Normal labour and puerperium Flashcards
What is labour
physiological process during which the foetus, placenta, umbilical cords and membranes are expelled from the uterus
Where can a woman give birth
Consultant led unit - abnormal labour/pregnancy
Midwife led unit - normal labour/pregnancy
Homebirth
What are the biological and physiological changes that initiate labour
Decrease in progesterone Increase in oestrogen Increase in oxytocin Mechanical stretching of the cervix stretching of myometrium Stripping of foetal membranes Fergusons (positive feedback) reflex
When can membranes rupture
Pre term Pre labour 1st stage 2nd stage not at all - born in a caul
What cervical changes occur in labour
Cervical softening
increase in hyaluronic acid
decreased strength of collagen fibres
What is Bishops score
method to determine if it is safe to induce labour
score>5 is favourable
What components are measure in Bishops score
Cervical: Dilatation Effacement Station Firmness / consistency Position "Pregnancy Can Enlarge Dainty Stomachs"
How many stages of labour are there
3
What happens in the 1st stage of labour
what phases make it up
Cervical dilatation
Latent phase - mild irregular uterine contractions, cervix shortens and softens
Active phase - 4cm to full dilatation, contractions become more rhythmic and stronger, painful stage
What defines the 2nd stage of labour
full dilatation of the cervix (10cm) to delivery of baby
What defines the 3rd stage of labour
period from delivery of baby to expulsion of placenta and foetal membranes
What is the average time the placenta is expelled
10 minutes after delivery
If the placenta is not expelled after ??, it should be removed under GA
1 hour
What is involved in active management of the 3rd stage of labour
oxytocin infusions
What are Braxton Hicks contractions
Pretend contractions Irregular tightenings of uterus don't increase in frequency or strength painless can occur from 6/40 but are most common in 3rd trimester
What are true labour contractions
painful contractions that increase in frequency and strength and duration
ie get longer and closer together
What hormone influences true labour contractions
Oxytocin
Where do true labour contractions start
in the fundus of the uterus and spread down symmetrically
name the 3 key factors in labour
Power
Passage/Pelvis
Passenger
What is responsible for “power” in labour
uterine contractions
What features are important in “passage” in labour
pelvis - anthropoid vs gynaecoid
cervix - Bishops score parameters
How should the “passenger” be positioned in labour
Ideally lying longitudinally, cephalic position, occipitoanterior
What analgesia can be used in childbirth
paracetamol/co-codamol TENS machine Entonox gas mixture Diamorphine Epidural Remifentanyl combined spinal/epidural
What are the 7 cardinal movements in labour
- Engagement of foetal head - measured in 1/5ths
- Descent of the foetal head into the pelvis
- Flexion of foetal cervical neck
- Internal rotation to adopt OA position
- Crowning and extension
- Restitution and external rotation
- Expulsion of the rest of the foetal body
What is delayed cord clamping and why is it better than immediately clamping the cord
keeping cord in tact for 1 minute to increase blood flow to the foetus - multiple benefits
only immediately clamp the cord if baby needs to have immediate resuscitation
How long should skin-skin contact be for after delivery
1 hour uninterrupted
What is the puerperium period
6 weeks after delivery
Period of repair and recovery
