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Reproduction Year 3 > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

what are the 3 key factors during labour

A

POWER: uterine contaction
PASSAGE: maternal pelvis
PASSENGER: fetus

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2
Q

What hormone initiates + sustains contractions

A

oxytocin

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3
Q

what other roles does oxytocin have

A

acts on decidual tissue to promote prostaglandin release

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4
Q

what hormone makes the uterus contract

A

oestrogen

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5
Q

name the other function of oestrogen in labour

A

promotes prostaglandin production

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6
Q

what is the role of progesterone

A

Keeps the uterus settled
Prevents formation of gap junctions
Hinders contractibility of myocytes

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7
Q

What hormone changes cause the initiation of labour

A

progesterone withdrawal

Increase in oestrogen + prostaglandin action

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8
Q

what hormone from the placenta is likely involved in starting the changes leading to labour

A

CRH

Corticotrophin-releasing hormone

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9
Q

What is the Ferguson reflex

A

name given to neuroendocrine reflex that self-sustains the cycle of uterine contractions initiated by the pressure at the cervix/vaginal walls

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10
Q

what is the bishop score

A

method used to assess if it is safe to induce labour

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11
Q

Name the 5 components of the bishop score

A 
position 
consistency 
effacement
dilatations
station in pelvis
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12
Q

Describe stage 1 of labour

A

Commences with onset of regular painful contractions
Latent phase - up to 3-4cms dilatation
Active phase - 4-10cms dilatation

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13
Q

Describe stage 2 of labour

A

Full dilatation achieved
Delivery of baby
Divided into pelvic/passive phase (head descends down pelvis)
Active phase (when the mother pushes)

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14
Q

describe stage 3 of labour

A

Expulsion of placenta and membranes after birth of baby

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15
Q

After what time is the decision made to remove the placenta under GA if it has not been delivered naturally

A

1 hour

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16
Q

What can be given to help the mother deliver the placenta

A

Oxytocic drugs- oxytocin 10 units OR syntometerine 1ml

Controlled cord traction, cord clamping + cutting, bladder emptying

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17
Q

what causes the cervix to soften in preparation for labour

A

increased hyaluronic acid

decreases bridging among collagen fibres - decreased firmness

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18
Q

what causes the cervix to ripen in preparation for labour

A

decrease in collagen fibre alignment/stretch/tensile strength
Increase in cervical decorin

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19
Q

What are Braxton hicks contractions

A

Tightening of the uterine muscles, thought to aid the body prepare for birth
Not usually felt until 2nd/3rd trimester

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20
Q

what are true labour contractions

A

pain described as a wave- starts low, rises until it peaks, and finally ebbs away

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21
Q

what will the mothers abdomen feel like during contraction

A

hard

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22
Q

where in the uterus do contractions start

A

fundus

23
Q

what are Braxton Hicks contractions also called

A

false labour

24
Q

features that differentiate Braxton hicks contractions from true contractions

A

irregular
do not increase in frequency or intensity
resolve eventually
relatively painless

25
Q

features of true labour contractions

A 
evenly spaced (e.g. 5 mins apart)
Time between them gets shorter and shorter
get more intense and painful
promote thinning of the cervix
don't resolve
26
Q

what is the Ostia

A

distal tube opening of the infundibulum of uterine tube into abdominal cavity

27
Q

where do contractions synchronise from

A

both Ostia

28
Q

what shaped pelvis is most suitable for labour

A

gynaecoid pelvis

29
Q

what are the other shapes of pelvis

A

anthropoid - oval shaped inlet
Android- triangle inlet (afro-carribean women)
Platypelloid

30
Q

What is the function of amniotic fluid (liquor)

A

nurtures and protects the foetus

facilitates movement

31
Q

what colour should liquor be

A

clear

Red/pink suggests bleeding

32
Q

what is the normal fetal position

A

longitudinal lie
cephalic presentation
presenting part = vertex

33
Q

Normal fetal position in labour

A

Occipitoanterior with head engaging occiptial-transverse

34
Q

what are the major fontanelles in the fetal skull

A 
anterior fontanelle (diamond shaped)
posterior fontanelle
35
Q

how do 95% of fetal heads appear in vertex presentation

A

flexed

36
Q

What position does a flexed vertex baby go into

A

NORMAL

e.g. occipitoanterior

37
Q

What position does an extended or deflexed vertex baby go into

A

ABNORMAL

e.g. occipitoposterior or transverse

38
Q

how is the descent of the head referenced

A

abdominal 5ths

39
Q

what is crowning

A

appearance of a large segment of head at the Introitus

Labia are stretched to full capacity

40
Q

what may be required to prevent trauma to the anal sphincters during crowning

A

episiotomy

41
Q

what are the analgesic options for Labour

A 
Paracetemol /co-codamol
TENS (electrical pulses)
Entonox (inhalation agents) 
Diamorphine
Epidural 
IV Remifentanyl 
Combines spinal/epidural
42
Q

what is the risk with epidural

A

respiratory depression

43
Q

what is a normal blood loss in labour

A

<500mls

44
Q

what is an abnormal blood loss in labour

A

> 500mls

45
Q

what is a significant blood loss in labour

A

> 1500mls

46
Q

what are the signs that the placenta has separated

A

uterus contracts, hardens and rises
Umbilical cord lengthens permanently
gush of blood

47
Q

How is haemostasis achieved after delivery

A

Tonic contaction of uterine muscle strangulates blood vessels
Thrombosis of the torn vessel ends- pregnancy is a hyper-coagulable state

48
Q

What is puerperium

A

period of repair and recovery

Return of tissues to non-pregnant state in 6 weeks

49
Q

What is lochia

A

vaginal discharge following delivery containing blood, mucus and endometrial castings

50
Q

different types of lochia

A

rubra (fresh red)
Serosa (brownish-red, watery)
Alba (yellow)

51
Q

what initiates lactation

A

placental expulsion

52
Q

what is colostrum

A

name given to milk produced by mothers

53
Q

what is colostrum rich in

A

immunoglobulins

Reproduction Year 3 (36 decks)

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