10. Labour & Post partum Flashcards

1
Q

when is parturition considered labour? what’s it called before this?

A

after 24 weeks gestation
spontaneous abortion (miscarriage)

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2
Q

define premature

A

labour before 37 weeks gestation

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3
Q

what must the cervix and vagina do in the first stage of labour?

A

enlarge and realign

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4
Q

‘lie’ of fetus

A

relationship of long axis of fetus to long axis of uterus

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5
Q

‘presentation’ of fetus

A

part of fetus adjacent to pelvic inlet

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6
Q

3 things that happen to create the birth canal

A
  1. soften pelvic ligaments
  2. increase myometrial activity
  3. cervical dilatation by ripening, and effacement by uterine smooth muscle contractions thinking cervix, then dilate it
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7
Q

why does myometrium thicken during pregnancy ?

A

increased cell size and glycogen deposition

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8
Q

Braxton hicks contractions

A

increased aptitude but decreased frequency as pregnancy continues, no effect on fetus

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9
Q

action of prostaglandins

A

increase calcium realise from intracellular stores

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10
Q

action of oxytocin

A

lowers threshold for action potentials

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11
Q

brachystasis

A

uterine smooth muscle contractions shorten muscle fibres but don’t relax fully, uterus shortens

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12
Q

Ferguson reflex

A

oxytocin stimulates uterine contractions, these stimulate oxytocin release from posterior pituitary to have more contractions in uterus

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13
Q

when does the first stage of labour end

A

cervix dilated 19cm

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14
Q

what helps prevent bleeding after giving birth?

A

uterus contracts so compresses blood vessels and reduces bleeding
can be helped by oxytocic drug

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15
Q

complications of shoulder dystocia

A

-erbs palsy
-PPH
-tears
-neurological dysfunction

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16
Q

what would be worrying on a CTG?

A

lack of HR accelrations
decelerations

17
Q

indications for assisted delivery

A

-failure to progress
-maternal exhaustion
-fetal compromise

18
Q

indications for c section

A

-macrosomia
-faiure to progress
-previous c section
-malpresentation

19
Q

physiological changes to anatomy post-partum

A

-reduction in size of vulva, vagina, cervix
-poor lubrication of vagina
-tranformation zone of cervix withdraws into endocervix

20
Q

lochia rubra

A

initial heavy flow, dark red

21
Q

lochia alba

A

after 10-14 days, whitish

22
Q

are clots normal postpartum?

A

no except for one on day 3-4

23
Q

initial ‘breast milk’

A

colostrum- high fat and immunoglobulins (IgA)

24
Q

volume of milk per day when fully established

A

800ml

25
Q

important components of breast milk

A

-lactoferrin: binds iron to prevent e coli
-lymphocytes, plasma cells: cell mediated immunity
-immunoglobulins

26
Q

primary PPH

A

> 500 ml blood loss in less than 24 hours

27
Q

secondary PPH

A

> 500 ml blood loss 24 hours-3 weeks

28
Q

psychological conditons post-partum

A

-post natal blues: day 4-5 peak, reassure
-post partum depression: within 4 weeks of delivery
-puerperal psychosis: 30% of women with pre existing mental illness
-PTSD

29
Q

link contraception to childbirth/post partum

A

ideal opportunity to discuss range of methods, can save mother and baby’s lives if born more than 2 years apart