Normal Labour and Delivery Flashcards
What is labour?
The onset of regular, painful uterine contraction with cervical effacement and dilation
What is cervical effacement and dilation?
Tubal cervix is progressively shortened prior to dilation
When does labour end?
Full cervical dilation at 10cm
What are the stages of labour?
Latent
Active
Delivery
What is the latent phase?
Slow progress to full cervical effacement and 3cm dilation, variable duration
What is spurious labour?
Painful regular contraction not associated with cervical change
What is rupture of membrane?
Fused chorion and amnion constitute “the membrane”
- rupture can occur spontaneously or artificially
Why artificially rupture membrane?
Induce production of hormones to induce/augment the progress of labour
What does low amnionic fluid indicate?
Chronic placenta insufficiency?
What can you tell from the appearance of AF?
Passage of meconium
What are the pattern of contractions?
Shortening interval
Lengthening of contraction
What foetal factors do you consider?
Size
Lie and presentation
What are the presentations?
Cephalic (head first)
Breach (bottom first)
Cord first
What is the lies?
Transverse, oblique, longitudinal
What is the attitude?
Position of the head, flexion vs extension
What is the passage?
Bony and soft tissue of birth canal
What is chorioamnionitis?
Infections of placental membrane and placenta
What do you observe in the mother during delivery?
Temp
BP, pulse
Pain and emotional control
What are the pain relief options?
Non pharmacological
- Massage, relaxation/breathing techniques, position change
Pharmacological
- Inhalational agents - NO
- Systemic analgesics - Opioids
- Neuraxial analgesia - epidural, spinal/CSE
- Local - pudendal nerve block, perineal infiltration
Why do a combined spinal/epidural?
Strong start off with the spinal
Then leave the catheter in for the epidural and prolonged relief
What happens to foetal blood flow during contractions?
Reduces by 40% during contractions
How do you monitor the foetus during labour?
Auscultation
Amount and colour of amniotic fluid
What determines the length of first stage of labour?
Parity
Duration of latent phase
How do you assess maternal well being?
Review history - medical history/medications - past OH - Complications during preg - GBS status, double check hep C, HIV - Blood group Labour history Examination
How do you assess foetal well being?
Colour and volume of amniotic fluid
auscultation of fetal heart beat or admission CTG
assess ? indication for continuous electronic fetal monitoring
How do you assess progress of labour?
Progress of contractions
Vaginal exam - every 4 hours
Documented on partogram
Routine care in normal labour consistents of what?
Observations Activity - ambulate as desired Fluids and diet IV access not routine Abx prophylaxis - if positive swab
How long does the second stage of labour last?
1-2 with no epi
2-3 with epi
What is caput?
Two plates of bone coming into contact with each other
What is moulding?
Two plates of bone overlapping
What are the diameters depending on attitude?
Suboccipitobregmatic diameter - 9.5
Occipitofrontal - 11cm
Supraoccipitomental (Brow) - 13.5cm
Face presentation - 9.5cm
What are the narrowest diameter?
Ischial spines
Why does the baby turn?
Because the ischial spine in the midpelvis is narrower than the AP diameter at that point
In what order does the body come out?
Head
Anterior shoulder
Posterior shoulder
What is the third stage of labour?
Separation and expulsion of the placenta
How do you help expulsion of placenta?
Controlled cord traction
What is a first degree tear?
Laceration involving perineal skin or vaginal mucosa only
What is a secondary degree tear?
Extending into the submucosal tissues of the vagina or perineal muscles
What is a third degree tear?
Extending to involve anal sphincter
What is a fourth degree tear?
Involvement of rectum
What is position?
Location of the presenting part in relation to location in maternal pelvis
