Spontaneous labour Flashcards
During labour how often and for how long do contractions last?
45-60 seconds every 2-3 mins
What passes through the vagina as the cervix effaces?
‘Bloody show’ - mucus plug which may be tinged with blood
When does the cervix dilate in primips?
When the cervix fully effaces
In multips effacement and dilation occur simultaneously
In what position does the head enter the pelvis?
transverse
What position is the head in to exit the pelvis?
occipito-anterior - occurs 90%
What is the ideal attitude (degree of flexion) of the head/neck for exiting the pelvis?
Full flexion - sow that vertex is the presenting part (smallest possible diameter)
What are Braxton Hicks contractions?
Sporadic contractions that occur throughout the 3rd trimester
Hormone and foetal decent
Foetus descent –> prostaglandins –> decreased cervical resistance –> oxytocin released by posterior pituitary –> stimulated contractions in each cornu of the uterus
What occurs in the latent stage of labour
Cervical effacement
Braxton Hicks contractions
Dilation <4cm
Stage 1
Dilation of cervix 4–>10cm (primip = 1cm/hr, multip = 1/2cm/hr)
Bloody show –> SROM
Occipitotransverse + felxion
Progress of labour - ‘Dont Forget I Eat Rhubarb In Labour’
- Descent
- Flexion
- Internal rotation of head
- External rotation of head
- Restitution (realignment)
- Internal rotation of shoulders
- Lateral flexion
Stage 2 - Passive
Passive = few minutes)
- Full dilation before urge to bear down
- Rotation and flexion normally complete
Stage 2 - Active
Primip - 40 mins, multip = 20 mins
Expulsive contractions with active maternal effort/urge to push (unless epidural present)
Signs: bulging of the perineum, anal dilatation, red congestion mark (from coccyx upwards)
NB. as head becomes visible, small pushes are encouraged to prevent tears
Stage 2 - Delivery
Head extends (crowning) and perineum stretches Head restitutes --> transverse position Deliver shoulders - anterior = symphysis pubis first
If slow –> foetal distress
Stage 3 - expulsion of placenta
Uterus contracts down to expel placenta (prevents haemorrhage) - normal blood loss = 500ml
Look for: lengthening of umbilical cord, a gush of blood vaginally, forming of the fundus
Active:
- Routine use of uterotonic drugs (e.g. syntometrine IM) after delivery of anterior shoulder –> contraction + retraction of uterus –> decreased blood loss
- If no signs of placental separation give syntocinon infusion –> increased uterine contraction
- Delayed cord clamping - wait until babys circulation is independent of mothers
Best positions during labour
Kneeling, squatting or left side
Try to avoid lying on back - occludes blood vessels
Why is food sometimes discouraged?
If there is a reasonable risk of having a GA
What should be done if the mother is pyrexic (>37 C)
Culture from vagina, urine and blood
How often are observations for the partogram filled out?
Every 30 mins - BP, pulse, FHR,
Except for temp and urinalysis (every hr)
Partogram - contractions
Noted every 1hr
Frequency, strength and regularity
Partogram - Cervical dilation
PV exam done every 4 hrs
Alert line:
primips - 1cm/2hr
Multip - 1cm/hr
Delay of first stage if:
- <2cm in 4 hours
- Multigravida - slowing of progress
Management = ARM, syntocinon infusion or CS
Partogram - head descent
PV exam every 4 hours:
- station of progressing part
- engagement
- Position of moulding caput
- 5th palpable in abdomen
Partogram - liquor
Noted hourly - look for meconium, blood, clearness
Final birth details:
Summarise times for:
- labour onset
- ROM
- active 2nd stage
- Birth
- Placenta delivery
Mechanism of delivery
Position of occiput
APGAR score at 1 and 5 mins
Estimated blood loss
APGAR Score
Appearance: pale = 0, blue extremeties = 1, pink all over = 3
Pulse: absent = 0, <100 = 1, >100 = 3
Grimacing: absent = 0. weak = 1, good = 3
Activity: no tone = 0, floppy = 1, normal = 3
Respiration: none = 0, weak = 1, strong = 3
