Normal Labour Flashcards
how many weeks is average pregnancy?
37-42
Define labour
Normal physiologic process during which the fetus, membranes, umbilical cord and placenta are expelled from the uterus after 24 weeks– most women experience without complications.
how long does labour last for?
12-18 prims, 6-8 multips
what is braxton hicks contractions
irregular contractions which do not increase in frequency or intensity
what is show labour?
bloody mucous from the cervix
what brings about contractions?
Increase in intracellular free calcium brings about contractions. Prostaglandins and oxytocin increase intracellular free calcium and hence stimulate uterine contraction
Key physiological changes must occur to allow for expulsion of the fetus:
Cervix softens
Myometrial tone changes to allow for coordinated contractions
Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate
what is assessed during th evaginal examination during labour?
effacement, dilaiton and consistency of the cervix. Weather the membranes are intact, colour of the amniotic fluid, presentation of the head, size the pelvic outlet.
What is the 1st stage of Labour?
begins with regular contractions and ends at full dilatation.
What is the 2nd stage of Labour?
starts with full cervical dilatation and ends with delivery of fetus
What is the 3rd stage of Labour?
period between delivery of fetus and delivery of placenta and fetal membranes
what is defined as full dilation?
10cm
what needs to be acessed at stage 1?
FHR, cervix is acessed for shortening, dilation and the posiiton of the head, colour of the membrane too. There is a latent and active phase. There will be 3-4 strong contractions every 10 mins, you should auscultate every 15 mins
how should the babies head descend?
the smallest diameter first with neck flexed and head tucked in, visible Occiput
what needs to be acessed at stage 2?
first there is restitution and external rotation then expulsion and delivery of the shoulders. Passive and active (passive is when the mother is fully dilated and not pushing).
what is seen in the 3rd stage of labour?
separation of the placenta and its descent to the lower segment and its expulsion with the membranes. There is a gush of blood, cord lengthening and a rising fundus, along with controlled cord traction. There is a release of oxytocin too
what analgesia is given for labour? Specify 2/3?
Breathing, massage, TENS, paracetamol and dihydrocodeine, Water immersion,
Entonox (inhalational nitrous oxide and oxygen),
Opioids (morphine, diamorphine, pethidine injecitons),
Remifentanil patient controlled analgesia,
Epidural and spinal anaesthetic.
when does active mx need to be used?
after 60 mins, Prolonged third stage of labour if it is not completed within 30 minutes of the birth with active management or within 60 minutes of the birth with physiological management.
mechanisms of labour?
Descent Flexion Internal rotation of the head Crowning and extension of the head Restitution Internal rotation of the shoulders External rotation of the head Lateral flexion then Expulsion
how long after the baby does the placena need to be expelled?
30 mins
maternal complications with epidurals
abcess, hypotension, urinary retention, delayed 2nd stage of labour, nausea and vomiting, heacache.
difference between epidural and spinal anaesthetic
anatomical location of insertion, epidural is inserted in the space between the dura mater and periosteum, spinal anaesthesia is induced by injecting small amounts of local anaesthetic into the CSF after having peirced the dura mater.
Contraindications to an epidural?
abnormal bleeding, skin infeciton, hypovolaemia, cvs disease, neurological disorders, patient refusal, anatomical abnormalitites, lack of adequately trained staff.
