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Appreciating Complex Midwifery Care > Progress & Delay in Labour; PROM & PPROM > Flashcards

Progress & Delay in Labour; PROM & PPROM Flashcards

1
Q

What is Latent phase 1st stage defined as , and the reference

A

Latent first stage of labour – a period of time, not necessarily continuous, when:

there are painful contractions and

there is some cervical change, including cervical effacement and dilatation up to 4 cm.

NICE (2014)

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2
Q

What is established 1st stage defined as , and the reference

A

Established first stage of labour – when:

there are regular painful contractions and

there is progressive cervical dilatation from 4 cm.

NICE (2014)

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3
Q

What is the average duration of the 1st stage for a primip?

A

Average of 8-18 hours (NICE,2014)

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4
Q

What is the average duration of the 1st stage for a multip?

A

Average of 5-12 hours (NICE, 2014)

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5
Q

How would you diagnose a delay in first stage?

A

A partogram with an action line
Vaginal examination
- if in the VE you identify that she
is ,2cm in 4 hours for a primip
and multips or a slowing in
progress for multips only
If there is no descent and rotation of foetus
changes in contractions

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6
Q

What do NICE 2014 recommend as interventions for delay 1st stage?

A 
ARM (Artificial rupture of membranes)
Analgesia 
Oxytocin  (syntocinon) 
Increased frequency of VE
Cesarean section
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7
Q

What is Passive second stage, define using a reference?

A

Passive second stage of labour:

the finding of full dilatation of the cervix before or in the absence of involuntary expulsive contractions. NiCE [2007]

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8
Q

What is active second stage, define using a reference?

A

Onset of the active second stage of labour:

the baby is visible

expulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation of the cervix

active maternal effort following confirmation of full dilatation of the cervix in the absence of expulsive contractions. NiCE [2007]

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9
Q

What is the average duration of active 2nd stage for a primip?

A

3 hours

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10
Q

What is the average duration of active 2nd stage for a Multip?

A

2 hours

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11
Q

Name the recommended methods/ interventions for delay in 2nd

A 
ARM 
Oxytocin 
More VEs
Change position 
Instrumental delivery 
C-section
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12
Q

What can be the causes of delay in labour think of the 3 Ps and the 4 Fs

A

The 3 P’s

  • Powers
  • Passages
  • Passenger

The 4 F’s

  • Foetus
  • Faeces
  • Full Bladder
  • Fibroids
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13
Q

Name the signs and symptoms of delay and obstruction

A 
Maternal Concerns 
Contractions 'gone off'
Progress via VE, Cx, descent, etc 
Haematuria 
History 
Bandl's ring- Emergency
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14
Q

Please define the 3rd stage of labour using the NICE guidelines 2014

A

the time from birth of the baby to the expulsion of the placenta and membranes (NICE,2014)

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15
Q

What is the average duration and diagnosing delay in active 3rd stage?

A

If the 3rd stage is not complete within the 30 minutes

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16
Q

What is the average duration and diagnosing delay in physiological 3rd stage?

A

If the 3rd stage is not complete within the 60 minutes

17
Q

What is recommended interventions of delayed 3rd stage of labour

A

Analgesia

  • Vaginal examination
  • Oxytocin (if bleeding)
  • Controlled cord traction (with an oxytocic drug when converting from physiological to active management).
  • Catheterisation
  • Intravenous access
18
Q

What does PROM stand for?

A

Pre-Labour rupture of membranes

19
Q

What does Prom mean.

A

PROM, is the sudden rupture of membranes which usually occurs at least 1hr prior to the onset of contractions

20
Q

What is the incidence of PROM

A

Approximately 8% of term pregnancies

21
Q

Name the three associated factors linked with PROM

A

Baby is in OP
Polyhydramnious
Chorioamnionitis

22
Q

How would you manage PROM

A

Assess risk factors

If risk factors are present: then place on CTG and make obstetric referral.
If no risk factors then listen to baby

If no clear evidence of ROM, no speculum

No vaginal examination unless in active labour

Risk of infection is 1%

4 hourly observations, monitor liquiour colour and FMs

If not in labour 24hr after ROM advice prostaglandins.

23
Q

What does GBS stand?

A

Group B Strep

24
Q

What is the statistic of women who have group B strep colonisation in their vagina.

A

<25% and they will require Intrapartum Antibotic Prophylaxsis (IAP)

25
Q

How can GBS be detected and what would be required as treatment?

A

GBS can be detected in urine samples, prior to labour. However, they need to be given oral antibotics and IAP

26
Q

What is the incidence for GBS and reference

A

10% mortality (50% long-term morbidity) and increasing. On average,

2 Babies daily develop GBS

1 baby weekly dies From GBS

1 Baby weekly survives with long-term disability
(GBSS,2017)

27
Q

What antibiotic would you give to a mother who has GBS, reference ?

A

Benzylpenicillin 3g IV followed by 1.5g 4hrly

or if they are allergic to penicillin then
Clindamycin 900mg IV 8hrly

(NICE,2012)

28
Q

What does PPROM stand for?

A

Preterm Pre-labour Rupture of Membranes (PPROM)

29
Q

What doe PPROM mean?

A

Rupture of membranes that occurs before the onset of regular uterine contractions and before 37weeks (Myles, Pat McGeown,2014)

30
Q

What is the incidence for PPROM?

A

Complicates 2% of pregnancies

Associated with 40% preterm deliveries

31
Q

Name the complications of PPROM

A 
Prematurity 
Sepsis 
Pulmonary Hypoplasia 
Cord prolapse
Misrepresentation
32
Q

What can contribute to PPROM (associating factors)?

A 
Smoking
BMI 
Domestic abuse
Infection 
Vaginal bleeding
33
Q

Name three ways in which PPROM can be diagnosed, what reference?

A

Positive if pool of fluid in vagina when sterile speculum is being done

Nitrazine test

Ultrasound Scan for oligohydramnios

RCOG, 2010

34
Q

Name the 5 different methods of managing PPROM

A 
Corticosteriods 
Antibiotics 
place of care
Timing of delivery 
method of delivery
35
Q

What is the role of the midwife?

A

Prevent PPROM as much as possible

do a risk assessment

assist medical staff and liase with MDT

visit SCBU if possible

Prepare parents for possible delivery and condition of baby

encourage healthy lifestyle and include hygienic advice

understandable antenatal care.
Routine MSU testing

Appreciating Complex Midwifery Care (13 decks)

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