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Women's Health > Normal Labour I > Flashcards

Normal Labour I Flashcards

1
Q

When is full term?

A

Between 37 and 42 weeks

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2
Q

Define normal labour.

A

Occurs between 37 and 42 weeks
Born spontaneously
In vertex position
Mother and baby in good condition

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3
Q

When in a pregnancy are the three trimesters?

A

1st: 1-12 weeks
2nd: 13-27 weeks
3rd: 28-40 weeks

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4
Q

How is the estimated due date calculated?

A

Add 9 months + 7 days onto the 1st day of the last menstrual period

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5
Q

When is the puerperium? What is its significance?

A

Up to 6 weeks after delivery

Its when the physiological changes that have occurred during pregnancy are reversed

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6
Q

List the stages of labour. When do they each start and finish?

A

Stage 1

  • latent phase: 0-3cm dilation
  • active phase: 3-7cm dilation
  • transition phase: 7-10cm dilation

Stage 2
- from full dilation to birth of the baby

Stage 3
- from birth of baby to delivery of placenta

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7
Q

What happens in stage 1: latent phase of labour?

A

May have ‘show’ a plug of mucus and blood which falls away from cervix opening

Irregular contractions, every 5-10 mins

Cervix effaces and dilates 0-3cm

Should be able to continue normal activities

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8
Q

What is effacement?

A

Cervix becomes thinner, softer

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9
Q

What happens in stage 1: active phase of labour?

A

Regular contractions, every 3-5 mins

Cervix dilates from 3-7cm

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10
Q

What happens in stage 1: transition phase of labour?

A

Very intense contractions, every 0.5-2 mins
Also contractions can slow

Mother gets anxious, distressed

SROM: spontaneous rupture of membranes

Dilates 7-10cm

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11
Q

Approximately how long do the latent, active and transition phases last?

A

Latent: 8-12 hrs

Active: 3-5 hrs

Transition: 0.5-2hrs

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12
Q

A mother should come to hospital as soon as she feels contractions. True or false?

A

False

During latent phase, she should stay at home.

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13
Q

When SROM occurs, what colour should fluid be? What if it’s not?

A

Clear

If it’s cloudy or yellowy-green this could be meconium passed by the baby because its passed its due date or is distressed

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14
Q

How frequent and what is the duration of contractions in each phase of stage 1?

A

Latent:

  • every 5-30 mins
  • last 30 secs

Active:

  • every 3-5 mins
  • last 1 min

Transition:

  • every 0.5-2 mins
  • 60-90 secs
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15
Q

A pregnant woman (week 40) rings you saying that she’s just passed what looks like phlegm with blood in it.

Should you tell her to come in to hospital?

A

No, this is the ‘bloody show’ which is normal

It is a mucus plug that is in the entrance to the cervix

Passing it indicates the cervix is beginning to dilate

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16
Q

A pregnant woman rings you saying she’s been having what seem like contractions. She is in week 35. The contractions are not very painful and occur very irregularly. They don’t seem to be getting closer together.

Should you tell her to come in to hospital?

A

No

These are probably Braxton-Hicks contractions (false contractions)

They don’t lead to labour

They’re mild, irregular and don’t get more intense and frequent

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17
Q

A pregnant woman (week 42) rings you saying her waters have just broken but the liquid looks dark yellowy green.

Should you tell her to come in to hospital?

A

Yes.

The baby has passed meconium into the amniotic fluid, which means it could be distressed.

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18
Q

What happens in stage 2 of labour?

A

Pushing starts!

Mother is fully dilated

Baby navigates through pelvis

Head becomes visible

Baby does some ‘cardinal movements’

Before being born

19
Q

What 3 things affect how well stage 2 of labour goes?

Describe them.

A

The 3 Ps

Power: how forceful the contractions are

Passenger: the fetus: size, position etc.

Passage: the route through the pelvis

20
Q

What can you do if contractions aren’t strong enough?

A

Give oxytocin

21
Q

One of the 3 P’s is passenger. What things about the fetus affect how easy stage 2 of labour is?

A

Size: of head

Attitude: is the baby flexed or deflexed? Better if the baby is flexed

Lie:

  • longitudinal (ideal, baby’s spine is in line with mother’s
  • transverse (perpendicular)
  • oblique (at an angle)

Presentation:

  • cephalic (head first, ideal)
  • breech (bottom first)
  • shoulder

Station:
- relationship between lowest point of presenting part and the ischial spines of mother’s pelvis

22
Q

What is it called when the baby:

  1. presents head first
  2. presents shoulder first
  3. presents bottom first
  4. is lying with spine perpendicular to mother’s
  5. is lying with spine at an angle to mother’s
  6. is lying with spine aligned with mother’s?
A
  1. cephalic
  2. shoulder
  3. breech
  4. transverse
  5. oblique
  6. longitudinal
23
Q

What is meant by vertex presentation?

