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The Reproductive System > Lecture 8.1: Parturition > Flashcards

Lecture 8.1: Parturition Flashcards

1
Q

What is Labour?

A

A series of continuous, progressive contractions of the uterus that help the cervix dilate and efface that results in expulsion of products of conception after 24 weeks

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2
Q

When in the pregnancy is it classed as Spontaneous Abortion?

A

Before 24 weeks

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3
Q

When in the pregnancy is the baby classed as Pre-Term?

A

Before 37 weeks

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4
Q

When in the pregnancy is the baby classed as Term?

A

37-42 weeks

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5
Q

When in the pregnancy is the baby classed as Post-Term?

A

After 42 weeks

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6
Q

How many Stages of Labour are there?

A

3

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7
Q

What happens in Stage 1 of Labour?

A
  • Interval between the onset of labour and full cervical
    dilation
  • Creation of the birth canal
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8
Q

What are the 2 Phases of Stage 1 of Labour?

A
  • Latent phase: onset of labour with slow cervical
    dilation to ~4 cm and variable duration
  • Active phase: faster rate of cervical change, 1-1.2 cm
    /hour, regular uterine contractions
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9
Q

What happens in Stage 2 of Labour?

A

Delivery of the foetus

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10
Q

What happens in Stage 3 of Labour?

A

Delivery of the placenta and membranes

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11
Q

Three Ps of Labour

A
  • Powers
  • Passenger
  • Passage
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12
Q

When is the Dating Scan done? What does it show?

A
  • Approx. 12 weeks
  • Confirms dates and identifies singleton or multiple
    pregnancy
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13
Q

By what week is the Uterus palpable?

A

12 weeks

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14
Q

By what week does the Uterus reach the umbilicus?

A

20 weeks

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15
Q

By what week does the Uterus reach the Xiphisternum?

A

36 weeks

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16
Q

How to describe baby’s position in uterus towards the end of the pregnancy

A
  • Lie: Longitudinal/Oblique/Transverse
  • Presentation: Cephalic/Breech
  • Anterior/Posterior
  • Occipital/Sacral
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17
Q

How much does cervix dilate in labour?

A

Up to 10cm

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18
Q

Maximum size of birth canal determined by pelvis, how large is the Pelvic Inlet typically?

A
  • 13.5cm X 11 cm
  • Softening of ligaments may increase it
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19
Q

After 36 weeks, the presenting part of the baby..?

A

“Sinks” into pelvis, known as the “lightening”

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20
Q

Does “lightening” occur in multi-parous women?

A
  • Happens less in multi-parous women
  • Multi-parous women often have some painful powerful
    contractions a few days before
  • But not regular and not effective in dilating the cervix
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21
Q

Creation of the Birth Canal

A
  • Expansion of soft tissues
  • Lower uterine segment
  • Cervix
  • Vagina
  • Perineum
  • Some relaxing of ligaments to increase pelvic inlet,
    cavity and outlet
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22
Q

What is ‘cervical ripening’?

A

The normal process of softening and opening the cervix before labor starts

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23
Q

What processes occur during ‘cervical ripening’?

A
  • Reduction in collagen
  • Increase in glycosaminoglycans
  • Reduced aggregation of collagen fibres
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24
Q

What triggers ‘cervical ripening’?

A
  • Triggered by prostaglandins
  • PGE2 and F2-alpha
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25
Q

What is the structure of the cervix throughout most of the pregnancy?

A
  • Cervix retains foetus for most of pregnancy
  • Tough, thick walled 3 cm canal
  • Collagen
  • Cervical incompetence
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26
Q

What is Cervical Effacement?

A

Effacement means that the cervix stretches and gets thinner

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27
Q

‘Braxton-Hicks’ Contractions

A

Also known as prodromal or false labor pains, are contractions of the uterus that typically are not felt until the second or third trimester of the pregnancy, they are the body’s way of preparing for true labor

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28
Q

Uterine contractions have two major goals, what are they?

A
  • To dilate cervix
  • To push the foetus through the birth canal
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29
Q

Contractions made more forceful and frequent by…?

A
  • Prostaglandins (more Ca2+ per action potential)
  • Oxytocin (more action potentials, lower threshold)
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30
Q

What are Prostaglandins? Where are they mainly produced?

A
  • Biologically active lipids
  • Local hormones
  • Produced mainly in endometrium
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31
Q

What is production of Prostaglandins controlled by?

A

Production controlled by oestrogen progesterone ratio

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32
Q

What effect do Prostaglandins have?

A
  • Powerful contractors of smooth muscle
  • Involved in cervical softening
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33
Q

What is a Low Oestrogen-Progesterone Ratio? What effect does this have on Prostaglandins?

A
  • Progesterone>Oestrogen
  • Low Prostaglandins
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34
Q

What is a High Oestrogen-Progesterone Ratio? What effect does this have on Prostaglandins?

