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Repro > Lecture 17 - Labour > Flashcards

Lecture 17 - Labour Flashcards

1
Q

Labour

A

Foetus, placenta and membranes are expelled through the birth canal after 24 weeks of gestation

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2
Q

Term

A

37 - 42 weeks

Labour usually completed within 18 hours

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3
Q

Stages of labour

A

1st stage

  • onset of regular contractions until the cervix is fully dilated
  • production of the birth canal
  • structures that normally retain the foetus are released

2nd stage

  • cervix is fully dilate
  • foetus expelled

3rd stage

  • changes to minimise maternal blood loss
  • expulsion of the placenta
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4
Q

What is required for labour

A
  1. Production of the birth canal
  2. Expulsion of the foetus and membranes that hold the foetus in vivo
  3. Minimisation of blood loss in the mother
  4. Enlargement and alignment of the cervix and the vagina
  5. Expulsion of the placenta
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5
Q

Lie of foetus

A

Position the foetus is in

Normally longitudinal but can be horizontal

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6
Q

Presentation

A

Which part of the foetus is adjacent to the pelvic inlet

Normally head - cephalic
Can be breech - podalic

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7
Q

1st stage phases

A

Latent phase
- painful contractions and cervical effacement and dilatation up to 4cm

Active phase
- regular painful contractions and progressive dilation last 4cm

Transition phase
- 8cm to 10cm

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8
Q

Birth canal

A

Cervix dilate and ripens

Foetal membranes rupture

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9
Q

Cervical ripening

A

The cervix normally has a high level of collagen fibres embedded in a proteoglycan matrix

Dilation

  • decrease in collagen
  • increase in glycosaminoglycans
  • collagen bundles loosen and aggregate less
  • influx of inflammatory cells and nitric oxide triggered by prostaglandins E2 and F2-alpha
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10
Q

Cervical effacement

A

Thinning

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11
Q

Lightening

A

Occurs 2 - 3 weeks prior to labour

  • expansion of the lower segment so the presenting part can engage with pelvis
  • foetal head engagement
  • symphysis pubis widens and the sacroiliac joint relax
  • increased vaginal secretions for lubrication
  • Braxton Hicks contractions
  • increase micturition - decreased bladder size so more space for uterus
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12
Q

Pre - labour

A

24 weeks

  • cervical ripening
  • gap junctions formed between cells for coordinated contractions
  • upregulation of oxytocin receptors in myometrial cells
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13
Q

Ferguson reflex

A
  1. Contractions
  2. Foetal head presses on the cervix
  3. Release of oxytocin from posterior pituitary
  4. Contractions - +vet feedback
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14
Q

Mechanical initiation of labour

A
  1. Uterus grows and stretches
  2. Detected by stretch receptors in the uterus
  3. Critical degree of stretch initiates contractions
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15
Q

Hormonal initiation of labour

A

Just before labour:
increase in cortisol converts progesterone into oestrogen

  • Progesterone decreases
  • Oxygen increases
  • prostaglandins are produced by the placenta, decidual and membranes
  • oxytocin released from the posterior pituitary
  • Therefore uterine contractions
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16
Q

Prostaglandins

A
  • increases intracellular calcium in the myometrium so myometrium cells are more contractile
  • cervical ripening
17
Q

Oestrogen in labour

A
  • Upregulates oxytocin receptors in the myometrium
  • increases gap junctions sin the myometrium
  • causes placenta to release prostaglandin
18
Q

Brachystasis

A

During contractions, muscle fibres shorten but do not relax fully so with each contraction the uterus gets shorter and shorter

19
Q

Oxytocin

A

Peptide hormone
Secretes by posterior pituitary gland
Lowers AP threshold so more APs

Increases force of contractions

20
Q

Duration of labour

A

1st child - 8 - 18 hours

2nd + child - 5 to 12 hours

21
Q

Factors for labour

A

Power - maternal contractions
Passenger - size, presentation and lie
Pathway - birth canal

22
Q

Show

A

Operculum - mucus plug

Comes away when the cervix dilates

23
Q

Phases of the 2nd stage of labour

A

Transition
- maternal restless and discomfort

Active phase
- more forceful and longer contractions than occur less frequently

Latent phase
- resting phase

Perineal phase

  • head visible at the vulva
  • crowning
  • release of operculum
  • foetal descent
24
Q

Mechanism of birth

A 
Descent
Flexion 
Internal rotation
Extension 
Restitution 
Internal rotation of the shoulder 
Lateral flexion
25
Q

Third stage

A

Powerful uterine contraction removes the placenta

Repro (20 decks)

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