Normal Labour Flashcards
what is the definition of labour?
physiological process during which the foetus, membranes, umbilical cord and placenta are expelled from uterus
associated with regular, painful uterine contractions with increasing frequency, intensity and duration
what are the 3 options of where a woman can give birth?
consultant led unit
midwife led unit
homebirth
what is a birth plan?
record of what the women would like to happen during her labour and after the birth
discuss adverse situations and her plans for this
allows woman to understand what may happen in labour - can identify her feelings and priorities
what physiological changes help to initiate labour?
change in the oestrogen / progesterone ratio
myometrial stretch increases excitability of myometrial fibres
mechanical stretch of cervix and stripping / rupture of foetal membranes
why does an increasing oestrogen : progesterone ratio causes initiation of labour?
oestrogen
- promotes uterine contraction
- promotes prostaglandin production
progesterone
- keeps the uterus settles
- hinders the contractibility
how does oxytocin help in the initiation of labour?
initiates and sustains contractions
promotes prostaglandin release
synthesised straight into maternal and placental tissue
number of oxytocin receptors increases near end of pregnancy
what physiological processes in the foetus help to initiate labour?
pulmonary surfactant secreted into amniotic fluid stimulates prostaglandin synthesis
foetal cortisol stimulates increase in maternal estriol
when can membrane rupture occur?
pre-term pre-labour first stage second stage born in a caul (baby born in sac)
what is the job of the liquor surrounding the foetus?
nurtures and protects foetus
facilitates movement
how does the cervix change during labour?
increase in hyaluronic acid
increases number of molecules between collagen fibres - decreases bridging between fibres which causes cervix to soften
what score is used to assess if it is safe enough to induce labour?
bishop score
- dilatation (how open cervix is)
- effacement (how thin cervix is)
- station in pelvis (babys head in relation to ischial spines)
- cervical consistency
- cervical position
a lower bishop score indicates a women is close to active labour - true or false?
false
- higher score = more active labour
- lower score = patient is struggling and may eventually have to be induced
what are the 3 stages of labour?
1st
- latent phase (up to 3-4cms dilatation)
- active stage (4cm-10cm)
2nd
- full dilatation and delivery
3rd
- expulsion of placenta
the latent phase of labour can last up to a few days - true or false?
true
after what length of time would the second stage of labour be considered prolonged?
women having their first child (ie no previous births)
- > 3 hours if regional analgesia
- > 2 hours without
women having a subsequent child
- > 2 hours with regional analgesia
- > 1 hour without
how long does the 3rd stage of labour normally last and after what point would surgical removal of the placenta be considered?
average duration 10 mins
after 1 hour, preparation made for removal under GA
why is an “active” 3rd stage of labour preferred to a physiological 3rd stage?
active management - use of oxytoxic drugs in active 3rd stage
+ controlled cord traction
this lowers risk of post partum haemorrhage
what are braxton hicks contractions?
false labour
tightening of uterine muscles, helps body prepare for birth
usually felt in 3rd trimester
irregular, do not increase in frequency or intensity
relatively painless
how can you tell if a patient is experiencing true labour contractions as opposed to braxton hicks?
timing of true contractions become evenly spaced
time between them gets shorter
length of contraction time increases (10sec-45sec)
gets more intense and painful over time
describe the path of a contraction in pregnancy?
density of myocytes highest at fundus
wave starts at fundus and spreads symmetrically downward
a baby in a normal presenting position is born with its head in the occipito-anterior position - true or false?
true
can also be born occipito-posterior (usually if it has been in previous abnormal position)
what landmarks on a baby’s skull can be used to determine their position?
frontanelles
- anterior = larger and more diamond shaped
- posterior = smaller and triangular
what are the various types of analgesia that can be used during pregnancy?
paracetomal / co-codamol TENS entonox (gas and air) diamorphine epidural remifenatyl combined spinal / epidural
what is recorded on a partogram?
graphic record of key data (maternal and foetal)
assess progress of labour (cervical dilatation, foetal heart rate)
