Women's health - Labour + delivery + postpartum Flashcards
What are the stages of labour?
- First stage - until fully dilated (10cm)
- Second stage - full dilation until delivery
- Third stage - delivery of baby until delivery of placenta
What is stage 1 of labour divided into and what are the criteria (2)?
- Latent = 0-3/4 cm dilated
- Active(established labour) = 3/4-10 cm dilated
What are the 4 signs of the start of labour?
- Regular painful contractions
- Show (mucous plug from cervix)
- ROM
- Dilating + thinning (effacement) cervix
What is stage 2 of labour divided into?
- Passive stage - head descends down pelvis
- Active phase - mother bears down
How long should the first two stages of labour last in a primigravida women?
- Latent stage 1 = less than 20 hours
- Active stage 1(established labour) = 1 cm/hour
- 2nd stage = 2 hours
How long should the first two stages of labour last in a multigravida women?
- Latent stage 1 = less than 14 hours
- Active stage 1 (established labour) = 1.5 cm/hour
- 2nd stage = 1 hour
How long should 3rd stage last?
30 minutes
What is important to give to some mothers during labour (2)?
- IV benzylpenicillin (if GBS infection)
- Anti-D Ig
What are contractions in the 2nd/ 3rd trimesters that do not progress to labour known as?
Braxton-hicks contractions
What influences the progression of labour (3)?
Three Ps
* Power - uterine contractions
* Passenger - size, presentation
* Passage - shape + size of pelvis/ soft tissues
What are the seven stages of the mechanism of delivery?
- Descent - head moves down pelvis
- Flexion - chin to chest
- Internal rotation - to occipital-anterior position
- Extension - of head to push through vagina
- Restitution - occiput re-aligns with shoulders
- External rotation - shoulders rotate to anterior-posterior position (perpendicular to mothers)
- Delivery of shoulders - anterior shoulder delivered, then posterior
What is involved in an initial assessment of a woman in labour (4)?
- History
- Obs + urinalysis
- Abdominal palpation - lie, contractions, engagement, ect
- Vaginal exam
What is the standard monitoring performed during labour (5)?
- Foetal HB (every 15 min)
- Contractions (every 30 min)
- Maternal pulse + BP
- Vaginal exam (every 4 hours)
- Urine dip (every 4 hours)
What is recorded on a partogram (lots of things)?
- Progress - dilation, descent, contractions
- Foetal wellbeing - CTG, amniotic fluid colour
- Maternal wellbeing - pulse, BP, temp, urinalysis
What does CTG stand for?
Cardiotocography
What are some indications for CTG (3)?
- Unwell mother (tachycardia, sepsis, bleeding)
- Delay in labour
- Use of oxytocin
What is monitored on a CTG (2)?
- Foetal heartbeat
- Uterine contractions
What are 4 reassuring features of a CTG?
- Rate = 110-160
- Decelerations = absent
- Accelerations = present
- Baseline variability = 5-25 bpm
What is an acceleration/ deceleration on a CTG?
Increase/ decrease of 15 bpm for 15 seconds
What are the types of deceleration and what do they mean? (4)
- Early (heart rate drops in time with peak of contraction) = innocent finding associated with compression of foetal head
- Late (HR drops after peak of contraction) = foetal distress e.g. hypoxia
- Variable (<2 min) = transient umbilical cord compression
- **Prolonged ** (2-10 min) = compression of umbilical cord
What is the most common cause of reduced foetal HB variability (<5)?
Sleeping foetus
How can foetal distress be further investigated, after a CTG has been done, during labour?
Foetal scalp sample
can indicate hypoxia
What are some non-pharmacological options for pain relief during labour (2)?
- Birthing pool
- Relaxation techniques
What are some medical options for pain relief during labour (4)?
- Paracetamol/ codeine
- Entonox (gas + air = 50/50 NO and O)
- IM opioids (e.g. diamorphine)
- Epidural
Where is an epidural carried out?
L3-4 epidural space (acts on nerve roots)
What medication is used in an epidural?
Bupivacaine + fentanyl
What are some adverse effects of an epidural (5)?
- Hypotension
- Motor weakness
- Nerve damage
- Prolonged second stage + increased likelihood of instrumental delivery
- Headache after insertion
What score can be used to determine whether to induce labour?
Bishop score
What are the criteria included in the bishop score (5)?
- Consistency (cervix)
- Dilation
- Effacement
- Foetal station (how much engaged)
-
Position (cervix)
CEDFP
What do different bishop scores mean (3)?
- 1-5 = unripe, inaction needed
- 6-7 = intermediate
- 8-13 = ripe, likely to spontaneously deliver
What are ways to induce labour (6)?
- Membrane sweep
- Vaginal prostaglandin E2
- Misoprostol (oral prostaglandin E1)
- Amniotomy (breaking waters)
- Balloon catheter
- Oxytocin infusion
When is a membrane sweep typically performed?
40 + 41 week antenatal visit
usually a precursor to full induction of labour
How should a bishop score of 1-6 be managed (2)?
- Vaginal prostaglandins
or - Oral misoprostol
How should a bishop score of 7-13 be managed (2)?
- Amniotomy
and - IV oxytocin (e.g. syntocinon)
What are some infections for induction of labour (4)?
- Prolonged labour
- Prolonged pregnancy
- PPROM
- Maternal GDM, pre-eclampsia, obstetric cholestasis
What is the main complication of induction of labour?
Uterine hyperstimulation:
* Foetal ischemia
* Uterine rupture
What are the categories of c-sections?
- Immediate threat to life - deliver within 30 min
- Not an imminent threat to life - deliver within 75 min
- Mother and baby are stable - deliver soon
- Elective c-section
What are some indications for an elective c-section (6)?
- Previous c-section (2 c-section = contraindication for vaginal)
- Placenta praevia
- Vasa praevia
- Breech
- Multiple pregnancy
- Herpes/ HIV
How is a c-section performed (2)?
- Joel-cohen incision = straight transverse incision
- Classical incision = midline
What are the layers of the abdomen that need to be directed for a c-section (7)?
- Skin
- Subcutaneous tissue
- Rectus sheaf/ fascia
- Rectus abdominis
- Peritoneum
- Uterus
- Abdominal sac
What are some complications of c-sections (3)?
- VBAC (vaginal birth after c-section) –> uterine rupture
- PPH
- Endometritis
What risk is associated with classical c-section incision?
Uterine rupture if vaginal birth after c-section (VBAC)
What are the two instrumental deliveries?
- Ventouse delivery
- Forceps delivery
What are some complications of ventouse delivery for the foetus (3)?
- Cephalohaematoma
- Caput succedaneum
- Subgaleal haematoma (even worse)
