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Repro > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

What is labour?

A

The process via which the foetus, placenta and membranes are expelled via the birth canal

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2
Q

What are some of the defining characteristics of normal labour?

A
  • Occurs spontaneously (not induced)
  • Occurs at 37-42 weeks gestation
  • Fetus presents by the vertex (head down)
  • Results in a spontaneous vaginal birth
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3
Q

What are some of the cervical and uterine changes that occur as labour initiates?

A

Cervix softens

Myometrial tone of the uterus changes to allow for coordinated contractions

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4
Q

What are some of the hormonal changes that occur at the initiation of labour?

A
  • Progesterone decreases

- Oxytocin and prostaglandins increase

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5
Q

How many stages of labour are there? What does each stage encompass?

A

First stage - early / latent phase, active first stage and transition

Second stage - passive and active second stage

Third stage - active / physiological stage

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6
Q

What is the longest phase of labour that the woman will encounter? What characterizes this stage?

A

The latent phase of the first stage - can be up to days in length

Irregular contractions start, they are quite short lasting.

There is also shortening, thinning, anterior movement and dilatation up to 4cm of the cervix

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7
Q

What characterizes the active first stage of labour? How long does this stage last?

A
  • Cervix dilating from 4cm to 10cm
  • Regular, painful contractions (3-4 contractions per 10 minutes, all lasting about a minute)

Stage lasts about 8-12 hours

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8
Q

What characterizes the transition phase of the first stage of labour?

A

Cervix dilated 8-10cm

Physical changes:

  • Patient may start to shake
  • Feel the urge to vomit / empty bowels
  • Express need for pain relief / feels she can’t cope
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9
Q

What characterizes the passive phase of the second stage of labour?

A
  • Being fully dilated to the birth of the baby

- Involuntary expulsive contractions yet to start

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10
Q

What characterizes the active phase of the second stage of labour?

A
  • Expulsive contractions begin / maternal effort to expel the baby
  • May see partial presentation of the baby
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11
Q

How long does the second stage of labour last?

A

Usually 2-3 hours

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12
Q

What is an important factor that can affect the length of each of the first two stages of labour?

A

Whether the woman is nulliparous or multiparous

Nulliparous - never given birth before, or only to a stillborn baby
Multiparous - has given birth before

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13
Q

What characterizes the third stage of labour?

A

Includes birth of the baby and the expulsion of the placenta and membranes

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14
Q

What are the two options for managing the third stages of labour?

A

Physiological management: no drugs, clamping and placenta delivered by maternal effort

Active management:

  • Uterotonic drugs
  • Cord clamping
  • Expulsion of placenta by cord traction
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15
Q

How long does the third stage of labour last?

A

Actively managed - completed within 30 minutes

Physiologically managed - within 60 minutes

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16
Q

How does contraction and retraction of the uterine wall facilitate delivery?

A

Creates a smaller volume in the uterus, increased pressure pushes baby out

Reduces diameter of the uterus to direct the baby through the pelvis

17
Q

In which direction does the baby rotate during delivery? What causes this rotation?

A

Rotates internally

Resistance from the diaphragm along with the shape of the pelvis causes this rotation, moving the baby into a more optimal position for childbirth

18
Q

When does crowning occur during childbirth?

A

When the occiput (back of head) slips below the pubic arch and the head no longer recedes backwards

(when you can see the top of the baby’s head)

19
Q

What are the extension and restitution mechanisms of labour?

A

Extension - baby’s full head past the pubic arch, see the brow face and chin born over perineum

Restitution - baby’s head rotates to put it back in plane with rest of body

20
Q

List the mechanisms of labour in order

A
  • Engagement and descent
  • Flexion
  • Internal rotation of head
  • Crowning and extension of head
  • Restitution
  • Internal and external rotation of head
  • Lateral flexion of shoulders
21
Q

What are the different types of fetal lie?

A

Cephalic / vertex - head towards pelvis, vertical

Breech - Buttocks towards pelvis, vertical

Transverse lie - horizontal lie of baby within uterus

22
Q

What are the different types of fetal presentation?

A

Face presentation - Face of baby facing the vaginal opening

Brow presentation - Crown of baby’s head facing vagina

Shoulder presentation - Shoulder of baby facing the pelvic opening

23
Q

What are the different fetal positions?

A
  • Left occipital transverse / anterior / posterior

- Right occipital transverse / anterior / posterior

24
Q

What is used to perform intermittent auscultation of the fetus’ heart rate? When is this done?

A

Pinards stethoscope or Hand held Doppler

Every 15 minutes for a full minute following a contraction in first stage of labour, every 5 minutes or after every contraction in second stage

25
Q

Advantage of a hand held doppler over a pinards stethoscope?

A

Hand held doppler amplifies fetal heart rate so everyone in the room can hear it, only midwife can hear it with the Pinards stethoscope

26
Q

What is the normal fetal heart rate?

A

110-160 bpm

Lots of variability (>5 bpm)
Often have accelerations of around 15bpm

27
Q

What are some methods of monitoring maternal health during labour?

A

Maternal Observations - HR, BP, Temp etc.

Abdominal palpation - position of the baby

Vaginal examination - is mother dilated & position of baby

Monitoring of amniotic fluid (amniotic liquor) - colour / content

Palpation of contractions - palpate contractions for a 10 minute period every half hour, strength and tone

External signs - eg. Rhomboid of Michaelis and anal cleft line

28
Q

What are some methods of supporting the mother through labour?

A

Maternal mobility and position - upright position and maintenance of mobility reduces pain

Breathing, hyponobirthing techniques, massaging, aromatherapy

TENS machines - encourages endorphin production & reduce pain signals

Oral analgesia

Pools / baths - water helps during first 2 stages

Entonox / opioids

Remifentanil PCA (patient controlled analgesia) / Epidurals

Repro (21 decks)

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