Week 4 - J - Brief Cards on Pain relief, delayed labour and induction techniques

Question 1

Giving birth is a life‑changing event. -Potential to affect her – both physically and emotionally and affect the health of her baby What are the options for giving birth?

Answer 1

Can give birth at home Midwifery unit - stand alone or juxtaobstetric unit Hospital birth - quicker if anything goes wrong, access to epidurals , also have access to obstetricians

Question 2

The first stage of labour begins when you start having contractions that cause progressive changes in your cervix and ends when your cervix is fully dilated. This stage is divided into two phases: What is the latent phase of the 1st stage of labour defined as?

Answer 2

This is defined as the cervix dilating up to 4cm - the contractions here are irregular and mild In the active/established phase - the cervix dilates up to full dilation at 10 cm and the contractions are rythmic and strong

Question 3

What is the reflex that occurs due to the increase in pressure at the cervical or vaginal walls during labour? Causes an increase in release of oxytocin

Answer 3

This would be the Ferguson reflex

The Ferguson reflex is the neuroendocrine reflex comprising the self-sustaining cycle of uterine contractions initiated by pressure at the cervix or vaginal walls. It is an example of positive feedback in biology.

Question 4

What are the options for pain relief in pregnancy?

Answer 4

• Non-opioid - TENS - transcutaneous electrical nerve stimulation
• Entonox
• Opioid - diamorphine
• Epidural
• Remifentanyl

Question 5

How often should the maternal pulse be checked in pregnancy? How often should the maternal BP and temp be checked? How aften should the contractions be assessed?

Answer 5

Maternal pulse checked hourly BP and temp assessed 4hourly Contractions assessed every 15 minutes

Question 6

When is the active phase of the first stage of labour said to be prolonged?

Answer 6

Said to be prolonged when there is less than 2cm dilation in 4hours (should be 0.5cm per hour minimum)

Question 7

What is the management of delay in the first stage of pregnancy?

Answer 7

The management of delay in the 1st stage of pregnancy is to give syntocinon

Question 8

What is delay in active phase of first stage of labour again? What is normal dilation speed? What is satisfactory dilation speed?

What is delay in the 2nd stage of labour?

Answer 8

Active phase of 1st stage

• * Satisfactory is 0.5cm/hour dilation
• * Normal is 1-2cm dilation/hour
• * Delay is <2cm dilatation in 4 hours

2nd stage of labour

• Nullparous - Considered prolonged if it exceeds 3 hours with regional analgesia, or 2 hours without In
• Multiparous women - Considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without

Question 9

IMportant to monitor PV loss in the third stage of labour Define primary postpartum haemorrhage? What is often given in active management of the third stage of labour and why?

Answer 9

Primary PPH - >500mls within 24hours of delivery Often syntocinon or syntometrine is given as active management - decreases third stage time and decreases risk of PPH (uterine ruputre more common in furutre pregnancies if uterotonics have been used)

Question 10

What are the categories in Bishop’s score? What is this scoring system used to decide?

Answer 10

Bishop’s score - parameter used by obstetricians and midwifes to decide if it is safe to induce pregnancy

• Cervical dilation
• Cervical effacement
• Cervical consistency
• Position of cervix
• Station

Question 11

What score indicates carrying out induction on Bishop’s score? What score indicates that labour is likely to commence spontaneously?

Answer 11

A score of 5 or less suggests that labour is unlikely to start without induction. A score of 9 or more indicates that labour will most likely commence spontaneously.

Question 12

What are different methods of inducing labour?

Answer 12

Prostoglandins - PGE2 ge Amniotomy - artificial rupture of membranes IV syntocinon