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Year 4 Family and Children ANNA > Labour > Flashcards

Flashcards in Labour Deck (24)
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1
Q

At what rate should cervical dilation occur after reaching 4cm?

A

Nulliparous: >1 - 1.2 cm per hour

Multiparous: >1.5 cm per hour

2
Q

What does APGAR stand for?

A

A - appearance

P - pulse

G - grimace

A - activity

R - respiration

3
Q

When are APGAR scores calculated?

What is good vs bad?

A

1 min after birth

5 minutes after birth

Good: 7-10

Bad <7

4
Q

What scores 0 - 2 for each APGAR?

A - appearance

P - pulse

G - grimace

A - activity

R - respiration

A
5
Q

What happens in Stage 1 of Labour?

A

Latent phase
Positive feedback loop of prostaglandins → contractions → stretch → oxytocin → prostaglandins and contractions (irregular→regular)

Active phase
3-4cm dilated, cervix now dilates to 10cm
Can see crowning

6
Q

What does oestrogen do to prepare body for labour?

A

Increases oxytocin receptors on uterus

7
Q

What does Progesterone do to ready body for birth?

A

Relaxes smooth muscle:

  • increases breast lobules (create milk)
  • Maintains uterine lining
  • Inhibits uterine contractions during pregnancy
8
Q

Describe what is happening in this stage of labour

A

Stage 1:

  1. Fetal distressACTH release by baby brain
  2. cortisol release
  3. placenta:
    1. inhibits progesterone ↓
    2. inhibits oestrogen ↓
    3. stimulates prostaglandins ↑↑↑
  4. Prostaglandins → uterine contractionsstretch receptors
  5. signal to hypothalamus to produce oxytocin
  6. stored in posterior pituitary
  7. Released Oxytocin causes
    1. Increased ↑↑ uterine contractions directly
    2. Increased ↑↑ prostaglandins via placenta
9
Q

Failure to Progress - how long should each be in a nulliparous vs multiparous woman?

  1. Stage 1 - intitial/latent (up to 4cm dilated)
  2. Stage 1 - active (rate of dilatation)
A

Nulliparous:

  1. <20 hr
  2. >1 - 1.2 cm per hour

Multiparous:

  1. <14 hr
  2. >1.5 cm per hour
10
Q

What does green or smelly “waters” indicate?

A

Meconium = the first poo from baby. Sign of distress, and risk of meconium aspiration

11
Q

What are the cardinal stages of labour?

A
  1. Descent
  2. Flexion
  3. Internal Rotation
  4. Extension
  5. Restitution (external rotation)
  6. Expulsion
12
Q

What 2 “leaks” often occur before labour begins?

A
  1. Bloody show
  2. Amniotic sac rupture (waters breaking)
13
Q

What about the fetus affects the process of labour / birth?

A
  1. Fetal SIZE
  2. Fetal ATTITUDE
  3. Fetal LIE
  4. Fetal PRESENTATION
14
Q

What is considered

Early term

full term

post-term

A

Early term is considered 37+0 weeks through 38+6 weeks,

full term is 39+0 weeks through 40+6 weeks

late term is 41+0 weeks through 41+6 weeks

post-term is 42+0 weeks and beyond.

15
Q

When should you be considered for VTE risk after giving birth?

A
  1. have a very long labour (more than 24 hours)
  2. have had a caesarean section
  3. lose a lot of blood after you have had your baby
  4. receive a blood transfusion.
16
Q

When should you consider a ventouse delivery?

A
  1. abnormal fetal HR in second stage (with or without abnormal scalp pH)
  2. Maternal exhaustion (has to have some push left)
  3. Failure to progress 2nd stage
17
Q

Which is the optimal position for baby to deliver in?

A

Occipitoanterior (OA) - left, right or straight

18
Q

when should you consider instrumental delivery?

A
  1. Fetal compromise
  2. Maternal health concerns re long second stage e.g. heart failure, myasthenia gravis
  3. Failure to progress:
    • Nulliparous women – lack of continuing progress for 3 hours (total of active and passive second-stage labour) 17 with regional anaesthesia, or 2 hours without regional anaesthesia
    • Multiparous women – lack of continuing progress for 2 hours (total of active and passive second-stage labour)17 with regional anaesthesia, or 1 hour without regional anaesthesia
    • Maternal fatigue/exhaustion
19
Q

what are the 2 stages of second phase of labour?

A

Passive: fully dilated but no urges to push

Active: expulsive contractions (making you want to push) with the finding of full dilatation of the cervix, or active maternal effort with full dilatation but without contractions

20
Q

When might instrumental delivery not work?

A

Higher rates of failure are associated with:

  • maternal body mass index over 30
  • estimated fetal weight over 4000 g or clinically big baby
  • occipito-posterior position
  • mid-cavity delivery or when 1/5th of the head palpable per abdomen
21
Q

What are risk factors for needing operative delivery?

A

Operative vaginal delivery is more common in:

Primiparous women

Supine and lithotomy positions

Epidural anaesthesia

22
Q

Why might a longer passive stage be encouraged before instrumental delivery?

A

If a primip with an epidural then evidence shows that delaying pushing for 1-2 hours has a lower risk of mid-cavity or rotational operations

23
Q

What is the accronym to interpret CTGs?

A

DR - Define Risk

C - Contractions

BRa - Baseline rate

V - Variability

A - Accelerations

D - Decelerations

O - overall assessment

24
Q

What are the complications of a caesarean section in the second stage of labour?

A

Maternal morbidity: uterine/cervical/high vaginal injury, postpartum haemorrhage, blood transfusion, sepsis, admission to intensive care, and length of stay.

Neonatal morbidity: admission to neonatal intensive care.