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Human Development > Labour and delivery > Flashcards

Labour and delivery Flashcards

1
Q

what is the definition of labour

A

Presence of regular painful uterine contractions becoming progressively stronger and more frequent, accompanied by effacement and progressive dilatation of the cervix and descent of the head through the cervix into the vagina and out

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2
Q

what does effacement mean

A

cervix undergoes changes – thins and has contact with the head of the baby, at 8 months it will turn round so its head is on top of the cervix

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3
Q

what does labour begin and end with

A

Usually begins with bloody mucoid “show”

Ends with expulsion of baby and other products of conception

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4
Q

what does the mucus plug do

A

acts as a stopper prevents things getting in that would harm the baby and prevent the baby from leaving

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5
Q

what is another word for labour

A

parturition

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6
Q

when do contractions start

A

from the 6th week of pregnancy contractions take but they are not noticed until 3rd trimester

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7
Q

when do Braxton hicks contractions take place

A

6-4 weeks before end of gestation uterus has uncoordinated contractions

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8
Q

what is a Braxton hick contraction

A
  • these are contractions that happen before 6-4 weeks before end of gestation uterus has uncoordinated contractions, they may or may not be aware of these contractions
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9
Q

what are the cause of increased labour contractions

A

Progressive hormonal changes

Progressive mechanical changes

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10
Q

what are the mechanical phases that take place that increase contraction

A
  • baby moves the head to be at the top of the cervix
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11
Q

what are the hormonal changes that take place that lead to increased labour contractions

A
  • foetal itself is producing some of hormones such as oxytocin, this feds back to the myometrium to increase oxytocin receptor which increases contraction, mothers oxytocin does the same thing

Oestrogen – pro smooth muscle contraction, increase in the amount of oestrogen and the amount of progesterone decreases

Relaxin is also produced by the placenta, it relaxes the ripening of the cervix and the softening of the cervix, also causes softening of the pubic symphysis to allow the joint to move further apart

Also local prostaglandin production – this causes relaxation and causes the contraction of the uterus

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12
Q

what does progesterone do

A
  • it inhibits uterine contractility during pregnancy this prevents expulsion of the foetus
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13
Q

what does oestrogen do

A
  • Oestrogens increase the degree of uterine contractililty

- Oestrogens increase number of gap junctions between adjacent smooth muscle

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14
Q

what happens in the 7th month of pregnancy

A
  • Both oestrogen and progesterone are secreted in progressively greater quantities throughout pregnancy
  • But from 7th month oestrogen continues to increase while progesterone stays the same or declines
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15
Q

describe what happens in the Ferguson reflex

A

Babies head stretches cervix and feedbacks on pituitary

Pituitary secretes oxytocin into blood and travels to uterine muscle

Oxytocin stimulates uterine contraction and pushes baby down, stretching the cervix further which feedbacks to the pituitary releasing more oxytocin

Cycle repeats until baby is
born

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

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16
Q

what are the stages of labour

A

Latent
baby expulsion
placental expulsion

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17
Q

what happens in the latent phase (first stage of the first stage of labour)

A
  • 0-4 cm cervix dilation
  • Duration not easily determined nothing to show other than cramps and possible backache,
  • Often long, especially in women having their first baby
  • Contractions last 30-60 second and are 5-20 mins apart
  • average duration is 12 hours
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18
Q

how long do the contractions last in the latent phase

A

Contractions last 30-60 second and are 5-20 mins apart

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19
Q

what happens in the active phase of labour ( second stage of the first stage of labour)

A
  • 4-10cm dilatation
  • Established labour
  • Cervix dilates at the rate of about 0.5 – 1 cm/hour
  • May be faster in multiparous women or slower in first
  • Average duration – 12 hrs
  • Contractions last 45-60 seconds and are 2-5 mins apart
  • Transistion contractions last 60-90 seconds and are 2-3 mins apart
20
Q

when do the 2nd stage of labour starts

A

Starts at full dilatation of the cervix to delivery of the baby

21
Q

describe the 2nd stage of labour

A
  • Within 3 hrs for first
  • Within 2 hrs for multiparous and often much quicker
  • Contractions last 45-90 secs and 3-5 mins apart
22
Q

describe the third stage of labour

A
  • After the delivery of the baby to the delivery of the placenta and amniotic membranes
  • Usually within 30 mins
23
Q

what is the most common fatal head position in delivery

A
    • left occiput anterior is most common

- Babies head is slightly off centre in the pelvis with back of the head toward the mothers thigh

