Vaginal Delivery Flashcards
Define the latent phase of Labour
The latent phase of labour is defined as – 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
Define Established Labour or First stage of labour
when contractions are regular and intense and the cervix is at least 4cm dilated.
Describe the duration of the stages of labour
while the length of established first stage of labour varies between women, first labours last on average 8 hours and are unlikely to last over 18 hours.
• Second and subsequent labours last on average 5 hours and are unlikely to last over 12 hours
Define the second stage of labour
Passive second stage of labour – defined as full dilatation of the cervix prior to, or in the absence of involuntary expulsive contractions
Active second stage of labour –
• Expulsive contractions alongside full dilatation of the cervix
• Active maternal effort following confirmation of full dilatation of the cervix
• The fetus is visible
When should delay in progress of birth be suspected?
• in a nulliparous woman delay should be suspected if progress (in terms of rotation and/or descent of the presenting part) is inadequate after 1 hour of active second stage.
A vaginal examination should be performed and then amniotomy offered if the membranes are intact
• For a multiparous woman, delay should be suspected if progress is inadequate after 30 minutes of active second stage.
• If full dilatation of the cervix has been diagnosed in a woman without epidural analgesia but she does not have the urge to push, further assessment should take place after 1 hour (NICE 2014).
Define the third stage of labour
- Third stage of labour – the time from the birth of the baby to the expulsion of the placenta and membranes
- Fourth stage of labour could be defined as the “hour or two following delivery when the tone of the uterus is established and the uterus contracts down”. (Beischer et al 1997).
- The placenta separates from the uterus when the uterus contracts down after the baby has been delivered. Signs of placental separation include lengthening of the cord and rising up and firming of the fundus of the uterus. A small vaginal bleed known as a separation bleed is also observed.
When is the third stage of labour diagnosed as prolonged?
The third stage of labour is diagnosed as prolonged if not completed within 30 minutes of the birth of the baby with active management, or 60 minutes from birth with physiological management (NICE 2014).
Describe active management of placental delivery.
- Delayed clamping and cutting of the cord
- Routine use of uterotonic drugs
- Controlled cord traction after signs of separation of the placenta.
Describe physiological management of placental delivery
- No clamping of the cord until pulsation has ceased
- No routine use of uterotonic drugs
- Delivery of placenta by maternal effort
Prerequisites for instrumental delivery
- Head not palpable abdominally
- Head at or below ischial spines on vaginal examination • Cervix fully dilated
- Position of head known
- Adequate analgesia
- Valid indication • Bladder empty
Preparation of mother for instrumental delivery
- Clear explanation should be given and informed consent obtained.
- Appropriate analgesia is in place for mid-cavity rotational deliveries. This will usually be a regional block.
- A pudendal block may be appropriate, particularly in the context of urgent delivery.
- Maternal bladder has been emptied recently. In-dwelling catheter should be removed or balloon deflated.
- Aseptic technique.
Indications for operative vaginal delivery
- Prolonged active second stage
- Maternal exhaustion
- Fetal distress in second stage
- To cut short the second stage in women with severe cardiac disease/hypertensive crisis
- For after coming head of breech
Ventouse or forceps
- Higher failure rate
- More fetal trauma
- No difference in Apgar scores • Less maternal trauma
Maternal and Fetal Complications of instrumental delivery
Maternal • Third and fourth degree perineal tears • PPH • Cervical tears Fetal • Skull fractures/facial nerve damage • Cephalhaematoma • Intracranial haemorrhage • Scalp lacerations • Neonatal jaundice
What kinds of forceps are used?
• Each has blade, shank , lock and handle Types-
Non-Rotational forceps
• Low cavity outlet forceps (e.g. Wrigleys)
• Mid cavity forceps (e.g. Neville Barnes, Simpson’s) for use when the sagittal suture is in the anteroposterior plane. Cephalic curve-for the head and pelvic curve which follows the sacral curve.
• Rotational or Keillands forceps: no pelvic curve • Malpositioned can be rotated to OA position
