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29 Cards in this Set
- Front
- Back
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Define labour |
A physiological process characterized by onset of palpable uterine contraction of increasing frequency and duration leading to progressive effacement and dilatation of the cervical os and descent of the fetal presenting part and eventual expulsion of the fetus and placenta through the vagina |
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Phases of uterine activity during pregnancy |
Quiescence Activation Stimulation Involution |
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What are the factors involved in labour |
The 3 Ps Power Passage Passenger |
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Normal uterine contraction |
Duration: 30-60 seconds every 2-5 minutes. 3-5 contractions in 10 minutes is adequate Pressure of >200-250 MVU (picked with intrauterine catheter) is adequate |
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Interventions when power is absent or suboptimal |
1. Induction 2. Augumentation •oxytocin •artificial rupture of membranes |
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Factors affecting passenger |
•size (macrosomia) •lie •presentation - 5% not vertex •attitude •position •station: engagement (widest diameter passes inlet) |
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Mechanism of labour |
This comprises the movements and changes in attitude of the fetus as it passes through the maternal pelvis. Aim is to present the smallest skull diameter at the different levels of the maternal pelvis. •Engagement •Descent •Flexion •Internal rotation •Extension •Restitution •External rotation |
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Stages of labour |
1. First stage •Latent phase of labour -1 in 10 contraction -Cervical dilatation 0-3cm •Active phase of labour -1 in 10 contraction -Cervical dilatation of 4-10cm 2. Second stage: from full cervical dilatation to delivery of the fetus 3. Third stage of labour: delivery of the placenta |
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Diagnosis of labour |
Clinical Presence of uterine contractions and cervical dilatation |
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Questions asked in history taking to diagnose labour |
•Onset of contractions •Passage of show •Drainage of liquor •Perception of fetal movement Review the antenatal notes for any special instructions |
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Examination |
1. General 2. Obstetric •confirm lie & presentation •engagement •confirm contraction (frequency & duration) •fetal heart tones 3. Vaginal examination •effacement •dilatation •position •caput/moulding •station |
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How frequently do you do vaginal examination in the latent phase of the first stage of labour |
Every 4 hours if contraction is improving otherwise after 8 hours |
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Prolonged latent phase |
Latent phase labour more than 8 hours |
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False labour |
Latent phase labour more than 24 hours |
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When do you commence pantographic monitoring |
Active phase of first stage of labour |
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What is a partograph |
A graphic representation of all events during labour |
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Who formulated the labour curve |
Friedman in 1954 |
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Which people constructed a labour normogram from their study |
Philport & Castle in 1972 |
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Minimum rate of cervical dilatation in active phase |
1cm/hr |
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When does active phase labour start |
Cervical dilatation of 4cm |
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The lag time between slowing of labour and need of intervention in the partograph is |
4 hours |
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Partograph is recommended for use only in tertiary health care T/F |
False Recommended for use in all maternity facilities |
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Components of the partograph |
1. General: biodata - name, gravidity, parity, date & time of admission, hospital number, how many hours since rupture of membranes 2. The fetal condition: FHR, liquor, moulding 3. The progress of labour: dilatation, descent, caput, moulding 4. The maternal condition: BP, PR, urine, contraction, oxytocin & drugs given if any |
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Relation of the action line to the alert line on the WHO partograph |
Drawn parallel to the alert line, 4 hours to its right |
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Components of active management of third stage of labour |
1. Use of oxytocics at the delivery of the baby - oxytocin, ergometrine 2. Early clamping of the cord 3. Delivery of the placenta by controlled cord traction (Brantz-Andrew method) 4. Uterine massage |
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For passive management of third stage of labour, what are the signs of placenta separation |
•lengthening of the cord •gush of blood •increase in fundal height |
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Components of basic emergency obstetric care |
•parenteral antibiotics •parenteral anticonvulsants •parenteral oxytocics •assisted vaginal delivery •manual removal of the placenta •removal of retained products of conception |
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Components of comprehensive emergency obstetric care |
•all the components of the basic emergency obstetric care plus •blood transfusion •caesarean section |
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What is the recommendation for emergency obstetric care |
That for every 500,000 people there should be at least 4 facilities offering Basic EmOC and 1 facility offering Comprehensive EmOC |
