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Medicine Unit 7 > Birth and Lactation > Flashcards

Birth and Lactation Flashcards

1
Q

factors involved in the onset of labour

A

fetal factors
progesterone withdrawal theory
corticotrophin releasing hormone

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2
Q

progesterone withdrawal hormone

A

progesterone inhibits myometrium contraction
suggested. decline in progesterone sensitivity without an actual fall in concentration could be an important initiation of labour

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3
Q

corticotropin releasing hormone

A

in response to stress hypothalamus releases CRH
travels to the anterior pituitary
stimulates release of adrenocorticotropic hormone
ACTH travels to adrenal cortex
stimulate release of cortisol and other steroids that liberate energy stores to cope with the stress
CRH increases but binding porting decreases
CRH stimulates PG released and potentially action of oxytocin in stimulating myometrium contractions

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4
Q

definition of labour

A

the process by which the fetus, placenta & membranes are expelled through the birth canal.

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5
Q

definition of normal labour

A

spontaneous onset, gestation 37 weeks plus, vertex presentation & completed within ~ 18 hours with no complications.

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6
Q

2 phases of labour

A

latent
active

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7
Q

prior to 23 and 6

A

miscarriage
recent advances in neonatal care may allow for active resuscitation from 22 and 6

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8
Q

pre-term labour

A

24- 36 and 6

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9
Q

prolonged pregnancy

A

T7 and beyond

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10
Q

latent phase of labour

A

presence of uterine contractions
cervical dilatation
effacement up to 4cm

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11
Q

active phase of labour

A

regular contractions and progressive dilatation beyond 4cm

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12
Q

effacement

A

softening, thinning and shortening
measures in %
in response to pressure on the cervix by the presenting part

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13
Q

first stage of =labour

A

0-4cm coincides with latent phase
4- 10 cm coincides with the active phase
onset of regular rhythmic contractions until full dilatation

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14
Q

second stage of labour

A

from full dilatation of the cervix to the delivery of the baby

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15
Q

third stage of labour

A

defined from the delivery of the baby to the delivery of the placenta and membranes

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16
Q

NICE recommendation of duration of labour

A

once labour established that a rate of 2cm in 4 hours
0.5cm per hour

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17
Q

what is cervical effacement, dilation and expulsion of the foetus, placenta and membranes is dependent on what

A

4 P’s
power
passage
passenger
psych

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18
Q

what is power

A

uterine contractility and maternal effort

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19
Q

what is passage

A

maternal bony pelvis or soft tissue of the birth canal

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20
Q

what is passenger

A

presentation or position of the foetus

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21
Q

what is psych

A

confidence, encouragement and positive affirmation

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22
Q

explain power

A

involuntary uterine contractions
primary force of labour that dilate and efface uterine cervix
descending foetus puts pressure on vaginal wall and rectum, triggers urge to push
aiding contractions
wave begins in fungus

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23
Q

pathway of muscular contractions

A

begins in fundus
where there is the greatest number of myometrial cells
contraction spreads across the uterine muscle
believed to begin near the cornea, spreads out and down

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24
Q

fundal dominance

A

most intense contractions in the fungus
weakest in the lower uterine segment

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25
Q

uterine contractions

A

tightening and shortening of uterine muscles
allows the progressive dilatation of the cervix
upper segment thickens and shortens and foetus is propelled down the birth canal

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26
Q

polarity

A

upper and lower poles of the uterus act in harmony with contraction and retraction of the upper pole
dilatation of the lower pole to allow expulsion of the foetus

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27
Q

retraction

A

following each contraction the muscle fibres don’t completely relax as they retain some of the shortening of contraction

leads to progressive shortening snd thickening of upper uterine segment and dimihsing of uterine cavity to accommodate the descending foetus

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28
Q

synchronous nature of contractions

A

necessary for efficient dilatation and effacement of the cervix
women who are dehydrated frequently experience preterm labour
can be stopped by rehydrating

