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61 Cards in this Set
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What is labour?
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Labour is the process by which the contents of the pregnant uterus are expelled.
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What are the purpose of antenatal classes?
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To provide prospective parents with advice on issues such as when to attend in labour, to teach parents about hospital procedures in the event of complications, and to educate parents about options in relation to pain relief around delivery.
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These measures help reassure the woman prior to labour and help her and her partner to feel positive about the delivery process. |
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What is the first stage of labour characterised by?
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Dilatation of the cervix. It lasts from the onset of labour until full dilatation.
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What is the latent phase of the first stage of labour?
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The latent phase describes the progress of labour from 0 to 3 cm dilatation.
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The woman may present, or the latent phase may occur in the cervical ripening stage prior to labour itself. |
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What is the active phase of the first stage of labour?
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The active phase describes the progress of labour from 3cm to just before full dilatation.
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This phase is normally characterised by progress of at least 1 cm per hour and presents no difficulty in diagnosis. |
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What is the second stage of labour?
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The second stage lasts from full dilatation to delivery of the foetus.
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What is the passive stage of the second stage of labour?
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The period of the second stage of labour where there is no pushing. Allows foetal head to descend.
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What is the active second stage of labour?
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The active process of the maternal pushing directed toward achieving delivery.
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What is the third stage of labour?
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This extends from delivery of the baby to delivery of the placenta and membranes.
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How is the diagnosis of labour normally defined?
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The onset of regular painful uterine contractiosn associated with effacement and dilatation of the cervix.
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What are the difficulties faced in diagnosing labour?
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1. When women complain of contractions in the absence of cervical change.
2. Not all women find contractions painful. 3. Effacement of the cervic prior to dilataion is characteristic of primaparous labour rather than multiparous labour. |
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How long is labour?
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It is difficult to say. Most women deliver within 10 - 12 hours of admission.
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Prolonged labour is defined as lasting more than 24 hours. |
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The process of normal labour and delviery is determined by the interaction of which three variables beginning with P?
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1. The passages.
2. The passengers. 3. The powers. |
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Which resistances must be overcome to allow delivery?
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1. Stretching of the pelvic ligaments (prior to and during labour)
2. Effacement and dilatation of the cervic (prior to labour and during first stage) 3. Compression of maternal sof tissues (first and second stage of labour) |
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What are the anatomical boundaries of the pelvic inlet?
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The pelvic inlet extends from the centre of the sacral promontory along the ileopectineal lines to the posterior aspect of the upper surface of the pubic bone.
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What is the shape and what are the diameters of the pelvic inlet?
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It is oval.
AP: 11.5 cm Transverse: 13.6cm |
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What are the anatomical boundaries of the pelvic outlet?
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The pelvic outlet extends from the tip of the coccyx to the ischial tuberosities and then to the lower border of the symphysis pubis.
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What is the shape and what are the diameters of the pelvic outlet?
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It is oval.
AP: 12.5cm Transverse: 10.5cm |
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What are the anatomical boundaries of the mid cavity?
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Superior boundary: pelvic inlet.
Posterior boundary: level of ischial spines and levator ani. |
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How does the foetus rotate to fit through the passage?
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1. Pelvic inlet: Foetal head enters transversely.
2. Mid cavity levator ani muscles: Internal rotation of foetal head. 3. Pelvic outlet: Foetal head exits in occipto-anterior position. |
Variants of the normal gynaecoid shape can impair descent or make head descend in unfavourable position, such as occipto-posteriorly. |
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At the beginning of normal labour, where is the foetal head positinoed?
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The head will lie over the pelvic inlet and be well flexed.
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What is the vertex of the foetal head?
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The area between the biparietal eminences and the anterior and posterior fontanelles.
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The vertex enters the pelvis first. |
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What is the maximum diameter of the foetal head?
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9.5cm.
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What factors relating to the foetus might impede progress?
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1. Foetal weight - larger babies have difficulties passing through the pelvis.
2. Adoption of an unfavourable position of the presenting part (occipto-posterior position), as this increased the relative diameter of the presenting part. 3. Foetal anamolies such as hydrocephalus. |
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What do "the powers" refer to?
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The force generated to ensure expulsion of the foetus from the genital tract.
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The force is generated by uterine activity alone for the first stage, and by uterine activity plus maternal effort for the second stage. |
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How can uterine contractions benefit delivery?
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They produce progressive cervical dilatation.
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How can uterine contractions harm the foetus?
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They can cause temporary impairment of foetal oxygenation by impairing intervillous blood flow.
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How can uterine activity be assessed?
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By palpation of by the use of an external pressure transducer on the abdominal wall overlying the uterus.
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What is the pattern of contractions during labour for most women?
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Approximately 2 to 4 contractions every 10 minutes.
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There is considerable variatino. |
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What does midwifery care within the first stage of labour include?
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1. Pulse and BP measurements - 30 minutes
2. Temp - 2 hours 3. Foetal heart auscultation - 15 minutes 4. Monitoring of urinary output and urinalysis 5. Vaginal examination at 2 - 4 hourly intervals |
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What is the advice regarding oral intake for women in labour?
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Fluid intake is encouraged to maintain hydration.
Women are encouraged to refrain from eating solids incase emergency anaesthesia is required. |
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What is Mendelson's syndrome?
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Mendelson's syndrome is chemical pneumonitis caused by aspiration of gastric contents during anaesthesia.
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Which women are at high risk of requiring emergency anaesthesia?
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1. Previous caesarean delivery.
2. Breech presentation. 3. Poor progress in labour. 4. Twin deliveries. 5. Persistently high head. |
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Is progress slower in nulliparous or multiparous women?
