Labour, and abnormal labour slides Flashcards
Are Braxton Hicks contractions painful?
No
After how many weeks of gestation will Braxton Hicks contractions occur?
After 30 weeks of gestation
Is progesterone pro-labor or pro-pregnancy?
How about oestrogen?
Progesterone is pro-pregnancy.
Oestrogen is pro-labor
What are the pro-pregnancy factors?
Progesterone, Relaxin, Nitric oxide and Catecholamines
What are the pro-labor factors?
Oestrogen, Prostaglandins, Prostaglandin dehydrogenase, Oxytocin, Inflammatory mediators
How does the placenta and fetus contribute to the initiation of labour?
The placenta changes the ratio between progesterone (decreases) and oestrogen (increases).
Intrauterine maturation of fetus leads to increased ACTH and cortisol, while fetal membranes increase prostaglandin.
What is the effect of oxytocin?
Oxytocin promotes uterine contractility
What is the effect of oestrogen?
Oestrogen increases oxytocin receptor expression
What is the effect of increased prostaglandin?
Prostaglandin causes cervical ripening and stimulates uterine contractility directly and indirectly by upregulating oxytocin receptors.
What causes the cervix to soften?
The cervix softens due to increased water content and collagen lysis.
In the active phase of the first stage of labour, what is the ideal minimum rate of cervical dilatation?
1cm/hour
What should be done if the perineum appears to be tearing excessively?
Episiotomy
What signs are assessed in the APGAR score?
Appearance, Pulse, Grimace, Activity, Respiration
How Ready Is This Child?
Heart rate, Respiratory effort, reflex irritability, Muscle tone, colour
How is the respiratory effort in the APGAR score assess?
By the cry of the new-born
What are the signs of placental separation?
Trickle of fresh blood
Cord lengthens
Uterus feels more firm and globular
How much blood loss usually occurs in the third stage of labor?
Usually <500mL due to placental separation
Define postpartum haemorrhage
Postpartum haemorrhage is the loss of 500-1000mL of blood within the first 24 hours following childbirth.
What are the three interventions in the active management of 3rd stage labor (AMTSL)?
In the active management of 3rd stage labor:
- Routine drug given to contract the uterus - uterotonic drug - syntocinon. Syntocinon is given just before, with or just after the birth of the new-born.
- Early cord clamping and cutting
- Controlled cord traction
How does flexion help in the delivery of foetus?
Flexion decreases the diameter of presentation (suboccipito-bregmatic diameter = 9.5cm) of the foetus in the longitudinal presentation.
Why does flexion occur during delivery?
Flexion occurs due to resistance from the cervix, the walls of the pelvis and the pelvic floor.
At which level does internal rotation occur?
Internal rotation occurs at the level of the ischial spines
According to the CTG, what will suggest fetal compromise?
Persistent tachycardia, Prolonged bradycardia, Persistent atypical deceleration Prolonged reduced variability Combination of the above
Define Preterm labour
Preterm labor is regular painful uterine contractions leading to cervical effacement and dilatation before 37 weeks of gestation.
What are the spontaneous causes of preterm labour?
Cervical incompetence Multiple pregnancies Polyhydramnios Chorioamnitis Antepartum haemorrhage Congenital uterine anomaly Severe maternal illness or infection
What will lead to elective preterm deliveries?
Maternal condition: Severe pre-eclampsia
Fetal condition: restricted growth
What is the management of cervical incompetence?
Cerclage, which is the suturing of cervix closed to reinforce a weakened cervix, done between 14 and 16 weeks of gestation
When will Cerclage not be eligible in the woman?
If there is irritation of the cervix, if the cervix is dilated >4cm, and if membranes have ruptured
What are the other treatment options of preterm labour?
Tocolytic agents: Magnesium sulphate, indomethacin, and nifedipine.
Steroids if less than 34 weeks gestation to help with fetal lung development.
When is syntocinon given?
Syntocinon is only given after delivery of the shoulder, so as to eliminate the risk of shoulder dystocia.
What is the ideal position of the fetal head?
Occipito-anterior
Is the anterior or posterior fontanelle diamond in shape?
Anterior fontanelle is diamond in shape.
What is the condition of the cervix when the foetal head is engaged at +1/+2 station?
Cervix is fully dilated at +1/+2 station
What is the rate of dilatation of the cervix in the active phase of stage 1 labour?
1cm/hour of cervical dilatation
Vaginal examination (VE) is carried out at what interval?Estimate what is the minimum dilatation of cervix expected at each interval of VE?
Vaginal examination is carried out 4 hourly and the minimum dilatation of cervix expected after 4 hours is 2cm (since ideal rate of dilatation is 0.5-1cm/hour).
Who are considered women of high dependency?
High dependency women are those who are diabetic, have pre-eclampsia, have intrapartum fever (>38 degrees celsius), previous history of stillbirth, uses drugs to augment labour such as syntocinon
What is the hands-on technique for?
Hands-on technique is used to keep the foetal head flexed during its descend down the pelvis.
