Labour Flashcards by S B

what are the 3 key factors during labour

POWER: Uterine Contraction

PASSAGE: Maternal Pelvis

PASSENGER: Fetus

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what hormone initiates and sustains contractions

oxytocin

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what other roles does oxytocin have

acts on decidual tissue to promote prostaglandin release

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what hormone makes the uterus contract

oestrogen

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what is the other function of oestrogen in labour

promotes prostaglandin production

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what its the role of progesterone

This keeps the uterus settled.
It prevents the formation of gap junctions
Hinders the contractibility of myocytes

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what hormone changes cause the initiation of labour

progesterone withdrawal

increase in oestrogen and prostaglandin action

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what hormone from the placenta is likely involved in starting the changes leading to labour

corticotrophin-releasing hormone (CRH)

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there are 3 stages of labour - what is involved in stage 1

Commences with onset of regular painful contractions - split into latent and active phase

Latent phase = 3-4cms dilatation
Active phase = 4cms -10cms (full dilatation)

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there are 3 stages of labour - what is involved in stage 2

Full dilatation achieved

Delivery of baby

Divided into pelvic/passive phase [head descends down pelvis] and active phase [when the mother pushes]

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there are 3 stages of labour - what is involved in stage 3

expulsion of placenta and membranes after birth of baby

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after what time is the decision made to go and remove the placenta under GA

1 hour

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what can be given to help the mother deliver the placenta

oxytocic drugs

oxytocin 10 units
Syntometerine

controlled cord traction

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what changes in the cervix happen for labour

Cervical softening and ripening

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what are Braxton Hicks contractions

Tightening of the uterine muscles, thought to aid the body prepare for birth

Can start 6 weeks into pregnancy but not usually felt until second or third trimester

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what are true labour contractions

pain described as a wave

- starts low, rises until it peaks, and finally ebbs away

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how will the mothers abdomen feel during contraction

hard

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where about do the contractions start in the uterus

the fundus

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what are Braxton Hicks Contractions also called

False labour

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what are features of a Braxton Hicks Contractions that can help you differentiate from true contractions

irregular
do not increase in frequency or intensity
resolve eventually
relatively painless

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what cause real labour contractions

oxytocin

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what are features of real labour contractions

evenly spared

time between them gets shorter

get more intense and painful

promotes thinning of the cervix

don’t resolve

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what is the ostia

distal tube opening of the infundibulum of uterine tube into the abdominal cavity

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where do the contractions synchronise from

both ostia

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what shape of pelvis is the most suitable female pelvis shape

Gynaecoid pelvis

what are the other shapes of pelvis called

Anthropoid Pelvis Android Pelvis. Platypelloid Pelvis

what is the function of liquor

nurtures and protects fetus and facilitates movement

what colour should the liquor be

clear | - red/pink suggests bleeding

what is the normal fetal presentation

Longitudinal Lie Cephalic Presentation Presenting part = vertex

hence, what is called normal position in labour

occipitoanterior | with head engaging occipital-transverse

what are the major fontanelles in the fetal skull

anterior fontanelle [diamond shaped] posterior fontanelle

how do the head's of the foetus in 95% of vertex presentation appear

flexed

what position does a flexed vertex baby go into

NORMAL i.e. occipitoanterior

what position does an extended or deflexed vertex baby go into

occipitoposterior OR transverse

how is the decent of the head referenced

abdominal fifths

what is crowning

Appearance of a large segment of fetal head at the introitus Labia are stretched to full capacity

what may be required, to prevent trauma to the anal sphincters due to crowing

episiotomy

what is the bishop score used for

to determine if it is safe to induce labour

what are the 5 elements of the Bishops score

``` Position Consistency Effacement Dilatation Station in Pelvis ```

what are analgesic options for labour

``` Paracetamol/ Co-codamol TENS [electrical pulses] Entonox [inhalation agents] Diamorphine Epidural IV Remifentanyl Combined spinal/epidural ```

why do mothers on epidurals need to be monitored

as it can cause resp depression

what is a normal amount of blood loss in labour

< 500mls

what is a abnormal amount of blood loss in labour

> 500 mls

what is a significant amount of blood loss in labour

> 1500 mls

what are the signs that indicate placental separation

Uterus contracts, hardens and rises Umbilical cord lengthens permanently Gush of blood variable in amount

how is haemostasis achieved after delivery

Tonic contraction of uterine muscle strangulates blood vessels Thrombosis of the torn vessel ends: pregnancy is a hyper-coaguable state

what is puerperium

6 week period after delivery as tissues return to non-pregnant state

in the puerperium period, there can be a lot of discharge, what are the different types?