A
  • Oestrogen>Progesterone
  • Increased Prostaglandins
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35
Q

What is Oxytocin?

A

Oxytocin is a peptide hormone, as an important role in many human behaviours including sexual arousal, recognition, trust, romantic attachment and mother–infant bonding

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36
Q

Where is Oxytocin secreted from?

A
  • Secreted by posterior pituitary
  • Controlled by hypothalamus
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37
Q

What is the Ferguson Reflex?

A

A neuroendocrine reflex in which the foetal distension of the cervix stimulates a series of neuroendocrine responses, leading to oxytocin production

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38
Q

What hormone induces oxytocin receptors on uterus?

A

Oestrogen from ovaries

39
Q

What is Induced Labour?

A

Artificially stimulated labour

40
Q

What is the Bishop Score?

A
  • A calculation used to predict how close you are to
    labor
  • A Bishop score of 8 or greater is considered to be
    favorable for induction
41
Q

What conditions may indicate induction of labour? (3)

A
  • Severe preeclampsia
  • Recurrent antepartum haemorrhage
  • Pre-existing disease (diabetes)
42
Q

What are the 3 Induction Methods?

A
  • Prostaglandin
  • Oxytocin
  • Amniotomy
43
Q

Induction Method: Prostaglandin

A
  • Locally applied PE2 as vaginal gel, tablet or pessary
  • Ripens cervix and reduces incidence of operative
    delivery when compared to use of oxytocin alone
  • NICE guidance reg. dose to reduce risk of
    hyperstimulation of uterus
44
Q

Induction Method: Oxytocin

A
  • IV infusion of synthetic oxytocin
  • Post amniotomy or SROM
  • Requires careful dose titration in accordance with
    frequency and strength of contractions
  • Requires constant foetal monitoring
45
Q

Induction Method: Amniotomy

A
  • Thought to cause local release of endogenous PG
  • Done using amnihook
46
Q

Complications of an Amniotomy? (6)

A
  • Cord prolapse
  • Infection
  • Bleeding from vasa praevia
  • Placental separation
  • Failure to induce efficient contractions
  • Amniotic fluid embolism
47
Q

What is a Cardiotocography?

A

A continuous recording of the foetal heart rate obtained via an ultrasound transducer placed on the mother’s abdomen

48
Q

What can happen to the foetal heart rate during contractions?

A
  • It can slow down but should return to normal post-
    contraction
  • If bradycardia persists, it is a sign of foetal distress
49
Q

With each contraction the baby descends, how can this descent be measures?

A
  • This can be assessed per vagina
  • Position relative to ischial spines
50
Q

During the 2nd Stage of Labour, the baby’s head rotates internally and meets resistance of the …… ……. , the …… is “leading” and meets the sloping “gutter” of the ……. ……

A
  • Pelvic Floor
  • Occiput
  • Levator ani
51
Q

Head extends when the occiput “escapes” from under the …… ……

A

Symphysis Pubis

52
Q

What is an Episiotomy?

A

A surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues

53
Q

What is Restitution?

A

When the head is delivered it rotates back to the neutral position with the occiput facing the thigh

54
Q

How many degrees of Tears are there?

A

4

55
Q

What happens in a 1st Degree Tear?

A

Small tear in skin and vaginal epithelium

56
Q

What happens in a 2nd Degree Tear?

A

Tears are deeper and affect the muscle of your perineum

57
Q

What happens in a 3rd Degree Tear?

A

Tears also involve the anal sphincter

58
Q

What happens in a 4th Degree Tear?

A

Tears goes further into the lining of your anus or bowel

59
Q

What positions can help make labour easier? (6)

A
  • Walking and Standing
  • Kneeling
  • Sitting
  • Use a birthing ball
  • Supported standing or squatting
  • Rock on all fours or rock your pelvis in whatever
    position you find comfortable
  • Water Birth
60
Q

What Analgesia can be given during Labour? (6)

A
  • Oxygen/nitrous oxide (Entonox)
  • Paracetamol
  • Pethidine
  • Pudendal block
  • Epidural
  • Spinal anaesthesia
61
Q

Why may a Failure to Progress in Labour occur: Passage Issues (5)

A
  • Abnormal Shaped Pelvis
  • Cephalopelvic Disproportions
  • Uterine/Cervical Fibroids
  • Cervical Stenosis
  • FGM
62
Q

Why may a Failure to Progress in Labour occur: Passaenger Issues (4)

A
  • Foetal Size
  • Foetal Abnormality
  • Foetal Malpresentaion
  • Foetal Malpostion
63
Q

Why may a Failure to Progress in Labour occur: Power Issues

A

Lack of co-ordinated regular strong uterine contraction

64
Q

What is an Assisted Birth/Operative Vaginal Delivery?

A

Operative vaginal delivery is a vaginal delivery that is assisted by the use of forceps or a vacuum extractor

65
Q

What is a Cesarean Section?

