Machanism of labour - GM

Question 1

first stage of labour

Answer 1

cervix starts to soften and open
ends when there is full cervical dilatation and effacement

Question 2

second stage of labour

Answer 2

commences with complete cervical dilatation and ends with delivery of the fetus

Question 3

third stage of labour

Answer 3

initiates after the fetus is delivered and ends when the placenta is delivered

Question 4

discomforts of pregnancy

Answer 4

nausea and vomiting
fatigue
constipation
haemorrhoids
insomnia
heartburn
backache
varicosities

Question 5

solutions for nausea and vomiting

Answer 5

small frequent meals, low fat, dry carbohydrate before rising, keep hhydrated, ginger
more severe is called hyperemesis gravidarum

Question 6

constipation during pregnancy is caused by

Answer 6

slowing of gut motility
may be worsened by iron supplements

Question 7

changes in the fetus during labour

Answer 7

anterior pituitary gland releases adrenocorticotrophic hormone to stimulate the adrenal gland to produce glucocorticoids and androgens

Question 8

changes in the mother during labour

Answer 8

decrease in progesterone increases uterine sensitivity to stretching
increase in prostaglandins from the placenta increases uterine contractions, uterine sensitivity to oxytocin, and softening of cervix

Question 9

is rupture of membranes a true indicator of labour

Answer 9

no - unless cervical change is present

Question 10

latent vs active labour

Answer 10

latent - time between start of contractions to cervix openng 4cm
active - between 4-10cm

Question 11

parts of the second stage of labour

Answer 11

full dilation of cervix until birth
propulsive phase - full dilation with descent of the fetal head to the pelvic floor, no maternal urge to push
expulsive phase - maternal effort, bearing down resulting in birth

Question 12

posterior labour

Answer 12

longer labour - because it takes longer to rotate
baby may not sit well on the cervix - less likey to promote cervix to dilate

Question 13

reasons to perform vaginal assessments

Answer 13

baseline on admission
before administering analgesia
to confirm full cervical dilatation
fetal distress
to determinne best method of induction of labour depending on cervical length and position
usually performed 4 hourly to assess progress

Question 14

if the patient is pushing to early

Answer 14

if the patient is getting the urge to push while the cervix is still present/palpable, the pushing against the cervix can cause cervical oedema, which will slow down labour
advise patient not to push until the cervix is no longer palpable, this may reuire pain relief or channge of position to remove pressure off the back passage so that they no longer feel the urge to push.

Question 15

4 Ps of labour

Answer 15

Powers: uterine contractions + secondary Powers which are abdominal muscles and diaphragm
Passeges
Passenger: lie/presentation/attitude
Psyche: psychological or emotionl barriers to physiological labour if the patient feels unsafe, has had a previous traumatic birth experience, are survivors of sexual abuse

Question 16

lie

Answer 16

the relationship between the long axis of the fetus and the mother
longitudinal, transverse or oblique

Question 17

presentation

Answer 17

the fetal part that first enters the maternal pelvis
cephalic vertex is the most common and is considered the safest
other presentations include breach, face and brow

Question 18

position

Answer 18

the position of the fetal head as it exits the birth canal
usually occipital-anterior, this is ideal for birth
occipito-posterior or occipito-transverse

Question 19

risk factors for abnromal fetal lie, malpresentation and malposition

Answer 19

prematurity
multiple pregnancy
uterine abnormalities
fetal abnormalities
placenta praevia
primiparity

Question 20

involution pain

Answer 20

pain while the uterus goes back to where it normally is