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2.3.2. Reproductive System > Labour and Delivery > Flashcards

Labour and Delivery Flashcards

1
Q

Define parturition

A

Transition from being preg to non-preg state

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2
Q

Define labour

A

Physiological process by which fetus is expelled from uterus to outside world

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3
Q

Define delivery

A

Method of expulsion of fetus, transforming fetus to neonate

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4
Q

What are the stages of labour?

A

First stage = creation of birth canal

Second stage = descent, rotation, delivery

Third stage = placental delivery

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5
Q

Outline the first stage of labour

A

Contractions begin

Descent of fetal head into birth canal

Creation of birth canal

1) latent phase = slow cervical softening, shortening, opening
2) active phase = faster rate of change, regular contractions

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6
Q

Outline the second stage of labour

A

Fetal head descent and rotation through the dilated cervix, birth canal and delivery

1) passive phase = descent and rotation
2) active phase = maternal effort to expel the fetus and achieve birth

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7
Q

Outline the third stage of labour

A

Delivery of placenta

Usually 5-15 mins

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8
Q

How does labour get initiated?

A

Rise in oestrogen:progesterone ratio

Prostaglandins = initiate softening of cervix, maintain/initiate uterine contractions

Oxytocin = uterine contractions

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9
Q

Outline the functions of prostaglandins

A

Induce cervical ripening

Induce cervical contractions

Increase myometrial sensitivity to oxytocin

Raise intracellular Ca = myometrial cell contract

Enhance myometrial gap junctions = strengthen contractions

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10
Q

What is cervical ripening?

A

The changes in the cervix when labour is being initiated

1) reduction in collagen
2) increases in GAGs
3) increase in hyaluronic acid
4) reduced aggregation of collagen fibres

Due to oestrogen, relaxin and prostaglandins breaking down the connective tissue

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11
Q

Where are prostaglandins produced?

A

Mainly in myometrium and decidua

Increased synthesis by amnion in third trimester

Released from cervical stretching

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12
Q

How does progesterone effect contractions?

A

Inhibits

Relative fall in progesterone = facilitates myometral excitability

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13
Q

Where is oxytocin secreted from and how is it controlled?

A

Secreted by posterior pituitary

Controlled by hypothalamus = +ve feedback from cervix and vagina (Ferguson reflex)

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14
Q

What is the role of oxytocin?

A

Initiates uterine contractions

Increases prod of prostaglandins which increase the contractions further

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15
Q

What increases the number of oxytocin receptors?

A

Oestrogen

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16
Q

Define cervical effacement

A

Thinning of the cervix = cervical ripening

17
Q

What is the normal diameter of the birth canal?

A

9.5cm

Max size determined by the pelvis but softening of ligs may increase it

18
Q

Outline how the pelvic floor, vagina and perineum change during labour

A

stretching of the fibres of the levator ani and the thinning of the central portion of the perineum transforms to almost transparent membranous structure

19
Q

Describe the contraction of myometrium during labour

A

Contracts but only partially relaxes = doesn’t return to original size

Contraction from 2 poles – then fundus – then lower segment

Forces in upper segment more powerful than lower segment

20
Q

How can the fetus lie?

A

Longitudinal

Transverse

21
Q

Outline the positions of altitude the fetus can be in

A

Flexion = head, arms, leg flexed tightly against trunk

Extension = head, arms, legs extended

22
Q

Outline the different presentations of a fetus

A

Frank breech = bottom first, legs extended

Full breech – bottom first, legs flexed

Single footling breech = bottom and one leg first

23
Q

How is labour induced?

A

Stimulate release of prostaglandins – membrane rupture

Artificial prostaglandins

Synthetic oxytocin

Anti-progesterone agents

24
Q

How can the physiology be monitored during labour?

A

Heart rate

Maternal temp

Doppler

Colour and amount of amniotic fluid

Scalp capillary pH

25
Q

Outline the mechanism of labour

A

Head flexes = present minimum diameter

Head rotates internally = hits levator ani which contracts and rotates it (head tucked under and facing backwards)

Head crowns = stretches perineal muscle and skin

Extension of head and external rotation

Shoulder rotate, shoulders delivery – followed rapidly by body

26
Q

How can delivery be facilitated?

A

Cesarean section

Forceps

Vacuum extraction

27
Q

Describe the separation and descent of the placenta

A

Baby born = reduced uterus size

Inelastic placenta squeezed by contraction

28
Q

How is bleeding controlled?

A

Powerful contractions of uterus = constrict blood vessels through myometrium

Pressure on placental site by wall of contracted uterus

Blood clotting

29
Q

Describe the control of milk let down

A

Suckling = activation of mechanoreceptors = up spinal cord to hypothalamus = 1) on signal to PP to prod oxytocin, 2) off signal to AP to stop prod dopamine, which allows prolactin to be secreted

Prolactin = milk fat synthesis

Oxytocin = stim myoepithelial cell = milk ejection

30
Q

Describe the mechanism which produces cessation of lactation

A

Mother stops breast feeding

Reflex that cause milk let down is lost = lactation ceases

31
Q

Describe the structure of a normal breast

A

Alveolus = milk secretion

Ductule = connecting alveolus to duct

Duct = feeds to lactiferous sinus – exits via nipple pore

Ampulla = sac

Areola = pigmented region around nipple

32
Q

Order the cardinal movement of labour

A 
engage
flexion of the neck
rotation
extension of the neck
restitution
delivery of anterior shoulder
delivery of posterior shouder
33
Q

What does the first stage of labour end with?

A

Ripening = pull dilation of the cervix

34
Q

What is the most common cause of post-partum haemorrhage?

A

uterine atony = uterus fails to contract after delivery

35
Q

What hormonal change is responsible for secretion of milk after delivery?

A

decreased progesterone and oestrogen

2.3.2. Reproductive System (20 decks)

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