What is labour?
Labour is the process in which the foetus, placenta and membranes are expelled via the birth canal.
When does normal labour usually occur
In normal labour occurs spontaneously, at term (37-42 weeks gestation), with the foetus presenting by the vertex and results in a spontaneous vaginal birth (SVD)
How is labour triggered?
By paracrine and autocrine signals generated by maternal, foetal and placental factors which interplay
What are the key physiological changes which must occur before expulsion of the foetus will occur?
- Cervix softens
- Myometrial tone changes to allow for coordinated contractions
- Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate
What is the latent first stage of labour?
A period during which there are intermittent, often irregular painful contractions which bring about some cervical effacement and dilatation up to 4cm
What is the established first stage of labour?
Regular, painful contractions that result in progressive effacement and cervical dilatation from 4cm
When is the first stage of labour complete?
When the cervix is fully dilated (10cm)
How long does the first stage of labour last?
Length of established first stage of labour varies between women but for a primagravida this stage lasts on average 8 hours (unlikely to last longer than 18 hours) and for a multigravida this stage lasts on average 5 hours (unlikely to last over 12 hours).
How fast does the first stage of labour progress?
0.5-1cm per hour
How does the cervix thin and dilate?
- Uterine contractions start at the fundus, the top of the uterus and move down and across.
- This exerts pressure on the fetal pole which encourages flexion and a well applied presenting part which in turn puts pressure on the cervix to thin and dilate
What does stage 2 of labour encompass?
From full cervical dilatation to the birth of the baby
What is the passive second stage of labour?
- Finding of full dilatation of the cervix before or in the absence of involuntary expulsive contractions.
- Plan to allow one hour of passive second stage to allow for further fetal descent.
What is the active second stage of labour?
- The presenting part is visible.
- Expulsive contractions with a finding of full dilatation of the cervix.
- Active maternal effort following confirmation of full dilatation of the cervix in the absence of expulsive contractions.
How long should the second stage of labour last?
- In a primagravida birth would be expected within two hours of active second stage commencing
- For a multigravida birth would be expected within one hour of active second stage commencing.
What is the third stage of labour?
Time from the birth of the baby to the expulsion of the placenta and membranes
What does active management of the third stage of labour involve?
Package of care
- Routine use of uterotonic drugs
- Deferred clamping and cutting of the cord
- Controlled cord traction after signs of separation of the placenta
What does physiological management of the third stage of labour involve?
Package of care
- No routine use of uterotonic drugs
- No clamping of the cord until pulsation has stopped
- Delivery of the placenta by maternal effort
When is the third stage of labour considered delayed?
- If not completed within 30 minutes of the birth with active management
- If not completed within 60 minutes of the birth with physiological managemnet
How should progress be monitored during labour?
- Blood pressure, pulse, temperature, respirations, oxygen saturation, urine output and urinalysis
- Abdominal palpation
- Vaginal examination
- Monitoring of liquor once spontaneous or artificial rupture of membranes has occurred
- Auscultation of the foetal heart
- Palpation of the uterine muscle contractions
- External signs
What is abdominal palpation used to assess?
Foetal lie, presentation, attitude, denominator, position and engagement
What is vaginal examination used to assess?
Used to assess presentation, engagement and station, position, cervical effacement and dilatation and presence/ absence of membranes
How is the foetal heart auscultated
- Intermittently with handheld Doppler or Pinards
- Continuosly with CTG
When is intermittent monitoring of babies heartbeat carried out?
- Every 15 minutes in the first stage of labour
- Every 5 minutes in the second stage of labour
Where should information be recorded during labour?
Partogram
-
Physiology: Male and Female42
-
Antenatal Care and Screening46
-
Physiology of the Reproductive System38
-
Embryology42
-
Physiology in Pregnancy48
-
History Taking24
-
Contraception60
-
Normal Labour31
-
Pharmacology49
-
Maternal and Perinatal Mortality35
-
Abnormal Labour and Postpartum Care69
-
Infertility66
-
Complications of Pregnancy108
-
STI: Infections of the Genital Tract34
-
Common Genital Symptom Syndromes30
-
Paediatric and Adolescent Gynaecology34
-
Common Pathologies of Pregnancy34
-
Pelvic Organ Prolapse54
-
Applied Anatomy32
-
Applied Embryology28
-
Ovarian Cancer34
-
Endometrial Cancer17
-
Secondary Amenorrhoea and Menopause37
-
Pelvic Anatomy12
-
Genetics39
-
Sexual Health Demonstrations52
-
Menstrual Disorders58
-
Breast: Normal Anatomy46
-
Breast: Radiology and Cytology52
-
Breast: Pathology65
-
Breast: Treatment of Disease42
-
Cervical Screening Symposium55
-
Female Urinary Incontinence59
-
Violence Against Women22
-
Vulval Cancer and Precancer26
