Normal Labour Flashcards
How many stages of labour are there?
3 stages
The first stage of labour is divided into…
Latent phase
Established phase
Describe the latent phase of stage 1 labour
Painful, irregular contractions
Cervix effaces (shortens and softens)
Cervix dilates to 4cm
Days to hours
Describe the established phase of stage 1 labour
Regular contractions 3 every 10 minutes
Cervix dilates from 4-10cm
A satisfactory rate from 4cm is 0.5cm per hour
Examine every 4 hours
The second stage of labour is divided into…
Passive phase and active phase
Describe the passive phase of the second stage of labour
Complete cervical dilatation but no pushing
Particularly seen in women with epidural anaesthesia (1-2 hours of passive stage is recommended to reduce instrumental delivery rate)
Describe the active stage of stage 2 labour
Maternal pushing uses the abdominal muscles and valsalva manoeuvre until baby is born
How long should stage 2 labour last?
4 hours if primip (3 hours midwife, 1 hour doctor) - can be 1 hour passive and 2 hours active or 2 passive and 2 active
3 hours if multip (2 hours midwife, 1 hour doctor) - 1 hour passive and 1 hour active
What is a precipitate delivery?
Childbirth after an unusually rapid labour - combined first and second stage in under 2 hours and culminating in rapid, spontaneous expulsion of the infant
What maternal risks are there with a precipitate delivery?
Lacerations of the cervix, vagina, perineum - can cause haemorrhage
Does not allow maternal tissues an adequate time to stretch and accommodate passage of infant
May be infection due to unsterile delivery
Uterine atony - due to unusually strong and rapid labour causing muscular exhaustion
What neonatal risks are there with precipitate delivery?
Intracranial haemorrhage - suddenly change in pressure on fetal head during rapid expulsion
Infection due to unsterile delivery
What is stage 3 labour?
Placental delivery
Placental delivery can be physiological or active. Describe both
Physiological - not recommended in UK due to bleeding risk (uterus cannot contract properly if placenta still present)
Usually takes 1 hour
Active - given oxytocin IM/IV, takes approximately 30 minutes
If the is an increased risk of PPH, what is given instead of just oxytocin at stage 3 of labour?
Syntometrine - oxytocin and ergometrine
Also decreases S3 time to around 5 minutes
Given as anterior shoulder born
What contraindications are there to giving syntometrine?
Can precipitate MI Pre-eclampsia Severe HTN Severe renal or liver impairment Severe heart disease If BP not measured in labour just give oxytocin
What signs are there that the placenta has separated?
Cord lengthening
Gush of blood (due to retroplacental haemorrhage)
Uterus rises and contracts
How long does the first stage of labour usually take?
8-18 hours in primip
5-12 hours in multip
When should the oxytocin/syntometrine be given?
At anterior shoulder delivery
What kind of monitoring should be done in the first stage of labour?
Maternal BP and temp 4 hourly
Pulse hourly
Assess contractions every 30 minutes - strength (should not be able to indent uterus with fingers during a contraction) and frequency (ideally 3/4 every 10 minutes lasting 1 minute)
Note frequency of bladder emptying
Offer vaginal examination every 4 hours - degree of dilatation, position and station of head (measured in cm above/below ischeal spines) and note degree of head moulding
Auscultate fetal HR if not continuously monitored, every 15 minutes, listen for 1 min after contraction
What monitoring is required during second stage?
BP and pulse hourly Temp 4 hourly Assess contractions every 30 mins VE hourly Record urination during second stage If contractions wane, oxytocin may be needed