Lochia: Vaginal discharge containing blood, mucus and endometrial castings Rubra (fresh red) Serosa (brownish-red, watery) Alba (yellow)

what induces lactation

placental expulsion

what is Colostrum

name given to milk produced by mothers

what is Colostrum rich in

immunoglobulin

what is in an epidural anaesthesia

Levobupivacaine +/- Opiate

why is epidural anaesthetic useful

Does not impair uterine activity [May inhibit progress during stage 2[

what are complications of epidural anaesthetic

``` Hypotension Dural puncture Headache Back pain Atonic bladder ```

how can progress be assessed in labour

Cervical dilatation Descent of presenting part Signs of obstruction

when should you suspect delay in stage

If Nulliparous <2cm dilation in 4 hours Parous <2cm dilation in 4 hours or slowing in progress

what should you think about when considering a cause for failure to progress

3 P's Power Passage Passenger

what dysfunction in power could lead to failure to progress

Inadequate contractions: frequency and/or strength

what dysfunction in passages could lead to failure to progress

Short stature / Trauma / Shape

what dysfunction in passenger could lead to failure to progress

Big baby | Malposition - relative cephalo-pelvic disproportion

what is commenced as part of assessing progress as soon as a women enters the labour ward

the partogram

what tools are used to assess fetal well being

Doppler auscultation of fetal heart Cardiotocograph (CTG) (+/- STAN) Colour of amniotic fluid

when is doppler auscultation of the fetal done

Stage 1: During and after a contraction Every 15 minutes Stage 2: Every 5-10 minutes

what are risk factors for fetal hypoxia

``` Small fetus Preterm / Post Dates Antepartum haemorrhage Hypertension / Pre-eclampsia Diabetes Epidural analgesia Induction / Augmentation of labour ```

if a baby has any risk factors for fetal hypoxia what is done

continous monitoring of the fetal heart

what are acute cause of fetal distress

``` Abruption Vasa Praevia Cord Prolapse Uterine Rupture Feto-maternal Haemorrhage Uterine Hyperstimulation Regional Anaesthesia ```

what are subacute cause of fetal distress

hypoxia

what does a CTG monitor/record

``` contractions decelerations accelerations variability baseline HR ```

what is the normal baseline HR

110-150 bpm tachycardia > 150 bradycardia < 110

what is the normal variability in fetal HR

5-25 bpm

how is CTG results classified

normal non-reassuring abnormal

Mx of fetal distress

Change maternal position IV Fluids Stop syntocinon Consider tocolysis - Terbutaline 250 micrograms s/c Maternal assessment - Pulse / BP / Abdomen / VE Fetal blood sampling Operative Delivery

fetal blood sampling shows scalp pH = what result would be normal, baseline and abnormal

pH >7.25 = normal 7.20 - 7.25 = borderline < 7.20 = abnormal

what action would a borderline fetal blood sampling require

repeat in 30 mins

what action would an abnormal fetal blood sampling require

deliver the baby

what length of duration is ok in a women that has never given birth before for stage 2 of labour

no epidural < 2 hrs epidural < 3 hrs

what length of duration is ok in a women that has given birth before for stage 2 of labour

no epidural < 1 hrs epidural < 2 hrs

what is Ventouse

vacuum-assisted vaginal delivery or vacuum extraction (VE)

what is ventouse associated with

increased failure increased cephalohaematoma increased retinal haemorrhage increased maternal worry decreased anaesthesia decreased vaginal trauma decreased perineal pain

what are indications of C-section

``` previous CS fetal distress failure to progress in labour breech presentation maternal request ```

C-sections are associated with 4x greater mortality - what leads to morbidity

sepsis, haemorrhage, VTE, trauma, TTN, subfertility, complications in future pregnancy

what are indications for inductions of labour

Maternal = Pre-eclampsia, Poor obstetric history Fetal = Suspected IUGR, Rhesus isoimmunisation, Antepartum Haemorrhage Both= Post Dates Pregnancy, DM, Obstetric Cholestasis

what are methods for induction

Prostaglandins - PGE2 Dinoprostone (Prostin gel / Propess pessary) Mechanical - Membrane sweep, Foley Balloon Catheter Amniotomy IV Syntocinon [synthetic oxycontin]