A

When the baby is presenting cephalic (head first)

But with its head flexed, this is ideal

24
Q

How can you tell what presentation the baby is?

A

Vaginal examination

Feel for the head, use the fontanel to guide you, should feel the posterior fontanel

25
Q

How is fetal station described generally?
What about when:
- when mother starts to push
- when you first see baby’s head

A

On a scale from -3 to +3

0 = level of ischial spines, engagement

Mother pushes when baby is at +2
See head at +3

26
Q

What is meant by engagement?

A

When the baby’s head is at 0 station

At the level of the ischial spines

27
Q

During stage 2 the baby does some movements to help it be born. What are they and describe them.

A

Descent: baby moves into pelvic inlet, then further down where it ‘engages’

Flexion: chin presses against chest as head meets pelvic floor

Internal rotation: fetal shoulders rotate internally so widest part of shoulders are in line with widest part of pelvic inlet

Crowning

Extension: as baby moves further down, head extends as head is born

Restitution: head externally rotates

Expulsion: of anterior shoulder, posterior shoulder then rest of body

28
Q

What happens in the 3rd stage of labour?Explain how it happens.

A

Delivery of the placenta

Uterus contracts, placenta separates from uterus wall

And is delivered

29
Q

How’s the Bishop’s score calculated?

A
  1. Fetal station
  2. cervical effacement
  3. cervical dilation
  4. position of cervix (moves from post to ant)
  5. softness of cervix
30
Q

How would you induce labour in:

  • BS 0
  • BS 3
  • BS 8+
A

0 = prostaglandin

3 = can do membrane sweep, or prostaglandin

8+ = ARM

31
Q

How would you check if someone has ruptured membranes?

A

Nitrocene paper, like a litmus paper

32
Q

What are the problems associated with post-term pregnancy?

When is it considered post-term?

A

after 42 weeks

Meconium aspiration
PPH
Infection
Macrosomia
Shoulder dystocia
Maternal birth injury due to above
Peri-natal morbidity and mortality
33
Q

What’s the agpar score? What’s in it?

A 
Activity (muscle tone)
Grimace (reflex irritability)
Pulse
Appearance
Respiration
34
Q

What does a CTG show you?

A

Fetal heart and contractions of the uterus

35
Q

How do you interpret a CTG?

A

Dr C BraVADO

Dr: define risk
C: contractions
Bra: baseline rate
V: variability
A: accelerations
D: decelerations
O: overall impression
36
Q

How would you comment on contractions from looking at a CTG?

A

No in 10 mins
(big square = 1 min)

How long they last
Intensity (by feeling uterus)

37
Q

How would you comment on baseline rate from looking at a CTG?
What’s normal?

A

Average HR of baby within last 10 mins
Ignore accels or decels
Should be 110-150

38
Q

What would count as fetal tachycardia?

Causes?

A

Baseline rate above 160

Fetal hypoxia
Chorioamnionitis – if maternal fever also present
Hyperthyroidism
Fetal or maternal anaemia
Fetal tachyarrhythmia
39
Q

What would count as fetal bradycardia?
Causes?
Actions?

A

Baseline rate below 100 for 3 mins or more

Mild (100-120): late gestational age, OP position

Severe (80 or less): hypoxia caused by cord compression, prolapse, epidural or spinal, maternal seizures

If severe, deliver immediately

40
Q

How would you comment on variability on a CTG?

What’s normal?

A

Variability of the baby’s heart rate
Should be 5-25bpm

Can be reassuring, non-reassuring or abnormal

Reassuring: 5-25bpm

Non-reassuring:
less than 5 for 30-50 mins
over 25 for 15-25 mins

Abnormal:
less than 5 for 50+ mins
over 25 for 25+ mins

41
Q

What could cause reduced variability on a CTG?

A

Fetal sleeping (up to 40 mins)

Acidosis (due to hypoxia)
Drugs
Prematurity

42
Q

How would you comment on accelerations on a CTG?

A

Accelerations are good
Acceleration of HR by 15 or more for 15s or more seconds

If they happen at same time as contraction that’s good

Absence of them doesn’t really mean anything

43
Q

How would you comment on decelerations on a CTG?

A

Drop in HR of 15bpm for 15s or more

Early: happen at same time as contraction, normal, due to pressure on baby’s head during contraction = raised ICP

Variable: just happen randomly, worrying

Late: begin at peak of contraction and end after contraction ended, worrying

Prolonged: lasts more than 3 mins, very worrying

44
Q

What should you do if you see late or prolonged decelerations?

A

Take a fetal blood sample and test pH for acidosis
Late decels could be sign of hypoxia

Consider emergency C section

Women's Health (23 decks)

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