Normal labour and delivery Flashcards
Gestation of normal (not premature) delivery
37-42 weeks
Exact definition of labour
Painful contractions leading to effacement and dilation of cervix
What to ask in taking history of woman who thinks she is in labour
- CONTRACTIONS: frequency, duration, onset
- MEMBRANES: ruptured or intact
What to examine in woman who thinks she is in labour
- Maternal obs
- Urine
- Abdominal palpation
- Foetal movements
- May auscultate heart
- +/- vaginal exam to diagnose onset of labour
Role of prostaglandins in labour
- reduces cervical resistance
- increases release of oxytocin from posterior pituitary gland
3 mechanical factors of labour
- powers
- passage
- passenger
Describe the 3 stages of labour
- Initiation -> full cervical dilation
- full cervical dilation -> foetal delivery
- foetal delivery -> delivery of placenta
How long should the 1st stage of labour take on average
12h in nulliparous
7.5h in multiparous
What is considered adequate level of contractions
4-5 contractions every 10min
Most common presenting part of foetus (>95% of cases)
Most common presenting part of foetus (>95% of cases)
Where is the vertex of the foetus
Diamond shaped area between anterior and posterior fontanelles, between parietal eminences
How long should the active part of the 2nd stage take on average
40min in nulliparous
20min in multiparous
What is a normal level of bleed loss in the 3rd stage
500ml
How often should foetal monitoring be carried out during 1st stage of labour
Every 15min
How often should foetal monitoring be carried out during 2nd stage of labour
Every 5min
Non-pharmacological analgesia during labour
Hypnosis
TENS
Water birth
Acupuncture
Pharmacological analgesia during labour
Paracetamol Dihydrocodeine Entonox (NO + O2) Diamorphine + metoclopramide Epidural
Components of Bishop score
- Cervix dilation
- Cervix consistency: firm to soft
- Length of cervix
- Cervix position: posterior/ central/ anterior
- Station of presenting part (cm above ischial spin)
the higher the score, the more likely labour will commence soon
Components of APGAR score
Appearance Pulse Grimace Activity (floppy or normal muscle tone) Respiration
In foetal scalp blood sampling, what levels of pH and lactate would require intervention
o Scalp blood pH<7.2
o Lactate >4.8
Difference between foetal distress and foetal compromise
Distress = acute situation (eg hypoxia); diagnosed with foetal scalp blood
Compromise = chronic suboptimal growth conditions (eg placental dysfunction)
Absolute contraindications to vaginal birth
- Placenta previa
- Abnormal foetal lie
- Previous classical C section
- Active genital herpes
- HIV (if high viral load)
Who is VBAC suitable for
- Single baby
- Cephalic at 37 weeks
- Previous LSCS
