Normal Labour Flashcards
what is labour
physiological process during which the fetus membranes, umbilical cord and placenta are expelled from the uterus
when do you have women going through the consultant led unit for labour
abnormal growth
complications
most women
when do you go through the midwife led unit for labour
more homely
no complications
simple birth
what is a birth plan
record of what women would like to happen during labour and after the birth
what induced labour
change in oestrogen/progesterone ratio
fetal adrenals and pituitary hormones
mechanical stretch of cervix - positive feedback on oxytocin
Ferguson reflex
what does progesterone do in labour
keeps uterus settled
hinders contractibility of myocytes
what does oestrogen do in labour
makes uterus contract
promotes prostaglandin production
what does oxytocin do in labour
oxytocin initiates and sustains contractions
acts of decimal tissue to promote prostaglandin release
number of oxytocin receptors increases in myometrial and decidual tissues near the end of pregnancy
what happens after rupture of membranes
baby moves down and presses on the cervix
what happens to the cervix in labour
softens (decrease in collagen fibre alignment and strength, decrease in tensile strength of the cervical matrix, increase in cervical decorin)
dilates - about 10cm
what is bishops score
determines if it is safe to induce labour
what are the 5 elements of the bishops score
Position Consistency Effacement Dilation Station in pelvis
what are the stages of labour
First stage:
latent phase - up to 3-4cms
active stage - 4-10cms
Second stage:
Full dilatation - deliver of the baby
Third stage
Delivery of baby - expulsion of placenta and membranes
what is the second stage of labour
from complete dilatation of the cervix (10cm) to delivery of the baby
if 1st baby -considered prolonged if it exceeds 3 hours with regional analgesia or 2 hours without
if 2nd baby - considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without
what is the third stage of labour
delivery of the baby to expulsion of the placenta and fetal membranes
average duration 10 minutes but can be 3 minutes or longer
after 1 hours preparation made for removal under general anaesthetic
expectant management - spontaneous delivery of placenta
active management - oxytocin drugs and controlled cord traction is preferred for lowering risk of post partum haemorrhage
what are Braxton Hicks Contractions
tightening of the uterine muscles, though to aid the body prepare for brith
can start 6 weeks into pregnancy - more often felt in the third trimester
irregular, do not increase in frequency or intensity
resolve with ambulation or change in activity
relatively painless
what are true labour contractions
timing of contractions become evenly spaced and the time between gets shorter and shorter
length of time the contraction lasts will also increase
real contractions will also get more intense and painful over time
tighten the top part of your uterus pushing the baby downward into the birth canal in preparation for delivery
also promotes thinning of cervix
very painful!!
what are the analgesia options for birth
Paracetamol/co-codamol TENS Entonox Diamorphine Epidural Remifentanyl Combined spinal/epidural
what is a partogram
a graphic record of key data (both maternal and fetal) contained on one sheet used to asses the progress of labour
what are the 3 key factors at play in labour
Power - uterine contractions
Passage - maternal pelvis
Passenger - fetus
what happens to the uterus in contractions
Uterine muscle (smooth muscle in connective tissue) - density is highest at the fungus
Pacemaker - region of tubal Ostia - wave spreads in downward direction
synchronisation of contractions waves from both Ostia
upper segment contracts and retracts, lower segment and cervix are stretched - dilate and relax
what is the normal rate of contractions before birth
3-4 in 10 mins
duration 10-15 seconds - max 45 seconds
what is the normal fetal position
longitudinal lie
cephalic presentation
presenting part: vertex
position: occipito-anterior, head engages occipito-transverse
flexed head
what is abnormal fetal position
breech
oblique
transverse lie
position: occipto-posterior
how do you describe the position of the fetus
left or right
where the occipital is joining
1st cardinal movement of labour
Engagement
passage of widest diameter of the presenting part to a level below the plane of the pelvic inlet
3/5ths of the fetal head have entered the pelvis
2/5ths still felt abdominally
2nd movement of labour
Descent - downward passage of presenting part through the pelvis
maternal discomfort, feeling of pressure
vaginal examination should be carried out approximately 4 hourly in normal labour - see how dilated/how dar down the baby’s head is
3rd movement of labour
flexion:
fetal head flexes as it descends due to the shape of the bony pelvis
4th movement of labour
Internal rotation
rotation of presenting part from its original position to the anterior position as it passes through the pelvis
5th movement of labour
extension
occurs once the fetus has reached the level of the interotius bringing the base of the occiput in contact to the inferior margin at the symphysis pubis
6th movement of labour
external rotation is return of the fetal head to the correct anatomic position in relation to the fetal torso
7th movement of labour
Expulsion
delivery of the rest of the fetal body
what is crowning
appearance of a large segment of fetal head at the Introits
labia are stretched to full capacity
largest diameter of fetal head is encircled by vulval ring
burning and stinging feeling for mother
care of the perineum is vital to reduce trauma
head delivery should be down slowly with hands guiding
episiotomy may be required
why is delayed cord clamping done
leaving it to pulse for up to 3 mins after expulsion allows the baby to get more blood and reduce anaemia at 2 months and increases duration of earl y breast feeding
why is skin to skin contact needed immediately after birth
helps keep the baby warm and calm and considered to improve other aspects of transition to life outside the womb
recommendation says uninterrupted SSC for 1 hour following birth
what are the signs of the third stage of labour
uterus contracts, hardens and rises
Umbilical cord lengthens permeently
gush of blood in variable amount
placenta and membranes appear at introitus
what is active management of the third stage
prophylactic Syntometerine
OR
oxytoxin
Cord clamping and cutting
Controlled cord traction
Bladder emptying
what is the puerperium
period of repair and recovery
return of tissues to non-pregnant state
6 weeks
loch: vaginal discharge containing blood, mucus and endometrial casting