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29
Q

normal uterine contractions

A

like waves
composed of increment, acme and decrement

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30
Q

widest diameter of the pelvic inlet

A

in its transverse diameter

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31
Q

widest diameter of the pelvic outlet

A

AP diameter

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32
Q

coccyx in passage

A

slight mobility
increases the available space in the outlet

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33
Q

passage of baby

A

soft tissues of the cervix, vagina and perineum must stretch to allow passage of the foetus through the axis of the birth canal
progesterone and relaxin help facilitate the softening and increase the elasticity of the muscles and ligaments

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34
Q

key components of passenger

A

lie
presentation
presenting part
attitude
denominator
position

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35
Q

lie

A

relationship of the fatal long axis to that of the uterus, 99% longitudinal

positions are longitudinal, transverse, oblique

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36
Q

presentation

A

cephalic, breech, shoulder, compound

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37
Q

breech

A

complete
footling
frank

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38
Q

compound

A

e.g. a hand

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39
Q

presenting part

A

the part of the foetus that lies at the pelvic prim or in the lower pole of the uterus
cephalic, breech, face, brow, shoulder

40
Q

attitude

A

relationship of the fetal head and limbs to its body
fully flexed, deflexed, partially or completely extended

41
Q

denominator

A

The part of the presentation used when referring to the foetal position in relation to the pelvis. occiput, sacrum, mentum, acromion

42
Q

position

A

Relationship of the denominator to six key points on maternal pelvic brim. left and right anterior, lateral and posterior. Further two points are direct anterior and direct posterior.

Occurs when the widest presenting transverse diameter has passed the brim of the pelvis. Biparietal diameter at 9.5 centimetres in cephalic presentation

43
Q

what are the different positions of birth

A

Left occipital anterior, right occipital anterior - lateral (or transverse), posterior, direct occipatal anterior, direct occipital posterior

44
Q

fetal lie image to describe the position

A
45
Q

presenting part images

A
46
Q

fetal presentation images

A
47
Q

fetal attitude images

A
48
Q

cephalic

A

occiput

49
Q

face

A

momentum

50
Q

breech

A

sacrum

51
Q

shoulder

A

acromion

52
Q

brow

A

frontal eminence

53
Q

fetal denominator image

A
54
Q

fetal positions images

A
55
Q

what is the optimal fetal position for vaginal birth

A

DOA
it is the smallest diameter presents in the pelvis
SVD is possible with OP positions and mento anterior

56
Q

engagement

A

when the widest transverse diameter of the presenting part has passed through the pelvic inlet
measured in 1/5s
when > 2/5s palpable PA= not yet engaged

57
Q

what is the widest diameter

A

biparietal

58
Q

when does engagement of the fetal head occur

A

form 38 weeks gestation

59
Q

when is the fetal head said to be engaged

A

when the biparietal has passed the plane of the pelvic brim

60
Q

what can temporarily abolish contractions

A

emotional disturbances

61
Q

norepinephrine and epinephrine function

A

may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labour

62
Q

mechanisms of birth

A

The head enters the pelvic brim in the OT position
The neck is flexed
With uterine activity descent follows & engagement occurs
Internal rotation
Extension
External rotation & restitution

63
Q

internal rotation

A

Once the presenting part reaches the pelvic floor the fetal head rotates to OA position, less commonly the OP position

64
Q

what is restitution

A

Once the head is completely delivered it rotates back to the transverse position along with the shoulders

65
Q

how are baby’s shoulders delivered

A

by applying axial traction

66
Q

what is shoulder dystocia

A

difficulty delivering the shoulders
is an obstetric emergency

67
Q

potential complications in labour

A
68
Q

what is lactogenesis

A

Cellular changes by which mammary epithelial cell switches from a growing non secretory tissue to a secreting non-growing tissue (initiation of milk secretion)

69
Q

lactogenesis 1

A

breast development & colostrum production from from approx. 16 weeks gestation

Involves the differentiation of alveolar epithelial cells into lactocytes that secrete colostrum from around 3-4 months of pregnancy.

70
Q

lactogenesis 2

A

onset of increased milk secretion occurring between 32 and 96 hours after birth

This occurs in response to rise in prolactin and decrease in pregnancy hormones, and milk will ‘come in’ regardless of whether a woman wants to breastfeed or not.

