What are the 3 major diagnostic features of labour?
- Regular contractions (at least one every 10 mins)
- Cervical changes (effacement, dilatation) ± rupture of membranes
What is the latent phase of the first stage of labour?
- From onset of labour (hard to define) until cervix is 4cm dilated
- Usually takes ±8 hours, but there is no set time limit
What is the active phase of the first stage of labour?
- From 4cm cervical dilatation until delivery
- Cervical dilatation should occur at minimum 1cm/hour [1,5cm in multigravidae, 1,2cm in primigravidae]
What is the clinical importance if a patient crosses the “warning line” in the first stage of labour?
- Poor progress of stage 1 (i.e. dilating too slowly)
- Patient MUST be examined
- Reason for poor progress must be identified and addressed
What is the clinical importance if a patient crosses the “action” in the first stage of labour?
- Patient must be delivered ASAP
- A doctor must evaluate the patient
When to suspect cephalopelvic disproportion?
- Head does not descend into pelvic inlet (>2/5 of head above pelvis) AND cervix is dilating
How to exclude cephalopelvic disproportion?
- 2/5 or less of head is palpable above the pubic bone
Which bones may overlap in moulding?
- Occipital-parietal
- Parietal-parietal
Grades of moulding
0 Bones normally separated
+ Bones touching each other
++ Bones overlapping but may be separated with fingers
+++ Bones overlapping and inseparable
Maternal monitoring in first stage of labour
- 4-hourly assessment: abdominal and vaginal examinations
- 2-hourly assessment IF: >8cm; alert line crossed; evidence of maternal or fetal distress
Fetal monitoring in first stage of labour
- Every hour in latent phase
- Every 30mins in active stage (level 1 patients)
- Continuous CTG in all level 2 and 3 patients, or with meconium-stained liquor
Fetal monitoring in second stage of labour
- After every contraction
- Can alternatively use CTG
Active management of third stage of labour
- Ensure there isn’t an undelivered twin still inside!
- Administer oxytocin (10 IU, given IM)
- Clamp and cut umbilical cord
- Controlled traction of the cord until placenta is delivered
At what gestational age will the head engage in a primi gravida?
36/52
What are the components of intrauterine resuscitation?
IV fluids O2 for mother Left lateral position Tocolyse Monitor fetus
