Normal birth & the puerperium Flashcards

1
Q

What is a normal birth

A
  • Spontaneous
  • No drugs used for induction
  • Low- risk at the start of labour and remaining so throughout labour & delivery
  • The infant is born spontaneously in the vertex position between 37& 42 weeks of pregnancy
  • After birth mother & infant are in good condition
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2
Q

What are the characteristics of the early labour stage?

A
  • Irregular contractions
  • Bloody mucus show
  • Rupture of membranes
  • There is some cervical change, including cervical effacement & dilatation up to 4cms
  • A period of time, not necessary continuous, when there are painful contractions
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3
Q

What are the characteristics of the active first labour stage?

A
  • There are regular painful contractions and progressive cervical dilation from 4cm
  • Progress usually considered normal if cervix dilates at least 0.5cm/hour
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4
Q

How do we monitor labour?

A
Maternal:
-contractions
-dilatation
-vital signs
-drugs/fluids
-urine output
-PV loss: liquor, blood
-pain
-emotional state 
Fetal: 
-Fetal heart activity
-position
-descent
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5
Q

How is pain relief provided in labour

A
Non-pharmacological:
-breathing and relaxation
-massage
-water
Pharmacological:
-Entonox
-Opioids
Regional:
-epidural
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6
Q

What are the characteristics relating to transition into the 2nd stage of pregnancy

A
  • uncontrollable urge to push
  • holding breath/ grunting
  • sweating
  • mood changes ( sleepy/more focused)
  • external genitals or anus begin to bulge out during contractions
  • woman may feel the baby’s head begin to move into the vagina
  • A purple line between the mother’s buttocks as they spread apart from the pressure of the baby’s head
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7
Q

What are the characteristics of the 2nd stage of pregnancy?

A
  1. ) Passive 2nd stage:
    - Full dilataation of the cervix prior to or in the absence of involuntary expulsive contractions
    - The ‘rest and be thankful stage’
    - varies in length- usually around 1 hour
  2. ) Active 2nd stage: the baby is visible-expulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation
    - Diagnosis of delay should be made for nulliparous women when it has lasted 2 hours and for parous women when it has lasted 1 hour
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8
Q

What are the characteristics of the 3rd stage of pregnancy?

A
  • Comprises the phase of placental separation, its descent to the lower segment& its expulsion with the membrane
  • The cord and placenta system will contain about 1/3 of baby’s blood whilst the remaining 2/3 is in the baby
  • After a few mins the cord will stop pulsating. The mother will often feel an urge to push shortly after this
  • The contractions may be painful but the placenta usually slides out easily
  • The midwife will check it to ensure that it’s complete and none is left inside the mother
  • Breastfeeding can stimulate a contraction and help the placenta separate from the womb
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9
Q

Describe the different types of management of the 3rd stage of pregnancy

A
  1. ) ACTIVE MANAGEMENT:
    - speeds up the delivery of the placenta
    - Routine use of uterotonic drugs
    - Deferred clamping and cutting of the cord
    - Controlled cord traction after signs of separation of the placenta
  2. ) PHYSIOLOGICAL MANAGEMENT:
    - waiting for the placenta to come naturally, the mum pushes it out
    - can take between 10mins to an hour
    - No routine use of uterotonic drugs
    - No clamping of the cord until pulsation has stopped
    - delivery of the placenta by maternal effort
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10
Q

What is the puerperium?

A

-The time from the end of the 3rd stage through the first few weeks after delivery. This period is usually considered to be 6 weeks in duration

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11
Q

List some serious post partum complications and their signs/symptoms

A
Post partum haemorrhage:
-sudden and profuse blood loss
-faintness
-palpitations/tachycardia 
Pre eclampsia:
-Headaches accompanied by 1/more of the following symptoms within the 1st 72 hours after birth.. visual disturbances, nausea, vomiting
Thromboembolism:
-unilateral calf pain
-redness/swelling
Infection:
-fever
-shivering
-abdominal pain and/or offensive vaginal loss
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12
Q

What is involution of the uterus

A
  • Needs to be monitored during the puerperium

- Shrinkage& the body is sort of reabsorbing it all back

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13
Q

What is lochia

A
  • Needs to be monitored during the puerperium

- Vaginal discharge after giving birth

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