What are the parts to the mechanism of labour?

A
  • Descent
  • Flexion (of head)
  • Internal rotation of head (so facing downward)
  • Crowning and extension of head
  • Shoulders rotate internally
  • Head gets out and rotates to face sideways (restitution)
  • External rotation of head
  • Lateral flexion to deliver shoulders (Ant first then Post)
29
Q

What forms of analgesia can women get during labour?

A
  • Entonox
  • Opioids
  • Epidural
  • Breathing and massage
  • TENS
  • Paracetamol and Dihydrocodeine
  • Remifentanil Patient controlled Analgesia
  • Water
30
Q

What is entonox?

A

Inhalation Nitrous Oxide and oxygen

Aka gas and air

31
Q

Why does progesterone decrease during labour?

A

As it inhibits uterine contractions

32
Q

What is oxytocin and what is its action during labour?

A

A peptide hormone which releases prostaglandins from the uterine wall which causes uterine muscle contraction

33
Q

What changes occur to the cervix during stage 1 of labour?

A

Moves forward, thins, softens and dilates

34
Q

What are the two phases in stage 2 of labour?

A

Passive and active

35
Q

What does it mean by a Primagravida birth and a multigravida birth?

A

Primigravida - woman who is pregnant for the first time

Multigravida - woman who has been pregnant more than one time

36
Q

What is the normal position of foetus during expulsion?

A

Longitudinal lie, attitude is one of good flexion, presentation is cephalic, position is LOA or ROA, denominator is the occiput, the presenting part is the anterior parietal bone

Reproductive System (26 decks)

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