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block 11 anna > lecture 6 normal labour > Flashcards

lecture 6 normal labour Flashcards

1
Q

positioning of pelvis

A

tilted forwards

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2
Q

why do you need things to retain the prgnancy

A

uterus is adpated to push things out

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3
Q

main hormone in retaining prgnancy

A

progesterone

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4
Q

in the beginning wht secretes progesterone

A

corpus luteum

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5
Q

what takes over progesterone production

A

placenta

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6
Q

what actions does progesterone have on the uterus

A

dampens the smooth muscle

strengthens the internal os

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7
Q

what is the cerxic

A

long tube made of connective tissue

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8
Q

what happens to the cervix in labour

A

softer
thinner
dilates

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9
Q

how does hypervolaemia in pregnancy retain the

A

inhibiting the hormones at the posterior lobe of the posterior pituitary gland - inhibits contraction

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10
Q

what are the hormones at the posterior lobe of the posterior pituitary gland

A

oxytocin

vasopressin

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11
Q

how does adrenaline and sympathetic nervous system work

A

dampens the smooth muscle
strengthens the internal os
inhibits oxytocin

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12
Q

what regulates the activation of adenylate cyclase

A

relaxin

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13
Q

corticotropin releasing hormone derives from

A

placenta

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14
Q

when is CRH released into maternal circulation

A

third trimester

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15
Q

how does corticotropin releasing hormone inhibit labour

A

inhibits prostoglandin production

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16
Q

how can CRH help labour

A

increase the contractility of the myometrium

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17
Q

how is oestrogen involved in the birth

A

sensitises the uterine muscle to oxytocin

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18
Q

where is oxytocin released from

A

posterior pituitary gland

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19
Q

for birth what reduces progesterone levels

A

cortisol

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20
Q

how does prostoglandins help birth

A

increase the myometrium contractility and act as smooth muscle relaxants on the cervical sphincter

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21
Q

what else other than hormones can increase contractility

A

distension of the uterus ofc

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22
Q

what are the 4 types of pelvis

A

gynecoid
android
anthropoid
platypelloid

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23
Q

which is the best pelvis for labour

A

gynecoid

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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

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25
Q

what protrudes into the passage

A

ischial spines

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26
Q

how can the ischial spines affect birth

A

they can affect rotation

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27
Q

which pelvis is usually found in males

A

android

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28
Q

features of the android pelvis

A

triangular pelvis inlet and a narrow suprapubic arch and prominent ischial spines

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29
Q

which women would you find the android pelvis

A

afro carribean (mon)

