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Reproductive System > Labour + Birth > Flashcards

Labour + Birth Flashcards

1
Q

What is labour?

A

The process by which the fetus + its supporting placenta and membranes pass from the uterus to the outside world

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2
Q

Three key processes in labour

A
  • Regular high intensity contractions
  • Softening + dilatation of the cervix
  • Rupture of the fetal membranes
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3
Q

Timing of labour:
- miscarriage
- premature
- term

A
  • miscarriage: <22 weeks
  • premature: <37 weeks
  • term labour: 37 weeks +
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4
Q

Timing of a miscarriage

A

Before 22 weeks

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5
Q

When is baby deemed premature?

A

Before 37 weeks

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6
Q

What is classified as term labour?

A

37 weeks +

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7
Q

What are the stages on labour?

A
  • first stage: from the onset of regular uterine contractions until cervix is fully dilated 10cm
  • second stage: from full dilatation until birth of fetus
  • thirst stage: from birth of fetus until delivery of placenta + membranes
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8
Q

How is the birth canal created?

A
  • softening of the pelvic ligaments
  • increase in myometrial activity > contractions
  • cervical dilatation + effacement
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9
Q

First stage of labour

A

From the onset of regular uterine contractions until cervix is full dilated

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10
Q

Second stage labour

A

From full dilatation until fetus is born

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11
Q

Third stage of labour

A

From birth of fetus until delivery of placenta + membranes

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12
Q

What is cervical ripening triggered by?

A

Prostaglandins
E2 + F2a

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13
Q

What is cervical ripening?

A
  • marked reduction in collagen
  • marked increase in glycoaminoglycans
  • these both decease the aggregation of collagen fibres
  • collagen bundles loosen
  • influx of inflammatory cells + increase NO output
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14
Q

Movements of baby in labour

A

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation (restitution)
Anterior shoulder delivery
Posteior shoulder delivery

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15
Q

What happens to the myometrium in pregnancy?

A
  • becomes thicker
  • due to increased cell size x10
  • glycogen deposition
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16
Q

What hormones are involved in increases frequency + force of contractions inducing labour?

A

Prostaglandins
Oxytocin

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17
Q

Contractions in early pregnancy

A

Occur ~30 mins
Low amplitude

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18
Q

What are Braxton-Hicks contractions?

A
  • Noticeable contractions later on in pregnancy
  • Reduced frequency but increased amplitude
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19
Q

How do prostaglandins implement the change in contractions starting labour?

A

Enhancing release of calcium from intracellular stores > produces action potential

20
Q

How do oxytocin implement the change in contractions starting labour?

A

Lowers threshold for triggering AP

21
Q

Where is oxytocin secreted from?

A

Posterior pituitary gland

22
Q

What is the Ferguson Reflux?

A
  • brain stimulates posterior pituitary to release oxytocin
  • causes smooth muscle lining of uterus to contract
  • baby pushes against cervix > stretch
  • stretching causes nerve implases to be sent to brain
  • process repeats
23
Q

What is brachystasis?

A

Myometrial cells contract and shorten, but do not regain their original length upon relaxation > shortness uterus progressively

24
Q

What is effacement of the cervix?

A

Thinning of cervix

25
Q

What is full dilatation of cervix?

A

10cm

26
Q

Duration of second stage of labour

A

1 hour
2 hours in first pregnancies

27
Q

What is the physiological third stage of labour?

A
  • no medication used
  • midwife waits for umbilical cord to stop pulsating before it is cut + delivery of placenta occurs passively
28
Q

What is the active third stage of labour?

A
  • oxytocin or ergometrine injection given
  • causes contraction of uterus
29
Q

Why is active management of the third stage of labour recommended for all women?

A

Reduces risk of post partum haemorrhage

30
Q

What are the three Ps affecting labour?

A

Passage
Passenger
Powers (contractions)

31
Q

What is the diameter of the birth canal?

A

11cm max
Limited by the pelvis

32
Q

What are the three ways a baby can lie in the uterus before delivery?

A

Longitudinal lie (most common)
Transverse lie
Oblique lie (unstable)

33
Q

Types of fetal presentation

A
  • Cephalic (head first)
  • Breech (bum/feet first)
34
Q

Types of breech fetal presentation

A
  • Complete breech
  • Frank breech (bum first, feet up by head)
  • Footling breech (feet first)
35
Q

Types of cephalic presentation

A
  • vertex (well flexed head) | normal
  • vertex (deflexed head)
  • brow
  • face
36
Q

How do you determine fetal position?

A

Vaginal exam
Obstetric abdominal exam

37
Q

Does a high or low apgar score mean a baby is healthy?

A

Low apgar score

38
Q

What is shoulder dystocia?

A

Vaginal Cephalic delivery that requires additional obstetric manoeuvres to deliver the fetus after the head has delivered + gentle traction has failed + shoulder is stuck

39
Q

Complications of shoulder dystocia

A
  • Erb’s palsy
  • neurological dysfunction
  • neonatal mortality
  • PPH
  • tears
40
Q

Risk factors of shoulder dystocia

A
  • previous shoulder dystocia
  • macrosomia
  • diabetes mellitus
  • maternal BMI >30
  • prolonged labour
  • assisted vaginal delivery
41
Q

Types of intra partum monitoring

A
  • intermittent monitoring: Doppler stethoscope
  • continuous electronic fetal monitoring: Cardiotocography + fetal scalp electrode
  • fetal blood sampling
42
Q

What are the indications of assisted delivery?

A
  • failure to progress
  • maternal exhaustion
  • fetal compromise in 2nd stage
43
Q

Types of assisted delivery

A

Forceps
Suction cup

44
Q

What are the indications of C section

A
  • malpresentation
  • macrosomia
  • failure to progress
  • fetal compromise
  • previous C section
  • fetal malformation
  • multiple pregnancies
45
Q

Outline an induced labour

A
  • prostaglandins vaginal
  • IV oxytocin
  • artificial rupture of membranes

Reproductive System (20 decks)

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