Progress and Delay in Progress Flashcards
What is the 1st stage of labour?
Latent first stage of labour
painful contractions
some cervical change, including cervical effacement and dilatation up to 4 cm
Established first stage of labour:
regular painful contractions and there is progressive cervical dilatation from 4 cm.
(NICE, 2007)
What is the average duration of the 1st stage of labour?
Primip – Average of 8-18 hours
Multip – Average of 5-12 hours
How is a prolonged 1st stage diagnosed?
Partogram with an action line
Vaginal Examination
What are the recommended interventions in a prolonged 1st stage of labour?
Amniotomy (ARM)
Analgesia
Oxytocin (Syntocinon)
Increased frequency of vaginal examinations
Caesarian section
What is the 2nd stage of labour?
Passive second stage of labour:
Full dilatation of the cervix before or in the absence of involuntary expulsive contractions.
Active second stage of labour:
Baby is visible
Expulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation
Active maternal effort following confirmation of full dilatation of the cervix in the absence of expulsive contractions.
(NICE, 2007)
What is the average duration of the 2nd stage of labour?
3 hours within the start of active 2nd stage in primips
2 hours within the start of active 2nd stage in multips
At what point in 2nd stage of labour would it be considered prolonged?
Primips - 2 hours Multips - 1 hour
What are possible interventions in the delay of the 2nd stage of labour?
ARM
Syntocinon
Increased frequency of VEs
Position change
Instrumental delivery
Caesarian section
What 4 Fs cause delay in labour? (3Ps)
Foetus
Faeces (full rectum can be felt on inspection and can obstruct )
Fibroid
Full bladder
What could be a sign of delay and obstruction?
Blood stained urine draining from catheter- haematuria
Bandl’s ring- might not be picked up if very good muscle tone or high BMI (emergency!)
Maternal concerns
Contractions randomly stop
History
Progress via VE, Cx, descent. etc.
What is a bandl’s ring? And what are the possible complications of it?
The depression between the upper and lower halves of the uterus, at about the level of the umbilicus.
A late sign of obstructed labour
Above this ring is the grossly thickened, upper uterine segment which is pulled upwards (retracted) towards the mother’s ribs.
Below the Bandl’s ring is the distended (swollen), dangerously thinned, lower uterine segment. The lower abdomen can be further distended by a full bladder and gas in the intestines.
Polarity: polarity is a term used to describe the neuromuscular harmony that prevails between the two poles of the uterus throughout labour. During each uterine contractions, these two poles act harmoniously. The upper pole contracts slightly and dilates to allow expulsion of the fetus. If the polarity is disorganized, the labour is not progressed.
Retraction: retraction is a special function of uterine muscle whereby the contraction does not pass off entirely, the muscle fibers retaining some of the contraction instead of becoming completely relaxed. Retraction assists in the progressive expulsion of the fetus, the upper segment of the uterus becomes shorter and thicker and its cavity diminishes.
Development of retraction ring
The ridge which forms the lower border of the thick upper segment where it meets the thinner lower segment is known as the retraction or Bandle’s ring.
It is present in every labour and is perfectly normal until it is not marked enough to be visible above the symphysis pubis.
In a normal labour, it is not visible because the fetus is gradually being expelled through the dilating cervix.
But in obstructed labour, where the fetus cannot descend to pass through the cervix, the lower segment must stretch to accommodate it, because the fetus is being pushed out of the shortened upper segments.
In such cases, retraction ring would be visible transversely or slightly obliquely across the abdomen, above the symphysis pubis. It may cause rupture of the uterus.
Retraction ring is termed in a case of invisible and Bandl’s ring when it becomes visible.
What is the 3rd stage of labour?
Birth of the baby to the expulsion of the placenta and membranes
What is a delay in 3rd stage?
Over 30 minutes active management, over 60 minutes physiological as risk of PPH rises significantly
What are the recommended interventions in the 3rd stage of labor?
Analgesia
Vaginal examination
Oxytocin (if bleeding)
Controlled cord traction (with an oxytocic drug when converting from physiological to active management)
Catheterisation
Intravenous access
What is an asynclitic presentation?
Head rotated to the side slightly, so not direct OA
