L3 Flashcards
(55 cards)
Hormonal changes during labour
Except ___, other hormones (____) rises
Progesterone
estrogen
Oxytocin
Prolactin
Relaxin
Premonitory signs of labour
- Lightening
* Descent of the fetal presenting part into the pelvis, occurs
approximately 10 to 14 days before labour begins
* Fundus height slightly falls below xyphoid process
* ‘Lighter’ uterus will be felt by mother - Braxton Hicks Contractions (False Labour)
- The irregular, intermittent contractions that have been
occurring throughout the pregnancy - Activities of toning the uterine muscle
- Contractions may stop if change position or change activity
- Contractions usually felt in lower abdomen or groin
Signs of onset of labour
Show, Rupture of membranes (Leaking), Uterine contraction
- Sudden gush or scanty, slow seeping of clear fluid or
pale yellow fluid from vagina - 80-90% of term case, labour will occur within 24
hours - Can occurs in anytime, with or without labour onset
- Risk of infection increase as time of leaking prolonged
- Leaking can be sometimes confused with urinary
incontinence
Sign of onset of labour
Rupture of membranes (Leaking)
- Blood-tinged mucus plug inside the cervical canal
expelled at the onset of labour - Normal: small amount in bloody or pinkish mucus
based - Abnormal: large amount of fresh blood is noted
Sign of onset of labour
Show
Signs of onset of labour (2)
Test of amniotic fluid leaking
* Amniotic test
* Non-invasive, rapid and easy detection of ruptured
membranes
* Done by dipping to the pool of fluid in the vagina
during speculum test
* Nitrazine-based amnicators swab and will response to
pH medium from ____ to ____
yellow, blue
Definitive signs of labour onset
- Regular uterine contraction accompanied by cervical
effacement and cervical dilatation
Stages of Labour
The process of labor and birth is divided into four stages:
- First stage (Effacement and dilatation stage)
- Second stage (Expulsion stage)
- Third stage (Placental stage)
- Fourth stage (Post-placenta delivery stage)
Duration of Stage 1 of Labour
Nulliparous:
Multiparous:
~ 11 hours
~ 6 hours
Duration of Stage 2 of Labour
Nulliparous:
Multiparous:
~ 30-60min
~ 5-30mins
Duration of Stage 3 of Labour
Nulliparous:
Multiparous:
~5-15mins
~5-15mins
Duration of Stage 1,2,3 of Labour in total
Nulliparous:
Multiparous:
~12 hours
~7 hours
Duration of Stage 4 of Labour
Nulliparous:
Multiparous:
1 hour
1 hour
Factors affecting labour process (5P)
- Passage/passageway - birth canal (maternal pelvis and soft tissues
- Passenger – fetus
- Power –uterine contractions
- Position (maternal) – Squatting, water birth etc.
- Psyche-level of excitement, fear and tension experienced by the women
First stage of labour
* Starts with the _____ to _____of cervix
* Present with other signs of labour such as show or rupture of membranes
* 3 phrases : latent phase to active phase, then transition phase
first regular uterine contraction
full dilatation (10cm)
First stage of labour – Latent phase
- Onset of regularly perceived uterine
contractions → when rapid cervical
dilatation begins - Cervix dilates from ___ cm
- Contractions : *mild & short
contractions lasting ____ seconds
at ___ intervals - Contractions become stronger with
shorter intervals
0-3
20-40
5- to 10-minute
First stage of labour – Active phase
* More rapid cervical dilatation from ___ cm
* Cervical dilatation normally at ___cm/hour.
* Contractions :*grow stronger
contractions lasting ____ seconds
* *Occur approximately every ___
* Show, rupture of membranes usually occur at this phase
4-7
0.5-1.0
40-60
3-5minutes
First stage of labour – Transition phase
* More rapid cervical dilatation from ____ cm
* Contractions:
* *reach their peak of intensity
* *Lasting 60-90 seconds
* *Occur approximately every 2-3 minutes
* Full dilatation (10cm ) and complete cervical
effacement
* Contractions may be more painful, and women may have urge sensation to push
* Fetal head descends into the maternal pelvis and the fetal neck flexes
8 -10
Second stage of labour
____ stage
* This starts when the cervix is ____ and ends with ____
* Duration allowed : nulliparous - 1
hour, multiparous - 1/2 hour
* On epidural anesthesia - variable
Expulsion
fully dilated, the birth of the baby
Signs of second stage of labour
Signals from mother:
Presumptive evidence:
Maternal pushing
Signals from mother:
Breathing hard, powerful sounds,
overwhelming urge to push
Presumptive evidence:
* Expulsive uterine contractions
* Heavy show
* Congestion of vulva
* Dilated anus
* Presenting part is visible
* Vaginal examination - the cervix is
fully dilated
* Expulsive uterus contractions cause maternal pushing
- Involuntary push when mother feels urge
- More effective during uterine contraction
- Mother should encourage to push when uterine contraction begins.
- Take a slow, deep breath in and begin to
expel the breath slowly through pushing. - Breath-holding techniques when pushing should be ____ → Decrease oxygen intake and placental flow
discouraged
Birthing position in second stage of labour:
A woman may choose several positions
during second stage, depending on the
maternal preference, fetal position,
intensity of contractions, the urge to
push.
- Semi-sitting
- Squatting
- Side-lying
- Kneeing
- Standing
- All-four
Third stage of labour
- From the ____ to _____
- Average duration : 5-30 minutes
birth of baby, delivery of the
placenta
Signs of placental separation:
- Lengthening of umbilical cord from vulva
- A gush of blood from vagina
- Uterus is firm and contracted well on
abdominal palpation - The placenta in seen at vulva
