lecture 6 normal labour Flashcards
1
Q
positioning of pelvis
A
tilted forwards
2
Q
why do you need things to retain the prgnancy
A
uterus is adpated to push things out
3
Q
main hormone in retaining prgnancy
A
progesterone
4
Q
in the beginning wht secretes progesterone
A
corpus luteum
5
Q
what takes over progesterone production
A
placenta
6
Q
what actions does progesterone have on the uterus
A
dampens the smooth muscle
strengthens the internal os
7
Q
what is the cerxic
A
long tube made of connective tissue
8
Q
what happens to the cervix in labour
A
softer
thinner
dilates
9
Q
how does hypervolaemia in pregnancy retain the
A
inhibiting the hormones at the posterior lobe of the posterior pituitary gland - inhibits contraction
10
Q
what are the hormones at the posterior lobe of the posterior pituitary gland
A
oxytocin
vasopressin
11
Q
how does adrenaline and sympathetic nervous system work
A
dampens the smooth muscle
strengthens the internal os
inhibits oxytocin
12
Q
what regulates the activation of adenylate cyclase
A
relaxin
13
Q
corticotropin releasing hormone derives from
A
placenta
14
Q
when is CRH released into maternal circulation
A
third trimester
15
Q
how does corticotropin releasing hormone inhibit labour
A
inhibits prostoglandin production
16
Q
how can CRH help labour
A
increase the contractility of the myometrium
17
Q
how is oestrogen involved in the birth
A
sensitises the uterine muscle to oxytocin
18
Q
where is oxytocin released from
A
posterior pituitary gland
19
Q
for birth what reduces progesterone levels
A
cortisol
20
Q
how does prostoglandins help birth
A
increase the myometrium contractility and act as smooth muscle relaxants on the cervical sphincter
21
Q
what else other than hormones can increase contractility
A
distension of the uterus ofc
22
Q
what are the 4 types of pelvis
A
gynecoid
android
anthropoid
platypelloid
23
Q
which is the best pelvis for labour
A
gynecoid
24
Q
why is … best pelvis for labour
A
gynecoid because it is shallow, has a generous capacity, it has a wide suprapubic arch and short ischial spine
25
what protrudes into the passage
ischial spines
26
how can the ischial spines affect birth
they can affect rotation
27
which pelvis is usually found in males
android
28
features of the android pelvis
triangular pelvis inlet and a narrow suprapubic arch and prominent ischial spines
29
which women would you find the android pelvis
afro carribean (mon)
30
features of the anthropoid pelvis
oval with the AP diameter being wider than the transverse diameter
31
with anthropoid pelvises what position are the babies born in
OP
32
what affect does babies being born in the OP position have
slows labour
33
which pelvis is the least common
platypelloid
34
features of the platypelloid
wide suprapubic arch but prominent ischial spines and a prominent sacrum
35
what features of the vagina may impede labour
scarring
| lots of fat around it
36
what is the pelvic floor important for
flexion and rotation of the head
37
hwo can the bladder and bowel affect labour
obstruct the head if its full
38
at the inlet what size is the:
transverse diameter
OP diameter
13cm
12cm
39
at the outlet what size is the:
transverse diameter
OP diameter
11cm
| 12.5cm
40
what muscles make up the pelvic floor
levator ani
| coccygeus
41
what is under the pelvic floor
urogenital diaphragm
42
what muscle does the urogenital diaphragm contain
deep transverse perineal muscle
43
what is the most superficial muscle surrounding the anus and vagina
bulbocavernosus muscle
44
where is the power mainly from
contractions of the uterus
45
what does the abdominal wall have to help push the baby down
resting tone
46
what does the uterus have between contractions
resting tone
47
how can the contraction of the uterus differ in direction
can be co-ordinated or unco-ordinated
48
what is unco-ordinated contraction
muscle fibers pushing in different directions
49
what might you do ifunco-ordinated contraction was happening
start poeple on a drip of syntocinon
50
what is syntocinon
sythetic version of oxytocin
51
how do the contractions move in the uterus and what is this called
from fundus downwards
| fundal dominance
52
where in the uterus is the contractions longest
fundus
53
what does the rhythm of the contraction depend on
stage of gestation
| stage of labour
54
what are the contractions called before labour
braxton hicks
55
how many contractions in the first stage per 10 mins
3
56
how many contractions in the second stage per 10 mins
4-5
57
are there contractions after the labour
yes
58
why are there contractions after the labour
stop blood loss
59
