OSCE First stage of labour Flashcards
Define labour
A process in which the products of conception (fetus, placenta and membranes) are explled through the birth canal
Define Normal labour
The foetus is expelled at term, presenting by the vertex, and completed within 18 hours (does not exceed 24 hours) with both the mother and infant in good condition. There are no complications at any stage
When does the first stage of labour begin?
Begins with the onset of regular, painful uterine contractions until fully dilatation of the cervix.
The first stage is divided into two phases; what are those two phases?
Phase 1: Latent phase
Phase 2: Active phase
What is phase 1, or latent phase?
The time labour starts up to the time the cervix is 4 cm dilated
What is the duration of a primigravida in phase 1/Latent phase?
Last for 3-8 hours
What is the duration of the latent stage in a Multigravida?
When is phase 2 or active phase?
From the time the cervix is 5cm dilated until it is fully dilated
What is the duration of dilation in a primigravida during phase 2 or active phase?
Dilates at a rate of 1 cm per hour
What is the duration of dilation in a multigravida during phase 2 or active phase?
Dilates at 1.5cm per hour
When does second stage of labour begin?
Begins from the time the cervix is fully dilated until the time the baby is delivered
What is the duration of the second stage in primigrivida?
Up to 2 hours
What is the duration of the second stage in multigrivida?
Up to 45 minutes (30 minutes bearing down effort)
What are the signs of true labour
-Uterine contractions are always present
-Uterine contractions rarely exceed 60 seconds
-Uterine contractions are rhythmic and regular
-Uterine contractions are accompanied by abdominal tightening, discomfort or pain
-Uterine contractions are often accompanied by backache
-The cervix is shortened
-The OS is dilating progressively
-The membranes feel tense during a contraction
-Show is usually present
What are the signs of false labour?
-Uterine contractions are not always present
-Uterine contractions may last 3-4 minutes
-Uterine comtractions are irregular
-Uterine contractions may not be painful
-Uterine contractions are not accompanied by backache
-The cervix does not shorten progressively
-There is no increase in dilatation
-The membranes do not become tense
-There is no show
What is the management of the first stage of labour?
-Admit the woman in labour if in active phase of labour
-Monitor the patient on labour care guide
-Explain the findings to the woman and reassure her
-Conduct vaginal examination 4 hours a day to monitor progress of labour
-Monitor uterine contractions every half hourly for 10 minutes
-Monitor maternal condition by checking vital signs Bp, P, P, T, R 4hrly to rule out abnormalities
-Make sure the bladder is empty and encourage the woman to keep emptying it throughout the labour to promote good descent of the presenting part
-Monitor urine output for volume and do urine test to rule out the presence of proteins, glucose, ketones and blood
-Monitor fetal condition by checking fetal heart rate rhythm and regularity every 30 minutes
-During vaginal examination take note if there is presence of moulding and caput
-Check condition of memebranes, whether ruptured or intact; if raptured observe for meconium-stained liquor
-Teach woman breathing techniques
-Rub the back during a contraction to ease pain
-Manage pain correctly by administering prescribed analgesics
-Encourage the woman to mobilize to promote descent of the presenting part
-Encourage the woman to eat as required for energy
-Keep accurate records
How to care for the woman in first stage in the environment
-Physical surroundings should provide protection from harm and be clean and free from the hazards of infection
-Facilities should be available for prompt and efficient action in the case of an emergency arising
-A trusting atmosphere between a woman and her caregivers, a feeling of being among friends and a knowledge of the skills required to cope with the stresses of labour
-The wife should display a tolerant, non-judgemental attitude, ensuring the woman is accepted whatever her reactions and behaviour may be.
How to care for the woman in first-stage for emotional support
-The midwife should display a tolerant, non-judgemental attitude, ensuring the woman is accepted whatever her reactions and behaviour may be
-During labour the companion can help the woman by walking with her if ambulant in early labour, support her decisions about pain relief and encourage her with breathing techniques
-The companion will help with physical comfort, such as back-rubbing or providing cool cloths or sips of water
-The midwife must provide support and give all information which will help the woman to understand and feel free to ask questions and be aware of how labour is progressing
-Before performing an examination, explanations should be given of what is about to be done and why and feedback of progress should be given to the woman
-The presence of strangers and too many people entering and leaving the room increase stress for the woman, her partner and the midwife
-To ensure privacy, individuals should knock before entering, be introduced to all in the room and give an explanation for their presence
-Equally the woman has a right to remain alone with her partner if she wishes so and the midwife considers it safe for both mother and fetus
What are the indications for conducting a vaginal examination? (5)
