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human development > labour and delivery > Flashcards

labour and delivery Flashcards

1
Q

what is labour?

A

Presence of regular painful uterine contractions becoming progressively stronger and more frequent, accompanied by effacement (cervix undergoes changes – thin, and has contact with the baby) and progressive dilatation of the cervix and descent of the presenting part

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2
Q

how does labour start?

A

starst with bloody mucoid show

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3
Q

what is the function of the mucus plug?

A

seals the uterus to prevent infection getting to the fetus

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4
Q

why does the amniotic sac rupture?

A

bc the head of the fetus is against the cervix –> as uterus contracts, amniotic fluid is expelled

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5
Q

how should the amniotic fluid look?

A

should be clear - may contain bits such as dead cells, fetal urine etc.

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6
Q

how does labour end?

A

Ends with baby coming out along with other products of conception

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7
Q

what are Braxton Hicks contractions?

A

uncoordinated contractions of the uterus around 6-4 weeks before end of gestation

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8
Q

what causes Braxton Hicks contractions?

A

progressive hormonal changes - oxytocin from mum and baby, oestrogen, relaxin and prostaglandin

progressive mechanical changes

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9
Q

what does relaxin do?

A

made by the placenta to relax connective tissue of the cervix and causes softening of the pubic symphysis to allow it to move further apart

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10
Q

what do prostaglandins do?

A

causes contraction of the uterus

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11
Q

what does progesterone do?

A

inhibits uterine contractility during pregnancy –> prevents expulsion of fetus prematurely

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12
Q

what does oestrogen do?

A

increases the degree of uterine contractility –> increases number of gap junctions between adjacent smooth muscle

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13
Q

how do levels and ratio of oestrogen and progesterone change over the course of pregnancy?

A

secreted in progressively greater quantities throughout pregnancy

Increased ratio of oestrogen to progesterone at 7 months - Oestrogen continues to increase while progesterone stays the same or declines

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14
Q

what is the Ferguson reflex?

A

positive feedback mechanism involving oxytocin

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15
Q

explain how the ferguson reflex happens

A
  • baby’s head stretches cervix –> feedback on mother’s pituitary
  • mother secretes oxytocin
  • baby makes own oxytocin
  • oxytocin travels to uterine muscle and stimulates contractions –> pushes baby down and stretches cervix
  • also stimulates placenta to make prostaglandings
  • oestrogen induces more oxytocin receptors
  • cycle is repeated until the baby is born
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16
Q

how are abdominal muscles involved in labour and how are they activated?

A

• Abdominal muscles are activated by neurogenic reflexes to contract and their contraction aids the expulsion of the baby

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17
Q

what effect does baby’s oxytocin have on the mother?

A

gets across placenta and directly stimulates smooth muscle in the myometrium to contract. Upregulates the oxytocin receptor

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18
Q

how many stages of labour are there?

A

4

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19
Q

how many stages in the first stage of labour and what are they?

A

latent phase
active phase
transition phase

20
Q

how far is the cervix dilated in the latent phase?

A

0-4cm

21
Q

what happens during the latent phase of labour?

A
  • Duration not easily determined bc there isn’t much to show for it
  • Often long, especially in women having their first baby
  • Contractions last 30-60 second and are 5-20 mins apart
22
Q

how far is the cervix dilated in the active phase?

A

4-10cm

23
Q

what happens in the active phase of labour?

A
  • Cervix dilates at the rate of about 0.5 – 1 cm/hour
  • May be faster in multiparous women or slower in first
  • Average duration of this phase – 12 hrs
  • Contractions last 45-60 seconds and are 2-5 mins apart
24
Q

describe the transition phase contractions?

A

Transition contractions last 60-90 seconds and are 2-3 mins apart

25
Q

when does the second stage start?

A

at full dilation of the cervix - 10cm

26
Q

what is the second stage of labour?

A

pushing

27
Q

describe the contractions in the second phase of labour

A

o Contractions last 45-90 secs and 3-5 mins apart

28
Q

what happens in the 3rd stage of labour?

A
  • After baby is delivered, placenta and amniotic membrane need to be delivered
  • Usually within 30 mins
29
Q

what happens in the 4th stage of labour?

A

• Last from delivery of placenta until postpartum condition of woman stabilises (up to a week afterwards)
o 1-2 hours after delivery
• Uterus will continue to contract which help the uterus to return back to normal size over the next few days.

30
Q

at what rate does the cervix decrease in size during the 4th stage of labour?

A

descends 1 cm each day for about 10 days

31
Q

what is the widest and narrowest part of the pelvis?

A

Pelvic inlet is the widest bit, ischial spines are narrow

32
Q

what does left occiput anterior mean?

A

Means that baby’s head is slightly off centre in the pelvis with back of the head toward the mother’s thigh. Baby is face down when it comes out

33
Q

what does left occiput transverse mean?

A

When back of baby’s head points directly at the mother’s thigh

34
Q

why is left occiput transverse more painful?

A

bc the head doesnt fit into the bony pelvis as well

35
Q

what do fetal stations measure?

A

Ischial spines can be palpated through the skin. Head can be felt and measured in relation to the ischial spines

36
Q

what is the baseline of the fetal stations?

A

ischial spines - 0

37
Q

when is the fetal station negative?

A

• If the presenting part is higher than the ischial spine the station has a negative number

38
Q

when is the fetal station positive?

A

• Positive means that the presenting part has passed the ischial spine

39
Q

at what fetal station is the outlet?

A

+4cm

40
Q

what is cervical ripening?

A

increased softening, distensibility, (effacement and dilatation of the cervix)

41
Q

how does cervical ripening occur and why?

A

• Due to changes in the biomechanical properties of cervical tissue
o Rearrangement and realignment of collagen and an increase in the ground substance when compared early pregnant cervix.
o Allows for a thinner cervix which is more able to dilate

42
Q

what is cervical ripening under the control of?

A 
o	Prostaglandins – produced in uterus
o	Oestrogens 
o	Progesterone and antiprogesterones
o	Relaxin – produced by the placenta. Causes softening and thinning of the cervix
o	Inflammatory mediators
o	Nitric oxide
o	Apoptosis
43
Q

what is the bishops score?

A

• A method of measuring whether a pregnancy and labour is progressing at a normal rate or if there’s a need to induce

44
Q

what does the bishops score take into consideration?

A

Cervix dilation, cervical length, consistency, position and head station

45
Q

what does a bishop score of less than 5 suggest?

A

score of 5 or less suggests labour is unlikely to start without induction

46
Q

what does a bishop score of 9 or more suggest?

A

indicates that labour will most likely commence spontaneously

47
Q

what happens during birth?

A
  • engage: baby’s head is engaged
  • flex and descent - positive feedback
  • full dilation of cervix
  • internal rotation of head then extension
  • external rotation so the shoulders can come out
  • expulsion
  • cord is tied off
  • placenta needs to be removed

human development (20 decks)

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