Labour Flashcards by Carla de Kock

Latent phase of labour observations? (5)

4 - 6 hourly

bp
pulse
temperature
Pv: dilatation, cervical length, membranes, foetal head position, kaput + moulding
Rr

2 hourly

foetal heart rate
contractions

Urine when passed ‘

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Define active labour

Cervical dilatation 4 cm or more

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Active phase of labour observations? (7)

4 hourly

temperature
rr

2 hourly

pv
head above brim

1 hourly

bp
pulse

Half hourly

foetal heart
contractions

Urine when passed

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Define second stage labour and duration

Cervix fully dilated until delivery

First phase: full dilatation → desire to bear down
Second phase: desire to bear down → active pushing/delivery

PRIMI up to 3h
Multi up to 2

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Second stage of labour observations? (2)

Foetal heart after every 2nd contraction
Pv every 15 minutes to assess decent

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Oxytocin regimen for augmentation of labour? (4)

5 u oxytocin to 1 l ringers
start infusion 25 ml /hour
increase infusion by 50 ml /h every 30 min (50,100, 150, 200) until 3-4 strong contractions > 40 sec
if reaches 200 ml /h and still not strong contractions, increase dose by starting infusion 10 u in 1 L at 150 ml /h, increasing to 200 if necessary

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Management abnormal foetal heart / contraction pattern after oxytocin infusion in labour? ((4)

Stop infusion. Replace line with ringers.
No improvement: salbutamol 500 ug/ml injection preparation. 250 ug as a single injection. Give slowly iv over 5 minutes
continuous foetal, monitoring.
c/s if no improve

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Name 2 signs shoulder dystocia

Turtle sign: retraction of delivered foetal head against perineum
inability to deliver foetal shoulders with routine traction in axial direction

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Name 8 antepartum risk factors shoulder dystocia

Multiparity
post term gestation
maternal obesity
maternal diabetes
Prior shoulder dystocia
prior macrosomic child
excess gestational weight gain
foetal macrosomia

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Name 6 intrapartum risk factors shoulder dystocia

Induction/augmentation labour
abnormal labour
prolonged 1st stage
prolonged 2nd stage
epidural
operative vaginal delivery

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Name 2 maternal complications shoulder dystocia

Serious vaginal laceration
Postpartum haemorrhage

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Name 5 perinatal complications shoulder dystocia

Brachial plexus injury
fractures
hypoxia ischaemic encephalopathy
long term neurological disability
death

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Management shoulder dystocia (9)

HELPERR

First line

help: call for help
edge of bed + evaluate for episiotomy
legs: McRobert’s maneuvre (knees to chest )

Second line

pressure suprapubically + downward traction on foetal head to deliver ant arm
enter: rotational manoeuvres: posterior axilla sling traction, woods or Rubin’s
remove posterior arm.

(Consider repeating)

roll pt onto all fours (gaskin maneuvre )

3rd line

zavinelli (push head back) for c/s
clavicular #

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Active phase labour average length?

PRIMI: 12 hours
Multi: 10 hours

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Analgesia for labour

Pethidine 1 mg / kg (max 100 mg)
Or
Morphine 0,1 mg/kg (max 10mg) IM 4 hourly

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Typical duration latent phase labour?

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About 24 hours

What must be noted on pv during labour? (5)

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Dilatation
cervical length
membranes
kaput + moulding
position foetal head

Partogram: 1 block = how many hours in latent and active phases?

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Latent: 1 block = 2 hours
Active: 1 block = 1 hour

How describe liquor on partogram? (4)

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I/c/m/b

Intact: membranes not ruptured
Clear:
Meconium stained
Blood stained

Define caput and how to describe on partogram

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Swelling of infant’s scalp.
0,1 +,2+

Define moulding and how to describe on partogram

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Foetal skull bones moving closer/overlap to fit through pelvis. Try to separate sutures
O: sutures separate
1+ sutures opposed
2+ overlapped but reducible
3+ overlapped and not reducible

Management partogram on action line?

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4 ps

Power
Passage: CPD
Passenger: presentation, size…

Psyche: pain…

Name 3 indications assisted delivery

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Maternal: inefficient effort eg exhaustion, underlying condition precluding pushing eg cardiac
foetal: non-reassuring ctg
other: prolonged second stage labour

Name 6 contraindications assisted delivery

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Non vertex presentation
unengaged foetal head
unknown foetal head position
premature <34 weeks
known foetal coagulation disorder
known foetal demineralisation disorder

Pre-op Checklists for assisted delivery? (4)

- Maternal - foetal - uteroplacental - other

Pre-op maternal checklist for assisted delivery? (7)

- Informed consent - analgesia - lithotomy - empty bladder - adequate pelvis - consider episiotomy - for vacuum, uterine contractions and maternal effort must be present!

Pre-op foetal checklist for assisted delivery? (5)

- Vertex - foetal head must be engaged: 0/5 above brim - known foetal head position - document estimated foetal weight. Ideally 2500 - 4000g - assess foetal head attitude, kaput, moulding, asynclitism (oblique malpresentation)

Pre-op uteroplacental checklist for assisted delivery? (3)

- Fully dilated cervix - no placenta praevia - ruptured membranes

Pre-op procedural/other checklist for assisted delivery? (5)

- Alert anaesthesia, nursing, neonatology - experienced operator - monitor foetus continuously - be able to perform emergency Caesar - be prepared for shoulder dystocia

How choose assisted delivery instrument?

Forceps: safer for foetus. Generally preferred Vacuum: safer for mother ; need uterine contractions and maternal effort

Describe vacuum assisted delivery ( 5)

- Cup applied over flexion point, which is 3-4 cm in front of occiput in midline, indicated by sagittal suture - begin with suction at 0,7 - 0,8 kg/cc^2 - Traction in direct line of vaginal canal perpendicular to head - no rocking motions. Should not last > 5 mins. - discontinue if cup slips off 3 times

Describe forceps assisted delivery ( 3 )

- Appropriate application so that forceps grasp sides of foetal head. - long axis of blades correspond to occipital - mental diameter. Tips of blades over cheeks. - blades equidistant from sagital suture, which bisects horizontal plane. posterior fontanelle is 1 finger breadth anterior to this plane. - Fenestrated blades should admit no more than 1 finger breadth between heel of fenestration and foetal head. - don't grasp maternal tissue - abandon if difficulty applying, no descent with traction, not delivered in reasonable time, after 3 pulls

Name 7 maternal complications assisted delivery

- pain at delivery, perineal pain - lower genital tract lacerations/haematoma - urinary retention, incontinence - anal incompetence - pelvic organ prolapse - fistulae - Anaemia

Name 8 foetal complications assisted delivery

- Intracranial haemorrhage - bruises - abrasions, lacerations - facial nerve palsy - cephal haematoma - retinal haemorrhages - skull fracture - subgaleal haematoma

Labour Flashcards

(34 cards)