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Progress is slower in nulliparous women.
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For uterine activity to be translated into progressive cervical dilatation, what must occur?
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The uterus must contract, and then relax, but with retraction (that is, some length of the cervix must be taken up).
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There must also be a sustained relaxation between contractions of 1 - 2 minutes for intervillous blood flow and foetal oxygenation to recover. |
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Where should one palpate to detect the beginning of a contraction?
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Palpate near the fundus.
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How does the abdominal examination assess descent of the head?
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The head is said to be engaged when the maximum diameter of the foetal head has passed through the brim of the pelvis.
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How does the vaginal examination assess descent of the head?
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Usually assessed with reference to the ischial spines of vaginal examination.
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What does induction of labour refer to?
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Starting labour at a time of medical and social convenience.
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Why is induction of labour difficult to achieve?
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Because one must mimic the natural process of cervical ripening and onset of labour, which normally take weeks.
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What are some of the indications for induction of labour?
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1. hypertension or pre-eclampsia
2. post-maturity 3. antepartum haemorrhage 4. intra-uterine growth retardation 5. diabetes |
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What does cervical ripening involve?
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Progressive softening of the cervix, accompanied by some dilatation and effacement. The cervic moves towards a more anterior postion on vaginal assessment and the vertex descentds.
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The extent to which this has already occurred at the time of induction affects the success of the induction. |
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How are prostaglandins used in the induction of labour?
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Prostaglandins are used to ripen the cervix.
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They are effective in inducing labour, in reducing the possibility of failed induction, and in reducing the oprative delivery rate following induction. |
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What is the most commonly used prostaglandin?
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E2. The vaginal route is favoured over the endocervical route.
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What are other less effective methods of cervical ripening?
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Oestrogens, oxytocin, Foley catheter insertion, nipple stimulation and sexual intercourse.
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What is a serious side-effect of prostaglandin use to induce labour?
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Uterine hypertonus - excessive contractions impair placental exchange and make the foetus hypoxic and acidotic.
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What problems are associated with the induction of labour?
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1. Maternal stress
2. Maternal pain 3. Vaginal discomfort from the use of pessaries. 4. Hypertonic ureters. 5. Failed induction leading to caesarean. |
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What are prostaglandins?
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Prostaglandins are hormone-like substances. They act in a manner similar to that of hormones, by stimulating target cells into action. However, they differ from hormones in that they act locally, near their site of synthesis, and they are metabolized very rapidly.
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Another unusual feature is that the same prostaglandins act differently in different tissues. |
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What is amniotomy?
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An amniotomy is the artifical rupture of the membranes, perforemd by passing a finger/surgical instrument through the cervix and peeling the mebreanes of the lower segment of the uterus.
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It is useful in the process of induction, provided some cervical ripening has occurred. It works through local prostaglandin release. |
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What are some of the indications for induction of labour?
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1. hypertension or pre-eclampsia
2. post-maturity 3. antepartum haemorrhage 4. intra-uterine growth retardation 5. diabetes |
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What does cervical ripening involve?
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Progressive softening of the cervix, accompanied by some dilatation and effacement. The cervic moves towards a more anterior postion on vaginal assessment and the vertex descentds.
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The extent to which this has already occurred at the time of induction affects the success of the induction. |
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How is a Bishop score calculated?
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Position of the cervix: post = 0, mid-cavity = 1, anterior = 2
Dilation in cm: 0 = 0, 1-2 = 1. 3-4 = 2, 5+ = 3 Station: -3 = 1, -2 = 1, -1-0 = 2, 1-2 = 3 Consistency: firm = 0, medium = 1, soft = 2 Length (cm): 3 = 0, 2 = 1, 1 = 2, 0 = 3 |
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How are prostaglandins used in the induction of labour?
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Prostaglandins are used to ripen the cervix.
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They are effective in inducing labour, in reducing the possibility of failed induction, and in reducing the oprative delivery rate following induction. |
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What is the most commonly used prostaglandin?
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E2. The vaginal route is favoured over the endocervical route.
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What are other less effective methods of cervical ripening?
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Oestrogens, oxytocin, Foley catheter insertion, nipple stimulation and sexual intercourse.
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What is a serious side-effect of prostaglandin use to induce labour?
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Uterine hypertonus - excessive contractions impair placental exchange and make the foetus hypoxic and acidotic.
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What problems are associated with the induction of labour?
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1. Maternal stress
2. Maternal pain 3. Vaginal discomfort from the use of pessaries. 4. Hypertonic ureters. 5. Failed induction leading to caesarean. |
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What are prostaglandins?
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Prostaglandins are hormone-like substances. They act in a manner similar to that of hormones, by stimulating target cells into action. However, they differ from hormones in that they act locally, near their site of synthesis, and they are metabolized very rapidly.
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Another unusual feature is that the same prostaglandins act differently in different tissues. |
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What is amniotomy?
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An amniotomy is the artifical rupture of the membranes, perforemd by passing a finger/surgical instrument through the cervix and peeling the mebreanes of the lower segment of the uterus.
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It is useful in the process of induction, provided some cervical ripening has occurred. It works through local prostaglandin release. |
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What does foetal station refer to when calculating Bishop's score?
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Fetal station describes the position in of the fetus' head in relation to the distance from the ischial spines, which can be palpated deep inside the posterior vagina (approximately 8–10 cm) as a bony protrusion. Negative numbers indicate that the head is further inside, above the ischial spines.
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How should Bishop's score be interpreted?
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A score of 5 or less suggests that labour is unlikely to start without induction. A score of 9 or more indicates that labour will most likely commence spontaneously. A score of 8 is recommended for successful induction of labour to occur.
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