A

An operation to deliver your baby through a cut made in your tummy and womb

66
Q

When does 3rd Stage of Labour commence and end?

A
  • Commences with the completed birth of the baby
  • Ends with the complete expulsion of the placenta and
    membranes
67
Q

How long does 1st Stage of Labour last?

A
  • 12 to 19 hours
  • It may be shorter for moms who’ve already had
    children
68
Q

How long does 2nd Stage of Labour last?

A
  • Within 3 hours of the start of active pushing in most
    women having their first baby
  • Within 2 hours for most women who have had a baby
    before
69
Q

How long does 3rd Stage of Labour last?

A

Usually lasts between 5 and 15 minutes but any period up to 1 hour may be considered within normal limits

70
Q

Immediately after delivery of baby, the uterus becomes
quiescent for a few minutes, what does this mean?

A

It is a period of active relaxation of the myometrial smooth muscle cells

71
Q

How does Placenta expulsion occur?

A
  • Uterus contracts down hard (A)
  • Shears off placenta (B)
  • And expels it
72
Q

Uterine Retraction and Placental Separation

A
  • Blood in intervillous space forced back into veins of
    spongy layer of decidua basalis
  • Veins become tense and congested and kept under
    pressure by underlying muscle layer of uterus
  • Blood can’t drain back into maternal bloodstream
    because uterus has retracted and doesn’t allow it
73
Q

What is the importance of uterine contraction in the 3rd Stage of Labour?

A
  • Compresses blood vessels
  • Reduce haemorrhage
74
Q

What is Postpartum Haemorrhage?

A

Bleeding form the genital tract of more than 500ml after delivery of the infant

75
Q

What are the 2 Types of Postpartum Haemorrhage?

A
  • Primary: Within 24hrs
  • Secondary: Between 24hrs and 6 weeks
76
Q

How often does Postpartum Haemorrhage occur?

A

Incidence in 5% of deliveries

77
Q

When does Postpartum Haemorrhage become clinically significant?

A
  • Clinically loss of >1000ml more clinically significant
  • > 1500ml major obstetric haemorrhage
78
Q

What is Antepartum Haemorrhage?

A

Bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby

79
Q

Why may Antepartum Haemorrhage occur? (3)

A
  • Normally sited placenta: Abruptio placentae
  • Low lying placenta: Placenta praevia/Vasa praevia
  • Another cause such as cervical cancer/cervical erosion
80
Q

What is Abruptio placentae?

A

Occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery

81
Q

What is Placenta praevia?

A
  • Low lying placenta attached to the lower uterine
    segment
  • Partly attached to the lower segment to covering the
    whole of the internal cervical os
82
Q

What is Vasa praevia?

A

A very rare condition where blood vessels travelling from your baby to your placenta, unprotected by placental tissue or the umbilical cord, pass near to the cervix

83
Q

Symptoms of Antepartum Haemorrhage (4)

A
  • Vaginal Bleeding
  • Abdominal Pain
  • Uterine Contractions
  • Uterine Tenderness
84
Q

What System is used for Assessment of the Newborn?

A

Apgar Scoring System

85
Q

What does APGAR stand for?

A

Activity (muscle tone)
Pulse
Grimace (reflex irritability)
Appearance (skin colour)
Respiration

86
Q

How is APGAR Scored?

A
  • Each section scored 0-2
  • Total score of 1 to 10
  • A score of 7, 8, or 9 is normal and is a sign that the
    newborn is in good health.
87
Q

What happens when the neonate takes its first breath?

A
  • Reduces pulmonary vascular resistance
  • Increases arterial PO2
  • Left arterial pressure exceeds right
  • Foramen ovale closes
  • Ductus arteriosus contracts in response to raised pO2
  • Foetal converts to adult circulation
88
Q

What is Shoulder Dystocia?

A

When the baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pubic bone, delaying the birth of the baby’s body

89
Q

What 2 Manoeuvres are performed to help in the case of Shoulder Dystocia?

A
  • Woods Corkscrew Manoeuvre
  • McRoberts Manoeuvre
90
Q

Woods Corkscrew Manoeuvre

A

The obstetrician places a hand on the anterior aspect of the posterior foetal shoulder and rotates the shoulder toward the foetal back

91
Q

McRoberts Manoeuvre

A
  • Hyperflex maternal hips (knees to chest position) and
    tell the patient to stop pushing
  • This widens the pelvic outlet by flattening the sacral
    promontory and increasing the lumbosacral angle
  • This single manoeuvre has a success rate of about
    90% and is even higher when combined with
    ‘suprapubic pressure’
92
Q

What is Erb’s palsy?

A

The infant’s arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6

93
Q

What is Klumpke’s palsy?

A
  • A form of brachial plexus palsy
  • Paralysis of the arm

The Reproductive System (19 decks)

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