Normal labour Flashcards
What is labour?
A physiological process during which the fetus, membranes, umbilical cord and placenta are expelled from the uterus.
Three key factors in quality of labour?
Power
Passage
Passenger
3 P’s
Action of progesterone during labour?
Keeps uterus settled
Prevents formation of gap junctions
Oestrogen?
Makes uterus contract
Promotes prostaglandins
Oxytocin?
Oxytocin initiates and sustains contractions
Acts on decidual cells to release PGs
Where is oxytocin synthesised?
Decidual and extraembryonic fetal tissues and placenta
What is Fergusons reflex?
Cycle of uterine contractions initiated by pressure at the cervix or vaginal walls. + Fedback
First stage of labour?
Latent and active
Latent- mild irregular uterine contractions
Active- slow descent of presenting part
Second stage of labour?
Complete dilatation of cervix to delivery of baby
Third stage of labour?
Delivery of abby to expulsion of placenta and fetal membranes
Active management of third stage
Prophylactic syntometrine
Cord clamping
Controlled cord traction
Bladder emptying
What causes cervical softening?
Increase in hyaluronic acid decreases bridging amongst collagen fibres
What are braxton-Hicks contractions?
“False labour”
Irregular relatively painless contractions
What are real labour contractions?
Evenly spaced, painful contraction
Time between gets shorter and shorter
Pacemaker of contractions?
Region of tuba ostia
What is an anthropoid pelvis?
Oval shaped inlet with large AP diameter and smaller transverse diameter
What is an android pelvis?
Triangular or heart shaped inlet and is narrower from the front
How often should vaginal exams be carried out during labour?
Approx every 4 hours
5 parameters used to assess the cervix?
Effacement Dilatation Firmness Position Level of presenting part
What is Bishops score?
A pre labour scoring system used to assess whether induction of labour will be required
Analgesia options?
Para/Co codamol TENS Entonox Diamorphine Epidural Remifentanyl Combined spinal/epidural
What is considered normal blood loss during labour?
500ml or less, any more is abnormal
The 3 classic signs that indicate placental separation?
Uterus contract, hardens and rises
Umbilical cord lengthens permanantly
Gush of blood
How is haemostasis achieved after the baby is delivered?
Tonic contraction: Lattice pattern of uterine muscle strangulates blood vessels
Thrombosis of torn vessel ends
What is Peurperium?
Period of repair and recovery ~ 6 weeks
What is lochia?
Vaginal discharge containing blood, mucous and endometrial castings
Hormonal changes in puerperium?
Decrease in oestrogen
Decrease in progesterone
Prolactin maintained
