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Obs and Gynae > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

When does normal labour occur?

A

After 37 weeks gestation

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2
Q

What is labour?

A

Fetus, membranes, umbilical cord and placenta expelled from uterus
Regular, painful uterine contractions w biochemical changes in cervical tissue (cervical dilatation and effacement)

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3
Q

What does progesterone do in labour?

A

Hinders contractility of myocytes - reduced excitability of uterus

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4
Q

What does oestrogen do in labour?

A

Makes uterus contract

Promotes prostaglandin production

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5
Q

What does oxytocin do in pregnancy?

A

Initiates and sustains contractions

Acts on decidual tissue to promote prostaglandin release

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6
Q

What initiates labour?

A

Degree of uncertainty
Change in oestrogen and progesterone ratio
Positive feedback by stretch of cervix - increases uterine contractions and oxytocin release
Oxytocin release promotes prostaglandin release - increases uterine contractions

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7
Q

What is latent phase of the first stage of labour?

A

Latent phase - cervix shortens and softens (effacement), mild irregular uterine contractions

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8
Q

What is the second stage of labour?

A

passage of fetus through birth canal

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9
Q

What is the active phase of the first stage of labour?

A

Active phase - 4cm onwards, contractions more rhythmic and stronger, slow descent of presenting part
- usually 1-2cm/hour

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10
Q

What does the second stage of labour start with?

A

10cm dilatation

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11
Q

How long does the second stage of labour take in a multiparous woman?

A

within 2 hours

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12
Q

How long does the second stage of labour take in a nulliparous woman?

A

within 3 hours

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13
Q

Describe the movement of the fetus during the second stage of labour.

A

1 - descent
2 - flexion - chin to chest
3 - internal rotation - head turns to face mums back
4 - extension and crowning - birth of presenting part (head)
5 - external rotation (face to the side again)
6 - lateral flexion (delivers anterior shoulder - expulsion)

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14
Q

What is the third stage of labour?

A

Delivery of the placenta

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15
Q

When does the third stage of labour occur?

A

Usually within 10 mins of baby (after 1 hour, prepare to remove under GA)

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16
Q

Where is the plane of separation for the placenta?

A

Spongy layer of decidual basalis

17
Q

What can you do to decrease third stage time?Why?

A

Injection of oxytocin or syntometerine

Decreases time and incidence of PPH

18
Q

What do you assess when examining cervix?

A 
Station 
Position 
Firmness
Dilatation 
Effacement
19
Q

What happens to the cervix during labour?

A

Softens and shortens

20
Q

Why does the cervix soften during labour?

A

Increase in hyaluronic acid - increase in molecules among collagen fibres and decreased bridging between fibres

21
Q

What are Braxton Hicks contractions?

A

Tightening of uterine muscles
Should be painless
Usually in third trimester
‘practice’ contractions

22
Q

What causes labour contractions?

A

Oxytocin release

23
Q

Describe true labour contractions.

A 
Evenly spaced (time between them gets shorter and shorter)
More intense and painful over time 
Length of each increases (10 seconds to 45)
24
Q

What do contractions do?

A

Tighten top of uterus pushing baby downwards into birth canal

25
Q

What is normal fetal position?

A 
longitudinal lie 
cephalic presentation (presenting part - vertex)
occipitoanterior position (head engages occipitotransverse)
26
Q

What is the puerperium?

A

Return of tissues to non pregnant state in 6 weeks

27
Q

What happens in the puerperium?

A

Lochia
Lactation
Uterine involution

28
Q

What is lochia?

A

Vaginal discharge with blood, mucus and endometrial castings

29
Q

When does lochia occur?

A

10-14 days after birth

30
Q

What are the different types of lochia?

A

rubra - fresh red
serosa - brownish, red, watery
alba - yellow

31
Q

What is uterine involution?

A

Regression to (almost) pre pregnancy state

32
Q

How long does uterine involution take?

A

Fundal height from umbilicus to within pelvis in 2 weeks

33
Q

How long does it take the endometrium to regenerate?

A

7 days apart from placental site

34
Q

What initiates lactation?

A

Placental expulsion (third stage of labour)

35
Q

What do prostaglandins do in labour?

A

initiate uterine contractions and cervical ripening

Obs and Gynae (27 decks)

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