Normal Labour Flashcards

1
Q

Define normal labour?

A

Spontaneous labour at term (37-42 weeks) with fetus in vertex position resulting in a Spontaneous Vaginal Birth (SVD)

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2
Q

What physiological changes must occur for labour to initiate?

A
  • Cervix softens
  • Myometrial tone changes to allow for coordinated contractions
  • Progesterone decrease/ Oxytocin & Prostaglandins increase
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3
Q

How many stages of labour are there?

A

3

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4
Q

What are the parts of Stage 1 of labour?

A

Latent first stage

Established first stage

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5
Q

What occurs during the latent first stage of labour?

A

Intermittent painful contractions leading to up to 4cm of dilatation

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6
Q

What occurs during the Established first stage of labour?

A

Regular Painful contraction producing progressive cervical effacement and 10cm dilatation

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7
Q

How long does the first stage last?

A

Established first stage lasts an average 8 hours primagravida and 5 multigravida

Progresses at 0.5-1cm per hour

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8
Q

What occurs during stage 2 of labour?

A

Phase from full cervical dilation to birth of baby

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9
Q

What occurs in the Passive 2nd stage of labour?

A

This is the stage after your fully dilated but before Involuntary Expulsive Contractions occur

Allow 1 hour for the fetus to descend

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10
Q

What occurs in the Active Second stage of Labour?

A

Expulsive contractions with full dilatation = Active 2nd stage

The presenting part of fetus is visible and active maternal effort is required

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11
Q

How long does the Active second stage of labour take?

A

Average 2 hours for primagravida and 1 for multigravida

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12
Q

What occurs during the 3rd stage of labour?

A

Expulsion of the placenta and membranes

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13
Q

What are the different ways we can handle the 3rd stage of labour?

A
  • Active Management

- Physiological management

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14
Q

Whats involved in Active management of the 3rd stage?

A
  • Uterotonic drugs
  • Deferrend clamping and cutting of cord
  • Controlled cord traction

Physiological means no drugs, don’t clamp till it stops pulsating and deliver placenta by maternal effort alone

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15
Q

How long does the 3rd stage take?

A

Prolonged Third Stage is a diagnosis made after 30 minutes of active management or 60 minutes of physiological management

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16
Q

We use a partogram once established labour has been confirmed to monitor the labours progress.
What tests/measurments would this include?

A
  • Abdominal Palpation
  • Vaginal Exam
  • Monitoring colour, smell & volume of liquor
  • Fetal Heart rate
  • Palpate Uterine muscle contractions
  • External signs
  • BP/Pulse/Temp/RR/O2Sat/Urine output/Urinalysis
17
Q

What does abdominal palpation tell us about the labour?

A
Fetal Lie
Presentation
Attitude
Denominator
Position
Engagement
18
Q

Define Fetal Lie

A
Axis of foetus to mother.
Either Longitudinal (same axis as mom) or transverse (lying sideways) or Oblique
19
Q

Define Fetal Presentation

A

The part of the foetus that is foremost in the birth canal

20
Q

Define Fetal Attitude

A

Foetus’s posture

i.e. back concave, straight or convex and head tilted forward or back

21
Q

Define Fetal Position

A

orientation of the foetus. Determined by which way the occiput (post fontanelle is facing)

1) anterior vs posterior vs transverse
2) and left vs right

22
Q

Define foetal Engagement

A

Degree to which the baby’s presenting part (head in vertex) has entered the pelvic inlet

23
Q

What can be found on vaginal exam?

A

Fotal presentation, engagement and position

Cervical effacement and dilatation

Presence/absence of membranes

24
Q

How do we auscultate the foetal heart?

A

Intermittently with Hand held doppler or pinard

OR Continuously with Cardiotocograph (CTG)

25
Q

How often should be auscultate the foetal heart if doing it intermittently?

A

Every 15 minutes in first stage and 5 minutes in 2nd stage

26
Q

How often/long do you hope for when palpating uterine muscle contractions?

A

3-4 every 10 minutes lasting 40-60seconds each

And moderate to strong not weak

27
Q

What are some external signs of labour?

A

Rhomboid of Michaelis

Anal Cleft line

28
Q

What are the parts of the actual mechanism of labour?

A

Descent
Flexion (of head)
Internal rotation of head (so facing downward)
Crowning & extension of head
Shoulders rotate internally
Head gets out and rotates to face sideways (restitution)
External rotation of the head
Lateral flexion to deliver shoulders (Ant first then Post)
Expulsion

29
Q

What forms of analgesia can women get during labour?

A
  • Entonox
  • Opioids
  • Epidural
  • Breathing & massage
  • TENS
  • Paracetamol and Dihydrocodeine
  • Remifentanil Patient controlled Analgesia
30
Q

What is entonox?

A

Inhalation Nitrous Oxide and oxygen

Aka gas and air

31
Q

Mnemonic for mechanism of labour

A
Every damn fool in Egypt enticingly  Eats Raw Low fat  eggs. 
Engagement 
Descent 
Flexion 
Internal rotation of head 
Extension and crowning 
Restitution 
Internal rotation of shoulders 
External Rotation of head 
Lateral flexion of shoulder 
Expulsion