Labour Stages Flashcards
What are the stages of labour?
1st Stage
- Latent: contractions to 4cm dilated (hours - days)
- Active: 4cm to 10cm (0.5 cm/hr nullip, 1cm/hr multip)
2nd Stage
- 10cm dilation to delivery of the baby (3hrs epidural nullip, 2hrs no epidural nullip, 2hrs epidural multip, 1hr no epidural multip)
3rd Stage
- Delivery of the placenta and foetal membranes (up to 1 hr without active management, 30 mins with active management. Average duration =5-10 mins)
Which position is the pelvic inlet the widest?
Transverse
Which position is the pelvic outlet the widest?
Anterior-posterior
What is progress of labour determined by?
- Power (contractions)
- Passage (dimensions of pelvis)
- Passenger (diameter of the foetal head)
What is restitution?
Bringing the head in line with the shoulders (foetus does this naturally once the head has been delivered)
What is the Bishop’s score?
Score used to assess liklihood of labour
- Cervical position
- Cervical consistency
- Cervical effacement
- Cervical dilation
- Fetal station
What is the meaning of Bishop’s score?
- <3 IOL unlikely successful
- <=5 IOL with PV prostaglandin gel
- 6-8 ARM
- > =9 labour likely to occur spontaneously
How often should vaginal exams be performed in the first stage of labour?
4 hourly or as clinically indicated
(one to one midwife care)
How can the second stage of labour be divided?
Passive phase:
- Full dilatation until the head reaches pelvic floor and ends with the onset of involuntary expulsive contractions (eg. no maternal urge to push)
Active phase:
- Onset of involuntary expulsive contractions and ends with birth of baby (urge to push)
Prolonged >2hrs in nulip and >1hr in primip (+1hr if epidural)
What are causes of a prolonged second stage of labour?
o Secondary dysfunctional uterine activity
o Resistant perineum (particularly if nulliparous)
o Persistent OP foetal head
o Android pelvis
What is physiological management of 3rd stage of labour?
- Where the placenta is delivered by maternal effort
- Associated with heavier bleeding
- Prolonged = lasting >60mins
What is active management of 3rd stage of labour?
- Recommended to all women
- Involves administering 10 iU oxytocin IM to the mother (with the birth of the
anterior shoulder or immediately after delivery) - Controlled traction of umbilical cord after signs of separation of the placenta
- Reduces incidence of PPH (from 15% → 5%)
- Prolonged = lasting >30mins
What is the mechanism of labour?
- Descent
- Engagement – identified by abdominal palpation, foetal head is 3/5th palpable or less
- Neck flexion
- Internal rotation
- Crowning
- Extension of the presenting part
- Restitution
- External rotation
- Lateral flexion
- Delivery of the shoulders and foetal body
What is the management of labour during the 1st stage?
- Every 15 mins – foetal HR with intermittent auscultation (or continuous CTG if
indicated) - Every 30 mins – frequency of contractions
- Every 1 hour – maternal HR, BP and vaginal examination
- Every 4 hours – maternal temperature
- Document volume of urine passed, and test for ketones and protein, record any
accelerations and decelerations
What is the management during the 2nd stage?
- Every 5 mins – foetal HR with intermittent auscultation(or continuous CTG if indicated)
- Every 30 mins – frequency of contractions
- Every 1 hour – maternal HR, BP and vaginal examination
- Document volume of urine passed, and test for ketones and protein
