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Reproduction & Sexual Health > Labour > Flashcards

Labour Flashcards

1
Q

Define labour

A

Physiological process during which the foetus membranes, umbilical cord and placenta are expelled from the uterus

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2
Q

What is a sign pregnancy is about to begin?

A

‘Show’ - clear mucus like discharge

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3
Q

What helps to maintain the mucus plug during pregnancy?

A

Progesterone

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4
Q

Name four substances involved in imitation of labour

A
  • progesterone
  • oestrogen
  • oxytocin
  • prostaglandins
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5
Q

What is the function of progesterone in pregnancy?

A

Keeps the uterus settled and prevents gap junctions forming

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6
Q

What is the function of oestrogen in pregnancy?

A

Makes the uterus contract and promotes prostaglandin production

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7
Q

Describe the effect of oestrogen on oxytocin

A

Under the influence of oestrogen number of receptors increases causing the uterus to respond to the pulsatile release from the pituitary

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8
Q

What is the Ferguson Reflex?

A

Increase in oxytocin due to afferent impulses from the vagina/cervix stretch from the baby’s head causes a positive feedback loop

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9
Q

Describe cervical ripening

A

Softening of the cervix before labour to help dilate

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10
Q

What substances break down cervical connective tissue?

A

Oestrogen, relaxin and prostaglandins

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11
Q

What changes happen in cervical ripening?

A
  • reduced collagen
  • increased glycosaminoglycans
  • increased hyaluronic acid
  • reduced aggregation of collagen fibres
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12
Q

What is Bishops score used for?

A

Predicts how likely a patient is to respond to initiation of labour

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13
Q

Describe bishops score

A

Dilatation 0,1-2,3-4,5+
Effacement 0-30%, 40-50%, 60-70%, 80-100%
Station -3,-2,-1 or +1/+2
Cervical consistency - firm, med or soft
Cervix position - posterior, mid or anterior

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14
Q

Name the two parts of stage 1

A

Latent Phase

Active Phase

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15
Q

Describe the stage 1 latent phase

A

Slow cervical dilatation over several hours which lasts until 4cm dilated.

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16
Q

How does the amniotic sac rupture?

A

Due to regular painful contractions increasing the pressure

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17
Q

Describe stage 1 active phase

A

4cm - full dilatation, typically 1cm/hour nulliparous and 2cm/hour multiparous
Contractions become more rhythmic and stronger

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18
Q

Name the two parts of stage 2

A

Passive - no urge to push

Active - head reaches pelvic floor and involuntary desire to push

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19
Q

What happens in stage 2?

A

Uterine contractions become expulsive and foetus is pushed through the birth canal

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20
Q

How long should stage 2 take?

A

Nulliparous - <3 hours

Multiparous - <2 hours

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21
Q

What three factors are considered during labour?

A

Power
Passage
Passenger

22
Q

Name two types of contractions

A

Braxton Hicks Contractions

True contractions

23
Q

What are Braxton Hicks Contractions?

A

Tightening of uterine muscles, irregular, mild contractions resolve with change in activity, relatively painless

24
Q

Describe true contractions

A

Under the influence of oxytocin contractions are evenly spaced with less and less time between them and get more intense over time

25
Q

How does pressure in the uterus increase with contractions?

A

The myometrial fibres do not relax fully following each contraction

26
Q

How do prostaglandins and oxytocin alter contractions?

A

Prostaglandins - more calcium is released for AP increasing force
Oxytocin - lowers threshold for AP, increasing frequency

27
Q

Where is the density of muscle highest in the uterus?

A

Fundus

28
Q

Where is the pacemaker in the uterus?

A

Tubal ostia

29
Q

How often do contractions occur?

A

3-4 in 10 minutes range from 10-45 seconds

30
Q

Name three types of pelvis

A

Gynaecoid - most suitable
Anthropoid - oval inlet and anteroposterior diameter largest
Android - triangle/heart shaped (afro-caribbean)

31
Q

Where in the inlet/outlet is the widest diameter?

A

Inlet - widest transverse

Outlet - widest antero-posteriorly

32
Q

What analgesia can be given during labour?

A 
Paracetamol 
TENS 
Entonox 
IM opiates e.g. Diamorphine 
Epidural 
IV patient controlled Remifentanyl 
Spinal anaesthesia
33
Q

What are the cardinal movements?

A

Changes in position of baby’s head in the pelvis

34
Q

Name the seven cardinal movements

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation
  7. Expulsion
35
Q

At what level does extension occur?

A

Interoitus - brings the base of the occiput in contact with the symphysis pubis due to force from the uterus and pelvic floor

36
Q

What is crowning?

A

Appearance of foetal head at introitus, labia is stretched to full capacity and the largest diameter encircled by the vulval ring causing burning/stinging

37
Q

Why should cord clamping be delayed?

A

To allow higher infant haematocrit, Hb, blood volume and BP leading to overall better outcomes

38
Q

What is stage 3 of labour?

A

Expulsion of placenta and membranes takes around 10 minutes on average

39
Q

How long should you wait in stage 3 until surgical management?

A

1 hour

40
Q

What are the signs stage 3 is occurring?

A
  • uterus contracts/hardens and rises
  • umbilical cord lengthens permanently
  • frequently a gush of blood
  • placenta and membranes appear at introitus
41
Q

What is involved in active stage 3?

A

Syntometrine
Cord clamping
Bladder emptying
Cord Traction

42
Q

Why is active stage 3 offered to all women?

A

50% lower risk of post partum haemorrhage

43
Q

What is syntometrine?

A

Combination of ergometrine and oxytocin

44
Q

How is the placenta separated?

A

Shearing force on the spongy layer of decide basalis. The inelastic placenta reduces SA on placental bed due to sustained contractions

45
Q

Name two technniques of placenta separation

A
  • Matthew Duncan

- Schultz

46
Q

What volume of blood loss is normal in pregnancy?

A

<500ml

47
Q

How is haemostasis maintained in labour?

A
  • tonic contraction (muscle strangulates vessels)
  • thrombosis of torn vessel ends (hypercoaguable state)
  • myo-tamponade opposition
48
Q

What is the puerperium?

A

Period of recovery and repair - return of tissues to non-pregnant state. Around 6 weeks

49
Q

Name the discharge that can be experienced in the puerperium

A

Lochia - blood, mucus and endometrial castings
Rubra - fresh red for 3-4 days
Serosa - brown watery 4-14 days
Alba - yellow 10-20 days

50
Q

What uterine changes occur in puerperium?

A

Involution, reduction in weight and height, endometrium regenerates by the end of a week

51
Q

How long does physiological diuresis last?

A

2-3 days

Reproduction & Sexual Health (36 decks)

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