Progress & Delay in Labour; PROM & PPROM Flashcards
What is Latent phase 1st stage defined as , and the reference
Latent first stage of labour – a period of time, not necessarily continuous, when:
there are painful contractions and
there is some cervical change, including cervical effacement and dilatation up to 4 cm.
NICE (2014)
What is established 1st stage defined as , and the reference
Established first stage of labour – when:
there are regular painful contractions and
there is progressive cervical dilatation from 4 cm.
NICE (2014)
What is the average duration of the 1st stage for a primip?
Average of 8-18 hours (NICE,2014)
What is the average duration of the 1st stage for a multip?
Average of 5-12 hours (NICE, 2014)
How would you diagnose a delay in first stage?
A partogram with an action line
Vaginal examination
- if in the VE you identify that she
is ,2cm in 4 hours for a primip
and multips or a slowing in
progress for multips only
If there is no descent and rotation of foetus
changes in contractions
What do NICE 2014 recommend as interventions for delay 1st stage?
ARM (Artificial rupture of membranes) Analgesia Oxytocin (syntocinon) Increased frequency of VE Cesarean section
What is Passive second stage, define using a reference?
Passive second stage of labour:
the finding of full dilatation of the cervix before or in the absence of involuntary expulsive contractions. NiCE [2007]
What is active second stage, define using a reference?
Onset of the active second stage of labour:
the baby is visible
expulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation of the cervix
active maternal effort following confirmation of full dilatation of the cervix in the absence of expulsive contractions. NiCE [2007]
What is the average duration of active 2nd stage for a primip?
3 hours
What is the average duration of active 2nd stage for a Multip?
2 hours
Name the recommended methods/ interventions for delay in 2nd
ARM Oxytocin More VEs Change position Instrumental delivery C-section
What can be the causes of delay in labour think of the 3 Ps and the 4 Fs
The 3 P’s
- Powers
- Passages
- Passenger
The 4 F’s
- Foetus
- Faeces
- Full Bladder
- Fibroids
Name the signs and symptoms of delay and obstruction
Maternal Concerns Contractions 'gone off' Progress via VE, Cx, descent, etc Haematuria History Bandl's ring- Emergency
Please define the 3rd stage of labour using the NICE guidelines 2014
the time from birth of the baby to the expulsion of the placenta and membranes (NICE,2014)
What is the average duration and diagnosing delay in active 3rd stage?
If the 3rd stage is not complete within the 30 minutes
What is the average duration and diagnosing delay in physiological 3rd stage?
If the 3rd stage is not complete within the 60 minutes
What is recommended interventions of delayed 3rd stage of labour
Analgesia
- Vaginal examination
- Oxytocin (if bleeding)
- Controlled cord traction (with an oxytocic drug when converting from physiological to active management).
- Catheterisation
- Intravenous access
What does PROM stand for?
Pre-Labour rupture of membranes
What does Prom mean.
PROM, is the sudden rupture of membranes which usually occurs at least 1hr prior to the onset of contractions
What is the incidence of PROM
Approximately 8% of term pregnancies
Name the three associated factors linked with PROM
Baby is in OP
Polyhydramnious
Chorioamnionitis
How would you manage PROM
Assess risk factors
If risk factors are present: then place on CTG and make obstetric referral.
If no risk factors then listen to baby
If no clear evidence of ROM, no speculum
No vaginal examination unless in active labour
Risk of infection is 1%
4 hourly observations, monitor liquiour colour and FMs
If not in labour 24hr after ROM advice prostaglandins.
What does GBS stand?
Group B Strep
What is the statistic of women who have group B strep colonisation in their vagina.
<25% and they will require Intrapartum Antibotic Prophylaxsis (IAP)
How can GBS be detected and what would be required as treatment?
GBS can be detected in urine samples, prior to labour. However, they need to be given oral antibotics and IAP
What is the incidence for GBS and reference
10% mortality (50% long-term morbidity) and increasing. On average,
2 Babies daily develop GBS
1 baby weekly dies From GBS
1 Baby weekly survives with long-term disability
(GBSS,2017)
What antibiotic would you give to a mother who has GBS, reference ?
Benzylpenicillin 3g IV followed by 1.5g 4hrly
or if they are allergic to penicillin then
Clindamycin 900mg IV 8hrly
(NICE,2012)
What does PPROM stand for?
Preterm Pre-labour Rupture of Membranes (PPROM)
What doe PPROM mean?
Rupture of membranes that occurs before the onset of regular uterine contractions and before 37weeks (Myles, Pat McGeown,2014)
What is the incidence for PPROM?
Complicates 2% of pregnancies
Associated with 40% preterm deliveries
Name the complications of PPROM
Prematurity Sepsis Pulmonary Hypoplasia Cord prolapse Misrepresentation
What can contribute to PPROM (associating factors)?
Smoking BMI Domestic abuse Infection Vaginal bleeding
Name three ways in which PPROM can be diagnosed, what reference?
Positive if pool of fluid in vagina when sterile speculum is being done
Nitrazine test
Ultrasound Scan for oligohydramnios
RCOG, 2010
Name the 5 different methods of managing PPROM
Corticosteriods Antibiotics place of care Timing of delivery method of delivery
What is the role of the midwife?
Prevent PPROM as much as possible
do a risk assessment
assist medical staff and liase with MDT
visit SCBU if possible
Prepare parents for possible delivery and condition of baby
encourage healthy lifestyle and include hygienic advice
understandable antenatal care.
Routine MSU testing
