Labour, Delivery,lactation Flashcards

1
Q

What is parturition ?

A

Transition for pregnant to no pregnant state

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2
Q

What is labour ?

A

Physiologic process by which foetus is expelled from uterus

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3
Q

What is delivery ?

A

Method of expulsion of foetus

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4
Q

Which 2 physiological changes initiate labour ?

A

Uterine lining (decidua+myometrium) more excitable

Cervical ripening

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5
Q

What is the birth canal composed of ?

A
Pelvic minor 
Soft tissue (uterus,cervix,vagina,vulva)
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6
Q

How is the first stage of labour defined ?

A

Interval between onset of labour and full dilatation of cervix

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7
Q

What are the phases of the first stage of labour ?

A

Latent phase : onset of labour , slow cervical dilatation ,softening

Active phase : faster rate of change + regular contractions

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8
Q

What is the aim of the first stage of labour ?

A

Creation of the birth canal and descend of foetus

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9
Q

What is stage 2 of labour ?

A

Time between full dilatation of cervix (10 cm ) and delivery

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10
Q

Which changes occur during stage 2 of delivery ?

A

Changes in uterine contractions (direction) to expulsive

Descent of the foetus (crowning of head)

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11
Q

What are the 2 phases of stage 2 of labour ?

A

Passive : descent and rotation of head

Active: maternal effort to expel foetus

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12
Q

What is the 3rd stage of labour ?

A

Expulsion placenta and downward contraction of uterus

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13
Q

Which changes must happen to start labour ?

A
  • creation of birth canal (cervical ripening:effacement and dilatation )
  • myometrium more excitable for initiation of contractions
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14
Q

Which hormone inhibits contractions ? How ?

A

Progesterone, depresses responsiveness of uterus to oxytocin and reduces uterine prostaglandin release

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15
Q

What are the effects of oestrogen on the myometrium and on other hormones ?

A

Increases gap junction : increases contractility
Also increases number of oxytocin receptors in myometrium
Induce prostaglandin synthesis

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16
Q

Which changes in hormones occur near term are responsible for onset of labour ?

A

Increase in oestrogen:progesterone ration
Lead to increased excitability due to increased oxytocin receptors and contractility of myometrium Increase prostaglandin production leads to cervical ripening and aids in contraction

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17
Q

What are the effects of prostaglandin and what induces its release ?

A

Promote labour :
Powerful contractor of myometrium
Involved in cervical ripening

Production by decidua,myometrium and membrane induced by increased oestrogen:progesterone ratio, oxytocin ,rupture of membrane , cervical stretching

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18
Q

How is oxytocin secreted, what are its effects ?

A

Secreted by posterior pituitary , controlled by hypothalamus

Initiate uterine contraction and stimulates prostaglandin release

19
Q

Which physiological changes occur during cervical ripening ?

A

-Reduction of collagen and reduced aggregation of fibres
-increased glycosaminoglycans and hyaluronic acid : increase water content
More ground substance

Shortening and effacement

20
Q

What is the maximum size of birth canal , what determines it and how does it happen ?

A

Max size around 11cm , determined by pelvic inlet , due to softening of ligament : relaxin, oestrogen

21
Q

Which changes occur at the perineum ?

A

Stretching of fibres of levator and and thinning of perineum : almost transparent membrane

22
Q

What special properties does the myometrium have ?

A

Fibres contract and only partially relax , does not return to original size

Contraction and retraction leading to increased pressure in uterus

23
Q

How do myometrium contraction occur and how are they made more forceful and frequent during labour ?

A

Spontaneous action potential induce increase in intra cellular calcium

Prostaglandins : increase calcium per AP : increased force
Oxytocin : decreases threshold : more frequent AP

24
Q

What are the 3 types of position of the foetus ?

A

Lie : longitudinal or horizontal in relation to the long axis of the woman

Attitude : flexion or extension

Presentation : head down or breach : frank breach , full breach, footling breach

25
Q

How can we induce labour ?

