Labour and Puerperium Flashcards
What is the definition of labour?
- Physiological process during which the foetus, membranes, umbilical cord and placenta are expelled from the uterus.
- Associated with regular, painful uterine contractions with increasing frequency, intensity and duration
What are the 3 options of where a woman can give birth?
- Consultant Led Unit
- Midwife Led Unit
- Homebirth
What is a birth plan?
- record of what the woman would like to happen during herlabour and after the birth
- discuss adverse situations and her plans for this
- allows woman to understand what may happen in labour => can identify her feelings and priorities
What physiological changes help to initiate labour?
- Change in the oestrogen/progesterone ratio
- Myometrial stretch increases excitability of myometrial fibres
- Mechanical stretch of cervix and stripping/rupture of foetal membranes
Why does an increasing oestrogen:progesterone ratio cause initiation of labour?
Oestrogen
- Promotes uterus contraction
- Promotes prostaglandin production
Progesterone
- keeps the uterus settled.
- Hinders the contractibility
How does oxytocin help in the initiation of labour?
- Initiates and sustains contractions
- Promotes prostaglandin release
- Synthesised straight into maternal and placental tissue
- Number of oxytocin receptors increases
near the end of pregnancy
What physiological processes in the foetus help to initiate labour?
- Pulmonary surfactant secreted into amniotic fluid stimulates prostaglandin synthesis
- Foetal cortisol stimulates increase in maternal estriol
When can membrane rupture occur?
Pre-Term Pre-Labour First Stage Second Stage Born in a caul (Baby born in amniotic sac)
What is the job of the liquor surrounding the foetus?
- Nurtures and protects fetus
- Facilitates movement
How does the cervix change during labour?
- Increase in hyaluronic acid
- Increases number of molecules between collagen fibres
=> decreased bridging between fibres causes cervix to SOFTEN
What score is used to assess if it is safe enough to induce labour?
Bishop score
Dilatation (how open cervix is) Effacement (how thin cervix is) Station in Pelvis (baby's head in relation to ischial spines) Cervical Consistency Cervical Position
A lower Bishop Score indicates a woman is close to active labour. TRUE/FALSE?
FALSE
- higher score = more active labour
- lower score, patient is struggling and may eventually have to be induced
What are the 3 stages of labour?
1st
- Latent phase (up to 3-4cms dilatation)
- Active stage 4cms -10cms (full dilatation)
2nd
- Full dilatation and delivery
3rd Stage
- Expulsion of placenta
The latent phase of labour can last up to a few days. TRUE/FALSE?
TRUE
After what length of time would the second stage of labour be considered prolonged?
Women having their first child (i.e. no previous births)
>3 hours if regional analgesia
>2 hours without
Women having a subsequent child
>2 hours with regional analgesia
>1 hour without
How long does the 3rd stage of labour normally last and after what point would surgical removal of the placenta be considered?
Average duration 10 minutes
(can be 3 minutes or longer)
After 1 hour preparation made for removal under GA
Why is an “active” 3rd stage of labour preferred to a physiological 3rd stage?
Active management: use of oxytocic drugs in active 3rd stage
+ controlled cord traction
=> lower risk of post partum haemorrhage
What are Braxton Hicks contractions?
- “false labour”
- Tightening of uterine muscles, helps body prepare for birth
- usually felt in the third trimester
- Irregular, do not increase in frequency or intensity
- Relatively painless
How can you tel if a patient is experiencing true labour contractions as opposed to Braxton Hicks?
- timing of true contractions become evenly spaced
- time between them gets shorter
- Length of contraction time increases 10secs—-45secs
- get more intense and painful over time
Describe the path of a contraction in pregnancy
Density of myocytes highest at the fundus
Wave starts at fundus and spreads symetrically downward
A baby in a normal presenting position is born with it head in the occipito-anterior position. TRUE/FALSE?
TRUE
- can also be born occipito-posterior (usually if it has been in previous abnormal position)
What landmarks on a baby’s skull can be used to determine their position?
Fontanelles
- anterior = larger and more diamond shaped
- posterior = smaller and triangular
What are the various types of analgesia that can be used during pregnancy?
- Paracetamol/ Co-codamol
- TENS
- Entonox (Gas and Air)
- Diamorphine
- Epidural
- Remifentanyl
- Combined spinal/epidural
What is recorded on a partogram?
- graphic record of key data (maternal and foetal
- assess progress of labour (cervical dilatation, foetal heart rate)
What 7 cardinal movements make up the mechanisms of labour?
- Engagement
- Decent
- Flexion
- Internal Rotation
- Crowning and extension
- Restitution and external rotation (head adopts optimal position for shoulder)
- Expulsion, anterior shoulder first
When is the foetal head considered to be engaged?
- when the widest diameter of the head has entered the brim of the pelvis
- 3/5 of the foetal head have entered (as it cannot move backwards from this point)
How often should vaginal examinations be carried out during a normal labour?
approximately 4 hourly
What is meant by crowning?
- Appearance of a large segment of fetal head at the introitus
- Labia are stretched to full capacity
- Largest diameter of fetal head is encircled by the vulval ring
- Burning and stinging feeling for the mother
What is meant by delayed cord clamping?
Umbilical cord is not clamped for AT LEAST 60 seconds after baby is born
= allows blood flow from mother to continue and for baby to get enough iron
What is meant by skin to skin contact time?
- Early placing of naked baby on the mother’s chest
=> keep babies warm and calm
=> improves other aspects of baby’s transition to life outsidethe womb
How long should skin to skin contact time between a mother and her baby last for?
Current recommendation and practise isfor uninterrupted SSC for 1 hour following birth
What signs are present if a woman is in her 3rd stage of labour?
- Uterus contracts, hardens and rises
- Umbilical cord lengthens
- Frequently a gush of blood variable in amount
- Placenta and membranes appear at introitus
What is done during Active management of the third stage of labour?
- Syntometerine
- Oxytocin 10 units
- Cord clamping and cutting,
- Controlled cord traction
- Bladder emptying
Explain how the uterus expels the placenta
- Uterus contracts and decreases its surface area (both to stop bleeding and to shear off placenta)
- As placenta cannot shrink in size it comes away from the wall of the uterus and is expelled out
What amount of blood loss in labour is normal?
Volume of less than 500mls
- Above 800ml is abnormal*
- blood loss in labour prior to delivery is considered abnormal*
What is the puerperium and how long does it last?
Return of tissues to non-pregnant state (6 weeks)
Bloodstained discharge is common during the puerperium. TRUE/FALSE?
TRUE
Bloodstained discharge lasts for about 10-14 days following birth
How does the uterus change during the puerperium?
- Uterine Involution
- Weight reduces 1000 -> 50-100g
- Fundal height reduces in 2 weeks
- Endometrium regenerates by end of a week (except the placental site)
What stimulates lactation after childbirth?
- initiated by placental expulsion
- decrease in oestrogen and progesterone.
What is colostrum?
First milk production
Rich in immunoglobulin to protect baby
