Labour Flashcards
(42 cards)
Define labour. (2)
The process whereby the fetus and placenta are expelled from the uterus, which normally occurs during weeks 37-42.
How is labour diagnosed? (2)
Painful uterine contractions are accompanied by dilatation and effacement of the cervix
What are the three stages of labour. (3)
1: Initiation to full cervical dilatation
2: Full cervical dilatation to delivery of the fetus
3: Delivery of fetus to delivery of placenta
What are the three mechanical factors that determine progress through labour? (3)
Power
Passage- dimensions of pelvis and resistance of soft tissues
Passenger- dimensions of fetal head
What bony prominences are used to measure the degree of fetal decent? (1)
Ischial spines
What is the ideal presentation of the fetus at birth? (1)
Flexed vertex presentation
extension of various degrees causes increased presenting diameter
How does the fetus rotate during the second stage of labour? (6)
Engagement in occipito-transverse (OT) Descent and flexion Rotation 90' to OA Descent Extension to deliver Restitution and delivery of shoulders
(in 5% it rotates to occipital-posterior and increased difficulty of delivery)
With regards to describing the fetal head, what does presentation and presenting part mean? (2)
Presentation: part of fetus that occupies the lower segment or pelvis.
Presenting part: lowest part of the fetus palpable on vaginal examination. e.g. vertex, brow, face.
What does the position and attitude of the head describe/ (2)
Position: describes the rotation. OT, OA or OP
Attitude: describes the degree of flexion.
What is effacement of the cervix? (2)
Normally tubular cervix is pulled up into the lower segment until it is flat. Commonly associated with bloody show.
Name the 2 phases of the first stage of labour. (2)
Latent (first 3 cm)
Active: 1cm/hour in nulliparous, 2cm/hour in multiparous
Define slow labour and prolonged labour. (2)
Slow labour: after latent phase, progress less than 1cm/hr
Prolonged labour: after latent phase >12 hours duration
Name 3 causes of slow progress in labour. (3)
Power: inefficient uterine action
Passenger: fetal size, disorder of rotation, disorder of flexion
Passage: cephalo-pelvic disproportion, rarely cervical resistance
How is slow progressing labour managed? (3)
Generally: can wait if desired, mobilise
Nulliparous: amniotomy, oxytocin
Multiparous: amniotomy, oxytocin if malpresentation excluded
If fails: C/S in first stage or instrumental delivery if second stage.
What is Bishop’s score? (1)
Pre-labour scoring tool to help determine whether induction of about will be required.
Name 2 methods of inducing labour. (2)
Vaginal PGE2.
Amniotomy (artificial rupture of membranes)
Oxytocin after SROM or ARM.
(Cervical sweeping of membranes)
Name 3 indications for induction of labour. (3)
Fetal: prolonged pregnancy, suspected IUGR or compromise, antepartum haemorrhage, Prelabour term rupture of membrane
Maternal: Pre-eclampsia, hypertension and diabetes
Name 2 absolute contraindications for inducing labour. (2)
Acute fetal compromise Abnormal lie Placenta praevia Pelvic obstruction After 2+ caesarean sections (increased risk of scar rupture)
Name 2 complications of induction of labour. (2)
Failure to start- inefficient uterine activity
Hyperstimulation of uterus- rare but can cause distress
Umbilical cord prolapse
Post partum haemorrhage
Intrapartum and postpartum infection
What is a PROM? (1)
What is PPROM? (1)
Premature rupture of membranes
Preterm Premature Rupture of Membranes
Name 1 risk of premature rupture of membranes. (1)
Cord prolapse
Neonatal infection
Felicity has had a premature rupture of membranes. How will you manage her? (2)
Vaginal swab (look for infection)
Avoid digital vaginal exam (unless risk of cord prolapse- abnormal lie or fetal distress)
CTG
Await SROM or induce labour
Name 2 indications for instrumental delivery. (2)
Prolonged active second stage
Fetal distress
Prophylactic to prevent pushing in patients with heart disease or hypertension
Breech delivery to control delivery of head
Name the 2 methods of caesarean sections. (2)
Lower segment caesarean section (LSCS)
Classical (vertical incision)