normal labour

Question 1

what happens at the initiation of labour

Answer 1

• Change in estrogen/progesterone ratio
• Fetal adrenals and pituitary hormones may control timing of the onset of labour
• Myometrial stretch increases excitability of myometrial fibres
• Mechanical stretch of cervix and fetal of membranes
• Ferguson’s reflex

Question 2

what does progesterone do during the onset of labour

Answer 2

keeps the uterus settles
-prevents formation of gap junctions
-hinders the contractibility of myocytes

Question 3

what does estrogen do during the onset of labour

Answer 3

makes the uterus contract and promotes prostaglandin production

Question 4

what does oxytocin do during the onset of labour

Answer 4

initiates and sustains contraction, acts on decidual tissue to promote prostaglandin release

Question 5

other things can can help the onset of labour?

Answer 5

-pulmonary surfactant
-increase of production of fetal cortisol stimulates an increase in maternal estriol
-increase in myometrial oxytocin

Question 6

what causes cervical softening

Answer 6

increase in hyaluronic acid will decrease bridging among collagen fibres, decreasing firmness of the cervix

Question 7

what causes cervical ripening

Answer 7

changes include a decrease in collagen fibre alignment and strength, decrease in tensile strenght of the cervical matrix, and an increase in cervical decorin

Question 8

what are the two parts of the first stage of labour called

Answer 8

latent phase
active phase

Question 9

what happens in the latent phase

Answer 9

mild irregular uterine contractions, cervix shortens and softens, duration variable
-may last a few days

Question 10

what happens during active phase

Answer 10

• 4cms onwards to full dilatation
• Slow decent of the presenting part
• Contractions progressviely become more rhythmic and stronger
• Normal progress is assessed at 1-2cms per hour

Question 11

what is second stage of labour

Answer 11

complete dilatation of the cervix fully dilated to delivery of the baby

Question 12

normal length of 2nd stage in nulliparous women

Answer 12

-under 3 hours with regional analgesia
-under 2 hours without

Question 13

normal length of second stage in multiparous women

Answer 13

-under 2 hours with regional analgesia
-under 1 hour without

Question 14

what is the third stage

Answer 14

delivery of the baby to expulsion of the placenta and fetal membranes
-about 10 mins

Question 15

active management of third stage

Answer 15

use of oxytocic drugs
-controlled cord traction

Question 16

what causes contractions

Answer 16

uterine muscle and pacemaker (region of tubal ostia, wave spreads in downward direction)

Question 17

which one of these pelvises are preferred for labour

Answer 17

gynaecoid

Question 18

what are the 7 cardinal movements of labour

Answer 18

-engagement
-descent
-flexion
-internal rotation
-crowning and extension
-restitution and external rotation
-expulsion

Question 19

what is engagement

Answer 19

when 3/5ish of more of babys head is below pelvic inlet

Question 20

what is descent

Answer 20

baby moves down through pelvis

Question 21

what is flexion

Answer 21

baby puts chin to chest
-happens passively

Question 22

what is internal rotation

Answer 22

rotation to anterior position
-babys looking at the spine

Question 23

what is crowning and extension

Answer 23

when the head starts to come out of the vaginal ring
-very painful for the mother
-episiotomy may be require to prevent trauma at this point

Question 24

what is restitution and external rotation

Answer 24

the return of the fetal head to the correct anatomic position in relation to the fetal torso
-so the shoulders can get out, turn the baby on its side

Question 25

what is expulsion

Answer 25

delivery of the rest of the baby

Question 26

what is peurperium

Answer 26

period of repair and recovery
-6 weeks involving return of tissues to non-pregnant state

Question 27

how long does blood stained discharge last after birth

Answer 27

10-14 days

Question 28

what are braxton hicks contractions

Answer 28

• ‘False labour’
• Tightening of the uterine muscles, thought to aid the body to prepare for birth
• Can start 6 weeks into pregnancy but more usually felt in the third trimester
• Irregular, do not increase in frequency or intensity
• Resolve with ambulation or change in activity
• Relatively painless

Question 29

what hormone causes true labour contractions

Answer 29

oxytocin

Question 30

when does true labour happen

Answer 30

when the timing of the contractions become evenly spaced, and the time between them gets shorter and shorter

Question 31

when does the placenta get expelled

Answer 31

5-10 minutes after delivery
-considered normal up to 30

Question 32

what does Bishop’s score assess

Answer 32

whether its safe to induce labour or not

Question 33

what is assessed to make up Bishop’s score

Answer 33

-position
-consistency
-effacement
-dilation
-station in pelvis

Question 34

a Bishop’s score of what indicates unfavourable cervix and requires ripening

Answer 34

4 or less

Question 35

non-pharmacological methods of analgesia in labour

Answer 35

• Exercise/movement
• Heat e.g. warm bath, heat pack
• TENs stimulation
• Acupuncture
• Hypnosis
• Massage

Question 36

pharmacological methods of analgesia

Answer 36

-nitrous oxide (gas and air or entonox)
-paracetamol
-oral codeine phosphate
-IV/IM diamorphine
-epidural analgesia
-pudendal nerve block

Question 37

why choose delayed cord clamping

Answer 37

higher red blood cell flow to vital organs in the first week
-less anaemia
-increased duration of early breastfeeding

Question 38

when should delayed clamping happen

Answer 38

1-3 minutes after placenta is expelled