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REPRODUCTION & GYNAECOLOGY > Labour and Puerperium > Flashcards

Labour and Puerperium Flashcards

1
Q

What is the definition of labour?

A
  • 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
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2
Q

What are the 3 options of where a woman can give birth?

A
  • Consultant Led Unit
  • Midwife Led Unit
  • Homebirth
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3
Q

What is a birth plan?

A
  • 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
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4
Q

What physiological changes help to initiate labour?

A
  • Change in the oestrogen/progesterone ratio
  • Myometrial stretch increases excitability of myometrial fibres
  • Mechanical stretch of cervix and stripping/rupture of foetal membranes
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5
Q

Why does an increasing oestrogen:progesterone ratio cause initiation of labour?

A

Oestrogen

  • Promotes uterus contraction
  • Promotes prostaglandin production

Progesterone

  • keeps the uterus settled.
  • Hinders the contractibility
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6
Q

How does oxytocin help in the initiation of labour?

A
  • Initiates and sustains contractions
  • Promotes prostaglandin release
  • Synthesised straight into maternal and placental tissue
  • Number of oxytocin receptors increases
    near the end of pregnancy
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7
Q

What physiological processes in the foetus help to initiate labour?

A
  • Pulmonary surfactant secreted into amniotic fluid stimulates prostaglandin synthesis
  • Foetal cortisol stimulates increase in maternal estriol
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8
Q

When can membrane rupture occur?

A 
Pre-Term
Pre-Labour
First Stage 
Second Stage
Born in a caul (Baby born in amniotic sac)
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9
Q

What is the job of the liquor surrounding the foetus?

A
  • Nurtures and protects fetus

- Facilitates movement

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10
Q

How does the cervix change during labour?

A
  • Increase in hyaluronic acid
  • Increases number of molecules between collagen fibres
    => decreased bridging between fibres causes cervix to SOFTEN
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11
Q

What score is used to assess if it is safe enough to induce labour?

A

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
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12
Q

A lower Bishop Score indicates a woman is close to active labour. TRUE/FALSE?

A

FALSE

  • higher score = more active labour
  • lower score, patient is struggling and may eventually have to be induced
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13
Q

What are the 3 stages of labour?

A

1st

  • Latent phase (up to 3-4cms dilatation)
  • Active stage 4cms -10cms (full dilatation)

2nd
- Full dilatation and delivery

3rd Stage
- Expulsion of placenta

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14
Q

The latent phase of labour can last up to a few days. TRUE/FALSE?

A

TRUE

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15
Q

After what length of time would the second stage of labour be considered prolonged?

A

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

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16
Q

How long does the 3rd stage of labour normally last and after what point would surgical removal of the placenta be considered?

A

Average duration 10 minutes
(can be 3 minutes or longer)

After 1 hour preparation made for removal under GA

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17
Q

Why is an “active” 3rd stage of labour preferred to a physiological 3rd stage?

A

Active management: use of oxytocic drugs in active 3rd stage

+ controlled cord traction

=> lower risk of post partum haemorrhage

18
Q

What are Braxton Hicks contractions?

A
  • “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
19
Q

How can you tel if a patient is experiencing true labour contractions as opposed to Braxton Hicks?

A
  • 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
20
Q

Describe the path of a contraction in pregnancy

A

Density of myocytes highest at the fundus

Wave starts at fundus and spreads symetrically downward

21
Q

A baby in a normal presenting position is born with it head in the occipito-anterior position. TRUE/FALSE?

A

TRUE

- can also be born occipito-posterior (usually if it has been in previous abnormal position)

22
Q

What landmarks on a baby’s skull can be used to determine their position?

A

Fontanelles

  • anterior = larger and more diamond shaped
  • posterior = smaller and triangular
23
Q

What are the various types of analgesia that can be used during pregnancy?

A
  • Paracetamol/ Co-codamol
  • TENS
  • Entonox (Gas and Air)
  • Diamorphine
  • Epidural
  • Remifentanyl
  • Combined spinal/epidural
24
Q

What is recorded on a partogram?

A
  • graphic record of key data (maternal and foetal

- assess progress of labour (cervical dilatation, foetal heart rate)

25
Q

What 7 cardinal movements make up the mechanisms of labour?

A
  1. Engagement
  2. Decent
  3. Flexion
  4. Internal Rotation
  5. Crowning and extension
  6. Restitution and external rotation (head adopts optimal position for shoulder)
  7. Expulsion, anterior shoulder first
26
Q

When is the foetal head considered to be engaged?

A
  • 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)
27
Q

How often should vaginal examinations be carried out during a normal labour?

A

approximately 4 hourly

28
Q

What is meant by crowning?

A
  • 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
29
Q

What is meant by delayed cord clamping?

A

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

30
Q

What is meant by skin to skin contact time?

A
  • 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
31
Q

How long should skin to skin contact time between a mother and her baby last for?

A

Current recommendation and practise isfor uninterrupted SSC for 1 hour following birth

32
Q

What signs are present if a woman is in her 3rd stage of labour?

A
  • Uterus contracts, hardens and rises
  • Umbilical cord lengthens
  • Frequently a gush of blood variable in amount
  • Placenta and membranes appear at introitus
33
Q

What is done during Active management of the third stage of labour?

A
  • Syntometerine
  • Oxytocin 10 units
  • Cord clamping and cutting,
  • Controlled cord traction
  • Bladder emptying
34
Q

Explain how the uterus expels the placenta

A
  • 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
35
Q

What amount of blood loss in labour is normal?

A

Volume of less than 500mls

  • Above 800ml is abnormal*
  • blood loss in labour prior to delivery is considered abnormal*
36
Q

What is the puerperium and how long does it last?

A

Return of tissues to non-pregnant state (6 weeks)

37
Q

Bloodstained discharge is common during the puerperium. TRUE/FALSE?

A

TRUE

Bloodstained discharge lasts for about 10-14 days following birth

38
Q

How does the uterus change during the puerperium?

A
  • Uterine Involution
  • Weight reduces 1000 -> 50-100g
  • Fundal height reduces in 2 weeks
  • Endometrium regenerates by end of a week (except the placental site)
39
Q

What stimulates lactation after childbirth?

A
  • initiated by placental expulsion

- decrease in oestrogen and progesterone.

40
Q

What is colostrum?

A

First milk production

Rich in immunoglobulin to protect baby

REPRODUCTION & GYNAECOLOGY (58 decks)

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