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30
Q

features of the anthropoid pelvis

A

oval with the AP diameter being wider than the transverse diameter

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31
Q

with anthropoid pelvises what position are the babies born in

A

OP

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32
Q

what affect does babies being born in the OP position have

A

slows labour

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33
Q

which pelvis is the least common

A

platypelloid

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34
Q

features of the platypelloid

A

wide suprapubic arch but prominent ischial spines and a prominent sacrum

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35
Q

what features of the vagina may impede labour

A

scarring

lots of fat around it

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36
Q

what is the pelvic floor important for

A

flexion and rotation of the head

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37
Q

hwo can the bladder and bowel affect labour

A

obstruct the head if its full

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38
Q

at the inlet what size is the:
transverse diameter
OP diameter

A

13cm

12cm

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39
Q

at the outlet what size is the:
transverse diameter
OP diameter

A

11cm

12.5cm

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40
Q

what muscles make up the pelvic floor

A

levator ani

coccygeus

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41
Q

what is under the pelvic floor

A

urogenital diaphragm

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42
Q

what muscle does the urogenital diaphragm contain

A

deep transverse perineal muscle

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43
Q

what is the most superficial muscle surrounding the anus and vagina

A

bulbocavernosus muscle

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44
Q

where is the power mainly from

A

contractions of the uterus

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45
Q

what does the abdominal wall have to help push the baby down

A

resting tone

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46
Q

what does the uterus have between contractions

A

resting tone

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47
Q

how can the contraction of the uterus differ in direction

A

can be co-ordinated or unco-ordinated

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48
Q

what is unco-ordinated contraction

A

muscle fibers pushing in different directions

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49
Q

what might you do ifunco-ordinated contraction was happening

A

start poeple on a drip of syntocinon

50
Q

what is syntocinon

A

sythetic version of oxytocin

51
Q

how do the contractions move in the uterus and what is this called

A

from fundus downwards

fundal dominance

52
Q

where in the uterus is the contractions longest

A

fundus

53
Q

what does the rhythm of the contraction depend on

A

stage of gestation

stage of labour

54
Q

what are the contractions called before labour

A

braxton hicks

55
Q

how many contractions in the first stage per 10 mins

A

3

56
Q

how many contractions in the second stage per 10 mins

A

4-5

57
Q

are there contractions after the labour

A

yes

58
Q

why are there contractions after the labour

A

stop blood loss

59
Q

what is the babys skull made up of

A

separate bones

60
Q

what are the babys skull bones joined by

A

sutuli

61
Q

what are the bones either side of the baby skull

A

parietal

62
Q

what bond is at the back of the babys skull

A

occipital

63
Q

where does the sagital suture run

A

middle

64
Q

where is the lambdoidal suture

A

back

65
Q

what is the most favourable position of baby for labour -describe

A

head flexed and tucked in

diameter of 9.5cm

66
Q

what is it called if the head is only partially flexed and what is the diameter

A

suboccipital frontal

10.5cm

67
Q

what is the diameter if the babys head is unflexed

A

11.5cm

68
Q

what is the baby position with the widest diameter and what size is it

A

bravison

13cm

69
Q

hwo can you tell position of baby

A

feel for the fontanelles vaginally

palpate the abdomen

70
Q

head facing down position

A

occipital anterior

71
Q

head facing up position

A

occipito posterior

72
Q

after the head is fully engaged why does the baby move down

A

pressure of the amniotic fluid
direct pressure from contractions
internal abdominal muscles
extension and straightening of the fetus

73
Q

what effect can an epidural have on the rotation

A

relax the muscles of the pelvic floor and cause malrotation and get stuck in the OP or OT position

74
Q

what is the latent phase

A

the onset of contractions
regular contractions
3-4cm

75
Q

what is the first stage

A

3-4cm to full dilation

76
Q

how long is the first stage

A

5 and a half hours

77
Q

how long is the second stage

A

1 hour

78
Q

what does the second stage involve

A

active and passive

79
Q

what is the third stage

A

delivery of the baby to delivery of placenta and membranes

80
Q

how do changes to the cervix happen in the latent phase

A

babys head puts pressure on cervix
prostoglandin release
cervix softens and thins

81
Q

what is fully dilated

A

10cm

82
Q

how does the shoulder getting stuck affect the baby

A

baby breathing
placenta decreasing function
umbilical vein squashed
baby is hypoxic

83
Q

what does the uterus do to reduce blood loss

A

contracts down

84
Q

what is considered a post partem hemorage

A

loss more than 500 mls

85
Q

how can labour be measured

A

partogram

86
Q

what can stress do to labour

A

activates the sympathetic nervous system

decreases oxytocin release

87
Q

why might women not know they need a wee in labour

A

epidural

lots of pain

88
Q

what can happen if the bladder is overly stretches

A

damages the detrusor muscle

89
Q

why is pain relief important

A

pain stimulates the sympathetic nervous system and slow labour

90
Q

how is the progress of labour measured

A

every 4 hours with a vaginal exam

91
Q

what is CPD

A

head too big for pelvis

92
Q

what happens if CPD is not treated

A

uterus rupture and mother and baby die

93
Q

risks of a longer labour

A

sepsis
prolapse
incontinence

94
Q

symptoms of sepsis

A

pyrexia

tachycardia

95
Q

treatment for septic mother

A

antibiotics
fluid
delivery

96
Q

what can high blood pressure be a sign of

A

pre eclampsia

97
Q

what can pre eclampisia lead to

A

fit

98
Q

how do we avoid tears

A

test stretchyness of the membrane

99
Q

what is a third degree tear

A

tear to the anal sphincter

100
Q

how should delivery of the head be controlled

A

should be slowed

101
Q

what does third stage management involve

A

injection of syntometrine

102
Q

what is syntometrine

A

combination of syntocinon and ergometrine

103
Q

what is ergometrine

A

synthetic form of a hormone produced by a fungus = strong contraction

104
Q

at what speed should women be dilating

A

1cm an hour

105
Q

what is TENS

A

transcutaneous electrical nerve stimulation

106
Q

how does TENS work

A

makes the body release endorphin which work as morphine

107
Q

what is inhlaed gas called

A

entonox

108
Q

why do some women not like laughing gas

A

makes them feel faint/drunk

109
Q

examples of systemic opiates used

A

Pethidine
Meptid
morphine
diamorphine

110
Q

how does systemic opiates work

A

act on morphine receptors

111
Q

side effects of systemic opiates

A

nausea
vomitting
respiratory depression in mum and baby

112
Q

what can be done about respiratory depression in babys

A

naloxone can be given

113
Q

what is an epidural

A

inserting a catheter into the epidural space and inject local anesthetics and opiates

114
Q

negatives of epidural

A

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
Q

how long does epidural take to wear off

A

4 hours

116
Q

rare severe risks associated with epidural

A

spinal abscess
spinal hematoma
spinal damage

117
Q

what is intermittant auscultation

A

midwife listens in every 15 mins with a sonicaid

118
Q

CTG

A

CTG- cardiotocograph

119
Q

what happens to babys heart rate when spetic

A

incr

120
Q

most common way mothers are compramised

A

sepsis

hemorrage

121
Q

causes of hemorage

A

placenta born first

uterus rupture

block 11 anna (14 decks)

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