71
Q

lactogenesis 3

A

maintenance of milk production from approximately 10 days postnatal
This is the long term maintenance and becomes less reliant on prolactin and more on Feedback Inhibitor of Lactation (FIL).

72
Q

external changes in lactating breast

A

they become bigger, areola and nipple may darken, Montgomery’s tubercles appear on the areola to secrete an antiseptic sebum to lubricate the area. The sebum also secretes a scent to entice the baby to begin to search in the area for his first feed. In fair skinned women, may notice ‘marbling’as the blood supply to the breast increases.
The breasts may be tender during the early stages of pregnancy due to the ductal growth. May produce colostrum from around 16 weeks gestation

73
Q

how do the ductal and alveolus develops

A

under the influence of oestrogen and progesterone and human placental lactose

74
Q

what is found in each alveolar sac

A

thousands of milk producing cells called lactocytes

75
Q

what surrounds the alveolus and ductal syste m

A

series of muscle cells called myoepithelial cells
help squeeze milk down ducts to the openings in the nipple

76
Q

hormonal responses after birth

A

Oestrogen and progesterone levels drop
Prolactin and oxytocin levels rise in response to touch, smell and sight of baby

77
Q

prolactin

A

hormone responsbile for milk production
Responsive to touch & simulation
Levels higher at night
Frequent contact/feeds sets up long term production

78
Q

oxytocin

A

Milk delivery
Acts on muscle cells in pulsatile action
Levels higher when the baby is near
Stress can temporarily delay ‘let down’ reflex

79
Q

describe the image

A

prolactin receptor theory
on the cell wall of each lactocyte are prolactin receptors
prolactin levels in the blood stream rise n response to touch and suckling by the baby
more circulating prolactin due to more frequent contact and suckling
greater number of lactocytes that are activated

80
Q

rhythm of prolactin levels

A

circadian
levels during the nigher are higher than during the day

81
Q

feedback inhibitor of lactation

A

circulating prolactin in bloodstream controls milk production especially in early weeks post birth
volumes can be irregular at first so mothers may experience full breasts ad leaking as supply and demand establishes
FIL synthesis by signalling to the cells to stop production
down regulation is also caused by pressure within the full breast flattening and expanding the cells and the receptor sites, difficult for prolactin to attach and enter cells

82
Q

oxytocin (not related to pregnancy)

A

works on feelings and emotions
lowers blood pressure and improves sleep
reduces stress levels by taking on cortisol
reduces pain sensitivity
boosts our immune system

83
Q

special features of colostrum

A

packed with protective factors
concentrated nutrition
strong anti-inflammatory factors
stimulates gut growth
small volumes, intentionally
laxative effect, to clear meconium

84
Q

colostrum laxative effect

A

helps to minimise jaundice by assisting the passage of meconium
containing bilirubin

85
Q

relevance of anti-inflammatory factors in colostrum

A

help to reduce the risk of necrotising enterocolitis
especially in pre term babies

86
Q

breast milk composition

A

less salt
higher energy component
less protein
more lactose
more digestible

87
Q

signs of successful attachment and breast feeding

A

swallowing is audible and visible
sustained rhythmic suck
mouth wide open
arms and hands are relaxed
mouth is moist
nappies are soaked
minimal discomfort
mu feels sleepy and relaxed

88
Q

further signs of successful breast feeding

A

mouth wide open
less areolar Isabel underneath chin than above the nipple
chin touching the breast
lower lip rolled down
nose free

89
Q

benefits of breastfeeding

A
90
Q

disadvantages of breastfeeding

A
91
Q

engorged breasts

A

painful
feel heavy warm and sensitive

92
Q

mastitis

A

inflammation of the breast tissue that sometimes becomes infected
if left untreated can lead to the development of a breast abscess

93
Q

pain in breastfeeding

A

Blocked ducts, referred pain from nipple trauma, menstrual like cramps in the early days as the uterus involutes

94
Q

suppression of lactation

A

There are some situations where suppression of breast milk is important,for emotional and physical reasons. for example following a stillbirth. Medication such as cabergoline can be used in such instances

95
Q

websites you should refer to when prescribing during breastfeeding

A

LACTMED
BUMPS

Medicine Unit 7 (26 decks)

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