Modes of delivery Flashcards
What causes pain in labour?
- Painful contractions
2. Effectivness of pushing
When assessing a women’s contractions, what do you look out for
Duration
Intensity
Frequency
What factors does the pain experience depend on? (3)
- Type of pelvis
- Ability of the cervix to dilate
- Ability of the vaginal canal to distend
What factors do we need to take into consideration when assessing pain in labour
- Pain threshold
- Medical conditions
- Source of pain
- Foetal position and presentation
What type of pain do we get in the first stage of labour?
Visceral pain from uterine contractions and cervical dilation via afferent routes from T10-L1
What type of pain do we get in the Second stage of labour?
Somatic pain from the vaginal and perineal regions via S2-4 through the pudendal nerve
What are the consequences of pain in labour?
- Unpleasant mental health impact
2. Increases plasma cortisol and catecholamines leading to a reduction in utero-placental blood flow
What are the benefits of relieving pain in labour?
- Reduces plasma noradrenaline
- Prevents metabolic acidosis by reducing the rate of rise of lactate and pyruvate
- Decreases maternal O2 consumption
How does maternal pain lead to foetal metabolic acidosis?
- Pain causes hyperventilation which causes respiratory alkalosis and reducing transfer of O2 into baby
- Pain releases cortisol which stimulates lipolysis and hyperglycaemia causing hypoxia for the baby
- Both processes cause uterine vasoconstriction reducing placental flow and exchange
What are the 4 different ways of managing pain in labour?
- Non-pharmacological
- Inhalation
- Systemic opioids
- Epidural
List 6 Non-pharmacological methods to reduce pain in labour?
- Progressive relaxation
- Thermal stimulation
- Positioning
- Distraction
- Hydrotherapy
- Touch relaxation
What are the advantages of non pharmacological methods to relief pain in labour? (3)
- Non-invasive
- Addresses emotional and spiritual aspects of pain
- Promotes a women’s sense of control over pain
What are the disadvantages of non pharmacological methods to relief pain in labour? (2)
- Interventions require special training/practice
2. Not effective for everyone
Which opioid is recommended to treat pain in labour?
Pethadine
What are the SE of Pethadine? (4)
- N+V
- sedation
- Reduces labour progress
- Increases foetal heart rate and acidosis
What are the advantages of epidural analgesia in labour? (4)
- Effective
- Safe
- Does not increase the risk for C-section
- No foetal compromise
What are the disadvantages of epidural analgesia in labour?
- Prolonged second stage
- increased labour augmentation
- Increased risk of instrumental delivery - hospital stay, sexual dysfunction, incontinence
List 7 perquisites for instrumental delivery
- Head not palpable abdominally
- Head at or below the ischial spine (0/5 station)
- Cervix fully dilated
- Head position unknown
- Adequate analgesia (pudendal nerve block)
- Valid indication
- Bladder empty
What do you need to do before carrying out an instrumental delivery? (5)
- Clear consent from mother
- Appropriate analgesia - regional block
- Pudendal block for urgent delivery
- Maternal bladder emptied + catheter removed or deflated
- Aseptic technique
What are the Maternal complications of instrumental delivery?
- PPH
- Third/fourth degree perineal tear
- Cervical tear
List 5 indications for operative vaginal delivery
- Prolonged active stage
- Maternal exhaustion
- Foetal distress in second stage
- To cut short the second stage in women with severe cardiac disease/HTN
- Breech - for the head
What are the disadvantages of Ventouse? (2)
- High failure rate
2. Foetal trauma - haematoma
What are the advantages of Ventouse? (2)
- No difference in APGAR score
2. Less maternal trauma
What Foetal complications do we get with instrumental delivery? (5)
- Skull fractures/facial nerve damage
- Haematomas
- Intracranial haemorrhage
- Scalp laceration
- Neonatal jaundice
