Stages of labour and APGAR score Flashcards
(40 cards)
When does the first stage of labour begins?
It begins with regular contractions or on admission to hospital with obvious signs of labour.
Where is the presenting part at the first stage of labour?
The presenting part has descended into the true pelvis.
When does the first stage of labour end?
When the cervix is fully dilated to 10 cm.
How many phases is the first stage of labour divided into?
Two phases.
Latent phase and active phase.
What happens in the latent phase?
- Contractions are not particularly painful and at 5- to 10-minute intervals.
- Contractions become stronger with shorter intervals, although the cervix is still dilating relatively slowly, with membranes possibly breaking later in this phase.
What happens in the active phase?
- Starts with the cervix 3-4 cm dilated and is associated with more rapid dilatation normally at 0.5-1.0 cm/hour.
- Once the cervix is dilated to 9 cm, towards the end of the active phase, contractions may be more painful and women may want to push.
- During this time the fetal head descends into the maternal pelvis and the fetal neck flexes.
Is pushing desirable in the first stage of labour?
-Pushing is undesirable at this stage; there is the need to establish by vaginal examination whether the cervix is fully dilated.
Management of the first stage of labour
o Reassure and advise the patient on how her labour is progressing.
o Measure pulse hourly and temp and BP 4-hourly.
o Fetal HR should be auscultated for at least 1 minute immediately after a contraction. This should be carried out every 15 minutes.
o Offer a vaginal examination to assess cervical dilatation and fetal head descent every 4 hours and when the woman appears to be in established labour.
o Discuss the patient’s need and plan for pain relief in labour.
o Assess the position of the fetal head with regard to the mother’s pelvis.
What is a partogram?
This is a pictorial record of active labour.
What is the central feature of a partogram?
A graph used to record cervical dilatation as determined by vaginal examination.
When should you start the graph to record cervical dilation?
5 cm.
In induction of labour, this will be 4 cm.
What is the alert line of the partogram?
This shows that closer monitoring of the mother and foetus is indicated
What is the action line of the partogram?
WHO recommendation of a four-hour action line should be used. This means that, if the labour does not progress as predicted, some ACTION will be taken - eg, amniotomy, augmentation and caesarean section.
What are the maternal indicators plotted on a partogram?
- Vital signs (heart rate, blood pressure and temperature)
- Time of spontaneous or artificial rupture of the membranes
- Uterine contractions (number per 10 minutes and duration)
- Urine output
- Drugs administered (oxytocin, antibiotics, etc.)
What are the foetal indicators plotted on a partogram?
- Foetal heart rate
- Amniotic fluid (colour, odour and quantity)
- Descent of the foetal head and head moulding
When does the second stage of labour starts?
When the cervix is fully dilated.
When does the second stage of labour ends?
When the baby is born
What happens during the second stage of labour?
o Contractions are stronger, occur at 2- to 5-minute intervals and last 60-90 seconds.
o The fetal head descends deeply into the pelvis and rotates anteriorly so that the back of the fetal head is behind the mother’s symphysis pubis (98% of cases).
o The fetal head becomes more visible with each contraction until a large part of the head can be seen.
o The head is now born with first the forehead, then the nose, mouth and chin.
o The head rotates to allow the shoulders to be born next, followed by the trunk and legs.
o After this, the baby should start to breathe and to cry loudly.
Management of second stage of labour
o Check for level of pain relief and supplement if required.
o Ensure a midwife/doctor is present at all times to encourage pushing during contractions and relaxing in between.
o Monitor contractions and FHR - measure every 5 minutes - this should be 100-160 bpm.
o If this stage is >2 hours for a nulliparous woman or >1 hour for a multiparous woman then instrumental delivery should be considered.
What methods are used to guard the baby’s head?
- ‘Hands on’ - where pressure is placed on the baby’s head and the perineum supported. The application of a warm compress appears to reduce the severity of perineal trauma.
- ‘Hands poised’ - where these manoeuvres are not carried out. The ‘hands poised’ method may reduce episiotomy rates but more trials are needed to decide the issue.
When does the third stage of labour starts?
It starts with the birth of the baby.
When does the third stage of labour end?
With the delivery of the placenta and membranes.
When does the separation of the placenta occurs?
Separation of the placenta occurs immediately after birth due to forceful uterine contractions along with retraction of the uterus, thus greatly reducing the size of the placental bed.
How long does it take for the placenta to be separated from the uterus?
Approximately 5 minutes
