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WH > labour and birth > Flashcards

labour and birth Flashcards

1
Q

what is a normal labour ?

A

spontaneous labour that occurs between 37 and 42 weeks of gestation, with a single cephalic, term healthy, live fetus with no maternal or fetal complications

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2
Q

what is the duration of a normal labour in primigravida vs multigravida ?

A

primigravida: 12-18 hours
multigravida: 6-10 hours

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3
Q

what is a precipitate labour ?

A

an unusually rapid labour ( combined first and second stage of labour)

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4
Q

what are the physiological changes that happen prior to the onset of labour ?

A
  1. increased oxytocin and prostaglandins
  2. formation of gap junctions between myometrial cells
  3. formation of lower uterine segment
  4. increased myometrial tone with irregular contractions
  5. cervical softening ( effacement and dilatation)
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5
Q

what are the suggested theories about the inset of labour ?

A 
decrease in progesterone levels 
decrease in oxytocinase levels 
uterine distention 
increase in prostaglandin levels 
increase in fetal cortisone
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6
Q

how can we distinguish false labour pains ?

A

braxton hicks contractions are irregular , infrequent and there is no cervical dilatation associated with it

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7
Q

how can we distinguish true labour pains from false labour pains ?

A

true labour pains do not go away with analgesia or sleep
true labour pains are more frequent, more regular and more intense in strength and is associated with cervical dilatation

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8
Q

how many stages of labour are there ?

A

three main stages

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9
Q

what is the first stage of labour ?

A

full cervical dilatation

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10
Q

what are the different stages in the first stage of labour ?

A

latent phase

accelerated phase

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11
Q

how long does the first stage of labour last in primigravida and multi women ?

A

prima- 18 hrs

multi- 6-10 hrs

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12
Q

what is the difference between the latent phase and the accelerated phase in the first stage of labour ?

A

latent phase refers to the gradual dilatation of the cervix until 4 cms
the active phase refers to the accelerated dilatation of the cervix from 4cm to 10 cms

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13
Q

why is the duration of the first stage of labour shorter inn multi women ?

A

effacement and dilatation of the cervix happen simultaneously

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14
Q

what is the normal rate of dilatation of the cervix in multi women vs prima women ?

A
  1. 2 cm per hour in prima

1. 5 cm per hour in multi

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15
Q

what is the most common presentation of delivery in foetuses ?

A

cephalic presentation

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16
Q

what does vertex mean ?

A

when the baby lies in an attitude of flexion the part of the head presenting is called the vertex

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17
Q

what diameters are present in a cephalic vertex presentation ?

A

biparietal 9.5 cm

subocciptobregmatic 9.5 cm

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18
Q

what is the second stage of labour ?

A

expulsion of the fetus ( which is refers to the full dilatation of the cervix to the birth of the baby )

19
Q

how long does the second stage of labour last in prima and in multi ?

A

prima - 2 hours max
multi - 1 hour max
provided the woman has efficient uterine contractions

20
Q

what are efficient uterine contractions ?

A

3 contractions every 10 minutes each lasting one minute

21
Q

what is the difference between the passive and active stages of the second stage of labour ?

A
  1. the passive stage is from finding of the full dilatation of the cervix but before or in absence of involuntary contractions
  2. the active stage the baby is visible and expulsion contractions are present
22
Q

how is the patient instructed to strain/bear down ?

A

they are asked to strain with their uterine contractions and to relax in between

23
Q

what are the stages of fetal expulsion in order ?

A
  1. descend
  2. engagement
  3. increased flexion
  4. internal rotation of the head
  5. extension
  6. restitution
  7. external rotation of the head / internal rotation of the shoulders
24
Q

in what stage is delivery seen ?

A

in the extension part

25
Q

why does descend happen ?

A

due to uterine contractions and bearing down

26
Q

what is engagement ?

A

widest part of the baby’s head passes through the widest part of the pelvis

27
Q

during engagement if a PV examination was to be performed what would be the finding ?

A

the vertex would be felt on the level of the ischial spine

28
Q

why does increased flexion happen ?

A

due to meeting of the head at the levator ani

29
Q

why does extension of the head happen ?

A

the resultant force that happens due to the uterine contractions that happen downward and forward and the the contractions of the levator ani that happen up wards and forwards - resultant force is forward - extension

30
Q

by what mechanism does delivery happen ?

A

extension

31
Q

at what stage of labour should bearing down be avoided?

A

1st stage of labour

32
Q

what is the role of amniotomy in labour ?

A

induces labour by increasing prostaglandins

33
Q

what is the most preferred position of delivery for the mother ?

A

lithotomy postition

34
Q

what is the purpose of the Ritgen maneuver ?

A

to avoid perineal tears , support the head early

35
Q

when is an episiotomy indicated ?

A

performed when needed just before crowning of the head to avoid extensive perineal tears and facilitate head delivery

36
Q

what position does the fetus usually start to descend in n?

A

left occipito-anterior

37
Q

what is the third stage of labour ?

A

placental expulsion

38
Q

how long does the third stage of labour last ?

A

10-30 minutes

39
Q

why must placental delivery happen in a short period of time ?

A

to avoid the reforming of the cervix and retention of the placenta

40
Q

what are the signs of placental abruption/ 3rd stage of labour ?

A

gushing of blood
suprapubic buldge
elongation of the cord

41
Q

what are the two different mechanisms of placental delivery ?

A

Schultze mechanism - central

Duncan’s mechanism - peripheral

42
Q

which method of placental delivery is better ?

A

Schultze mechanism ( incidence of retainment is lower)

43
Q

what is the active method for the management of the third stage of labour ?

A

injection of methergine oxytocin

WH (68 decks)

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