Definition- Products of conception expelled by the mother
- Progressive dilatation and effacement of the cervix
- Painful, regular contractions
Stages of labour- Stages
- First = Onset of true uterine contractions to full dilatation of cervix
- Second = Full dilatation and rupture of membrane to delivery of foetus
- Third = Complete expulsion of foetus to complete expulsion of placenta and membranes
- Latent/active
- Latent = <4 cm dilated, irregular contractions
- Active = >4 cm dilated, rapid further dilatation, fast/continuous contractions
Assessment of cervix - Dilatation
- Effacement
- Consistency
- Position of foetus
- Presenting part
Post-partum haemorrhage - Primary (<24 hrs)
- Atonic uterus
- Retained placental part
- Tears
- Secondary (>24 hrs - 6 weeks)
- RPOC
- Infection
- Endometritis
Bishop score
- Interpretation
- > 8 => Likely to achieve a successful vaginal birth
- < 7 => Cervical ripening method (prostaglandins)
Indications for induction - Post-term
- Pre-eclampsia
- Obstructive cholestasis (risk of stillbirth)
- Diabetes (big baby)
Head position
- OA = Best
- ROA/LOA = Fine, but a bit slower as it has to rotate
- Transverse get stuck
- OP get stuck (face presentation)
CTG interpretation
Fetal blood sampling - pH < 7.2 => Urgent delivery
- pH 7.2 - 7.25 => Repeat in 30 mins
- pH 7.25 - 7.3 => Repeat in 60 mins
Notes - Braxton-Hicks contractions: Irregular, occur throughout pregnancy, start at first trimester
- Power, Passage, Passenger
- Uterine muscle doesn't ever relax - just progressively contracts
- Oxytoxin to encourage the placenta out (if >30 mins)
- ERCP = Evacuation of retained products of conception
- Station is measured relative to ischial spines (zero = head at spines)
- STAN = ST analysis/T:QRS ratio = Measure of chronic oxygen deprivation
|
|