A
  • stimulate prostaglandin release by rupturing of membrane
  • artificial prostaglandins
  • synthetic oxytocin
  • anti progesterone agents
26
Q

What is the Ferguson reflex ?

A

Oxytocin stimulate uterus to contract , contraction of uterus leads to positive feedback and afferent impulse from cervix and vagina to release more oxytocin

27
Q

How can the foetus be monitored during labour ?

A

HR, maternal temperature , colour and amount of amniotic fluid , scalp capillary pH

28
Q

Describe the changes in foetal position during the second stage of labour

A
  • present head down , facing sideways : Head flexes
  • Head rotates to face posteriorly ( due levator and contraction)
  • Crowning : head stretches perineal muscle and skin
  • Extension of head and external rotation (restitution , facing sideways)
  • Shoulder rotation , delivery of shoulder and body
29
Q

How can delivery be facilitated ?

A
  • Cesarean section : incision through skin and uterus , delivery of baby not through birth canal
  • Use of forceps or vacuum extraction
30
Q

In stage 3 , how does the placenta descend and separate from the endometrium ?

A

Reduced size of uterus due to retraction decreases size of placental site : placenta is squeezed causing separation

31
Q

Which normal processes happen to limit blood loss during separation of placenta ?

A
  • powerful contraction interlacing muscle fibres of uterus act as ligature of blood vessels in myometrium
  • pressure exerted at placenta site by contraction and retraction of myometrium
  • blood clotting mechanism
32
Q

Describe the first changes enabling the foetus to adapt to independent life (resp and cvs )

A
  • stimuli (trauma,cold,light…) to take first breath >alveoli inflate and maintained by surfactant
  • clamping of umbilicus result in closure of ductus venosus

First breath cause decreased resistance in lungs > blood flows to lungs and pO2 rises > net drop in pressure in RIght side and higher pressure in left atrium > closure of foramen ovale > increased pressure and pO2 cause ductus arteriosus to close

33
Q

Which changes occur in the lower genital tract after delivery ?

A
  • reduction in size of vulva,vagina,cervix
  • decreased lubrication
  • transformation zone of cervix back into the endocervix and internal is closed
  • heavy bleeding initially : lochia rubra
  • then bleeding changes from dark red to pink/white : lochia Alba
34
Q

Briefly describe the haematological and hormonal changes after delivery

A
  • reduction of plasma volume and increase in haemoglobin level
  • high WCC
  • low iron
  • prolactin remain high if lactation
  • thyroxine level decrease back to normal
35
Q

Briefly describe the anatomy of the breast and gland

A

Between 2n and 6th ribs , adipose tissue and glandular tissue

Tubuloacinar gland , apocrine secretion in mammary ducts which join in lactiferous duct which open at the nipple

36
Q

What causes growth of breast tissue during pregnancy ? What are the changes ?

A

Progesterone,oestrogen,growth hormones and especially prolactin cause hypertrophy of existing alveola and formation of new ones with proliferation of milk ducts

37
Q

Why is there minimal lactation lactation during pregnancy ?

A

Oestrogen and progesterone inhibits effects of lactogenic hormones (prolactin)

38
Q

What is milk production and secretion dependant on ?

A

Prolactin levels induce milk production
Prolactin level is dependent on frequency and duration of suckling

Milk secretion also depends on adequate emptying of the breast

39
Q

What induces milk let down (delivery) ?

A

Oxytocin : contraction of myoepithelial cells around alveola cause expulsion of milk in ducts

Oxytocin released in response to suckling, swing of hearing baby

40
Q

What is the name of the first product of lactation ?

A

Colostrum , high fat and immunoglobulins

41
Q

How does the milk differ between start and end of suckling ?

A

Foremilk : high water content

Hind milk : fats and iron rich

42
Q

What are the components of milk and function ?

A

Lactoferrin : binds iron to protect agains E. coli proliferation
Non pathogenic flora for colonisation of gut
Bacteriocidal enzymes
Immunoglobulins :IgA

43
Q

What breast pbm can occur are delivery ?

A
  • Nipple sensitivity and pain
  • engorgement
  • mastitis
  • breast abscess
  • lumps