what is the babys skull made up of
separate bones
60
what are the babys skull bones joined by
sutuli
61
what are the bones either side of the baby skull
parietal
62
what bond is at the back of the babys skull
occipital
63
where does the sagital suture run
middle
64
where is the lambdoidal suture
back
65
what is the most favourable position of baby for labour -describe
head flexed and tucked in
| diameter of 9.5cm
66
what is it called if the head is only partially flexed and what is the diameter
suboccipital frontal
| 10.5cm
67
what is the diameter if the babys head is unflexed
11.5cm
68
what is the baby position with the widest diameter and what size is it
bravison
| 13cm
69
hwo can you tell position of baby
feel for the fontanelles vaginally
| palpate the abdomen
70
head facing down position
occipital anterior
71
head facing up position
occipito posterior
72
after the head is fully engaged why does the baby move down
pressure of the amniotic fluid
direct pressure from contractions
internal abdominal muscles
extension and straightening of the fetus
73
what effect can an epidural have on the rotation
relax the muscles of the pelvic floor and cause malrotation and get stuck in the OP or OT position
74
what is the latent phase
the onset of contractions
regular contractions
3-4cm
75
what is the first stage
3-4cm to full dilation
76
how long is the first stage
5 and a half hours
77
how long is the second stage
1 hour
78
what does the second stage involve
active and passive
79
what is the third stage
delivery of the baby to delivery of placenta and membranes
80
how do changes to the cervix happen in the latent phase
babys head puts pressure on cervix
prostoglandin release
cervix softens and thins
81
what is fully dilated
10cm
82
how does the shoulder getting stuck affect the baby
baby breathing
placenta decreasing function
umbilical vein squashed
baby is hypoxic
83
what does the uterus do to reduce blood loss
contracts down
84
what is considered a post partem hemorage
loss more than 500 mls
85
how can labour be measured
partogram
86
what can stress do to labour
activates the sympathetic nervous system
| decreases oxytocin release
87
why might women not know they need a wee in labour
epidural
| lots of pain
88
what can happen if the bladder is overly stretches
damages the detrusor muscle
89
why is pain relief important
pain stimulates the sympathetic nervous system and slow labour
90
how is the progress of labour measured
every 4 hours with a vaginal exam
91
what is CPD
head too big for pelvis
92
what happens if CPD is not treated
uterus rupture and mother and baby die
93
risks of a longer labour
sepsis
prolapse
incontinence
94
symptoms of sepsis
pyrexia
| tachycardia
95
treatment for septic mother
antibiotics
fluid
delivery
96
what can high blood pressure be a sign of
pre eclampsia
97
what can pre eclampisia lead to
fit
98
how do we avoid tears
test stretchyness of the membrane
99
what is a third degree tear
tear to the anal sphincter
100
how should delivery of the head be controlled
should be slowed
101
what does third stage management involve
injection of syntometrine
102
what is syntometrine
combination of syntocinon and ergometrine
103
what is ergometrine
synthetic form of a hormone produced by a fungus = strong contraction
104
at what speed should women be dilating
1cm an hour
105
what is TENS
transcutaneous electrical nerve stimulation
106
how does TENS work
makes the body release endorphin which work as morphine
107
what is inhlaed gas called
entonox
108
why do some women not like laughing gas
makes them feel faint/drunk
109
examples of systemic opiates used
Pethidine
Meptid
morphine
diamorphine
110
how does systemic opiates work
act on morphine receptors
111
side effects of systemic opiates
nausea
vomitting
respiratory depression in mum and baby
112
what can be done about respiratory depression in babys
naloxone can be given
113
what is an epidural
inserting a catheter into the epidural space and inject local anesthetics and opiates
114
negatives of epidural
educe the resting tone of the abdominal muscles, it reduces the sensation of the pelvic floor making pushing harder, it also makes you less mobile
115
how long does epidural take to wear off
4 hours
116
rare severe risks associated with epidural
spinal abscess
spinal hematoma
spinal damage
117
what is intermittant auscultation
midwife listens in every 15 mins with a sonicaid
118
CTG
CTG- cardiotocograph
119
what happens to babys heart rate when spetic
incr
120
most common way mothers are compramised
sepsis
| hemorrage
121
causes of hemorage
placenta born first
| uterus rupture