24
Q

what does the left occiput anterior mean in regards to head position

A

Babies head is slightly off centre in the pelvis with back of the head toward the mothers thigh
- this is the better position

25
Q

what does left occiput transverse mean

A
  • When back of baby’s head points directly at the mothers thigh the baby is left occiput transverse
  • May lead to more pain and slower progression
26
Q

describe what is special about the fatal head

A

Bones of the fetal skull are not firmly united which allow moulding

  • Bones overlap makes it easier to get out of the pelvic bone
  • Head can rotate, flex and extend
27
Q

describe how the pelvis changes during pregnancy

A

Widest diameter of pelvic canal changes from transverse diameter at pelvic inlet to AP diameter at pelvic outlet

28
Q

why must the head rotate during pregnancy

A

To obtain best fit of fetal head, the longest diameter of the fetal head passes through the widest diameter of the pelvis

Therefore head must rotate during labour

29
Q

how do you measure the fatal descent

A
  • Measured in negative and positive numbers
  • Ischial spine is in 0 station
  • If the presenting part is higher than the ischial spine the station has a negative number
  • Positive means that the presenting part has passed the ischial spine
30
Q

where is the pelvic outlet

A

+4cm

31
Q

how is the process of cervical ripening compared to an inflammatory reaction

A 
Prostaglandins 
Oestrogens 
Progesterone and antiprogesterones
Relaxin 
Inflammatory mediators
Nitric oxide
Apoptosis
32
Q

what is cervical ripening

A

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

33
Q

how do the biochemical changes to the cervix happen in cerivcal ripening

A

Rearrangement and realignment of collagen and an increase in the ground substance when comparedearly pregnant cervix

34
Q

what is the bishops score

A

Assess whether labour and pregnancy is progressing at a normal rate or whether we need to induce with for example oxytocin to induce

35
Q

what does a bishop score o…

  • 5 suggest
  • 9 suggest
  • 5-9
  • 6 or less
A

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

A score of 9 or more indicates that labour will most likely commence spontaneously

Scores between 5 – 9 require additional consideration

A score of 6 or less indicates that induction with PGE2 is unlikely to be successful

36
Q

what does the bishops score do

A
  • how much the cervix has dilated
  • where the head is in the cervix
  • how soft the cervix is
37
Q

describe individuals parts of labour

A

First stage

  • Engage
  • flex and descent

second stage

  • full dilation
  • internal rotation and then extension
  • external rotation
  • expulsion

3rd stage
- placental devilry

38
Q

describe the first stage of labour

A

Head is pushing onto the cervix softening it

Uterus is starting to contract and push the head down giving us the positive feedback

The mucus plug separates

Head moulds and changes shape

39
Q

describe the full dilation stage

A
  • the mucus plug is gone
  • The head is through the cervix
  • The cervix is fully dilated at up to 10cm
  • Can see aead of feuts at the top of the cervix
40
Q

describe internal rotation and extension

A

As it comes out it is coming out face down

Rotate the head internally so you can assist in getting the head out

41
Q

describe external rotation

A

External rotation and delivery of anterior shoulder

When the head is out

Rotate it so that the shoulders can come out

42
Q

describe expusion

A
  • two shoulders are out

- then the whole body comes out

43
Q

describe placenta expulsion

A

Uterus is still contracting

The placenta comes out and the rest of the umbolical cord that is attached to it

44
Q

what does oxytocinin do

A

helps you bond with the baby as soon as it is born

It also reduces sesntivity to pain and awareness to pain

45
Q

what is the last stage of labour

A
  • Last from delivery of placenta until postpartum condition of woman stabilises
  • 1-2 hours after delivery
  • Uterus will continue to contract which help the uterus to return back to normal size
  • Not usually painful
  • Descends 1 cm each day for about 10 days

Human Development (28 decks)

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