WEEK 3B - Uterine Activity Variation Flashcards
The 6 P’s of Labour & Delivery
- Passenger
Refers to the baby, including its size, position, and presentation (head first, breech, etc), which influences the delivery process - Passageway
Refers to the birth canal (the mother’s pelvis and cervix). The shape and size of the passageway can impact the ease of delivery - Powers
These are the uterine contractions that help push the baby out. The strength, frequency, and duration of contractions play a significant role in the progress of labour - Position
Refers to the mother’s position during labour and delivery (e.g., upright, lying down). The position can influence the ease of labour and comfort, as well as help with foetal descent - Psychological response
The emotional state of the mother, which can affect her ability to cope with pain and stress. Anxiety or fear can slow labour, while a calm and confident mindset may help labour progress - Partnership
The support system around the mother, including her partner, healthcare team, and loved ones. Positive support and communication are important for the mother’s wellbeing during labour
Define the terms related to abnormal uterine activity - Prolonged first stage
Define the terms related to abnormal uterine activity -
slower than average progress from the onset of labour, decreased progress after initial satisfactory progress, or complete cessation of progress after initial satisfactory or slow progress (generally measured by less than 1 cm of cervical dilatation per hour) (less than 4cm dilated and 12 hours after commencement of labour with painful contractions)
Define the terms related to abnormal uterine activity - prolonged second stage
More than two hours without epidural and three hours with epidural in nulliparous women, and more than one hour without and two hours with epidural analgesia in multiparous women.
- Second stage consists of the passive (pelvic) phase where the presenting part descends with the aid of uterine contractions, and an active (perineal) phase during which the fetal head rotates to a more favourable position and maternal expulsive efforts aid in the delivery of the fetus.
- The pushing phase (fully dilated and active expulsion of the baby)
Define the terms related to abnormal uterine activity - prolonged third stage
delivery of the placenta. It is considered prolonged if it lasts more than 30 minutes after the baby is born
Define the terms related to abnormal uterine activity - delayed progress in labour
labour does not advance as expected. It can occur at any stage of labour. Can be due to ineffective contractions, malpresentation, maternal exhaustion, excessive pelvic size or shape issues, abnormal fetal position or size
Define the terms related to abnormal uterine activity - hypotonic uterine contractions
weak, infrequent contractions that are insufficient in strength or frequency to effectively dilate the cervix or propel the baby down the birth canal during labour.
- Contractions are typically less than 3-4 in 10, and their duration and intensity are inadequate to advance labour
- May lead to delayed progress or the need for interventions like augmentation or caesarean
Define the terms related to abnormal uterine activity - incoordinate labour
irregular and ineffective contractions that do not follow a consistent pattern. Contractions may be erratic, occurring too frequently or too infrequently, and do not lead to progressive cervical dilation or fetal descent
Define the terms related to abnormal uterine activity - precipitate labour
labour lasting less than three hours from the onset of regular contractions to delivery of the baby.
- Rapid progression may cause complications such as uterine rupture, perineal tears, or fetal distress
Define the terms related to abnormal uterine activity - obstructed labour
when the baby cannot pass through the birth canal despite strong and frequent contractions. It is typically caused by a mechanical barrier or obstruction that prevents normal fetal descent
- Cephalopelvic disproportion (the baby’s head is too large to fit through the mother’s pelvis)
- Malposition (e.g., breech or transverse lie)
- Large fetal size (macrosomia)
- Pelvic abnormalities (narrow or malformed pelvis)
- Shoulder dystocia
Explain how prolonged labour (1st stage) can lead to patterns of abnormal uterine action
Power - uterine contractions may be ineffective (weak and/or infrequent), causing poor progress of early labour, or even strong and uncoordinated (hypertonic)
Passage - potential abnormalities in the bony components and soft tissue of the pelvis - gynaecoid is the normal type, while anthropoid, android, and platypelloid are abnormally shaped pelves. A full bladder may hinder the progress of labour as well.
Passenger - presenting part may be too large (macrosomia), or the diameters of the presenting part may be increased due to a malposition of the vertex (face, brow, breech), attitude, asynclitism, malpresentation (OP)
Explain how prolonged labour (2nd stage) can lead to patterns of abnormal uterine action
Maternal factors (age, parity, height, weight, size and shape of the pelvis, uterine contractile forces, expulsion effort, analgesia)
Epidural analgesia can lengthen the second stage due to sensory blockade, which diminishes a woman’s urge to push
Maternal complications resulting from an abnormal labour
- Postpartum haemorrhage
- Genital tract lacerations
- Intrauterine infection
- Increased rate of operative delivery
- Uterine rupture
- Psychological effects of a traumatic experience
Fetal complications resulting from an abnormal labour
- Low apgar score
- Birth asphyxia
- Birth trauma
- Shoulder dystocia
- Increased rate of perinatal morbidity and mortality
Midwifery management of abnormal uterine action during prolonged first stage of labour
- Identify the cause
- Provide continuous support the to the labouring woman
- Correct the cause of poor progress (e.g., augmentation of labour with amniotomy and/or oxytocin infusion after excluding a malpresentation and fetopelvic disproportion)
- Carry out continuous electronic fetal monitoring
- Reassess (VE & CTG)
- Advise woman to have an ARM
- Repeat VE in 2 hours
- Nullipara - commence oxytocin infusion if no contraindications (e.g., malpresentation, severe moulding, significant fetal compromise), repeat VE after 3 hours of commencing oxytocin infusion & reassess
- Multipara - full assessment by medical team, oxytocin infusion only with approval of consultant obstetrician
Midwifery management of abnormal uterine action during prolonged second stage of labour
- Each case should be handled on an individual basis as intervention that happens too early may be unnecessary and possible end up in traumatic delivery, however intervention that happens too late may result in birth asphyxia
- Use of ultrasound in dysfunctional labour - to assess position, station, attitude, and asyncliticism
- Perform an abdominal palpation, offer VE, and ROM if membranes are intact
- Assess maternal bladder, consider intermittent catheterisation if unable to void
- Continue maternal obs and FHR
- Consider repositioning of the woman
- Provide birthing aids - birth stools, pillows, birth balls, mirrors
