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Reproduction Physiology > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

Definition of Labour

A

The process by which the foetus, placenta and membranes are expelled via the birth canal

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2
Q

Term of labour occurs at how many weeks gestation?

A

37-42 weeks

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3
Q

The 3 key physiological changes that occur to allow for expansion of the foetus

A
  1. Cervix softens
  2. Myometrial tone changes to allow for coordinated contractions
  3. Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate
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4
Q

Cervix changes for expulsion of the foetus

A 
From supportive role to birth canal 
Softens
Effaces
Thins out (paper thin)
Moves forward from being quite posterior
Dilate
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5
Q

How many stages of labour are there?

A

3

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6
Q

Substages of Stage 1 of Labour

A

Latent stage

Established stage

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7
Q

What does the latent stage of stage 1 involve?

A

Intermittent, often irregular painful contractions which bring about some cervical effacement and dilatation up to 4cm

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8
Q

Does everyone experience the first latent stage?

A

No

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9
Q

What does the established first stage 1 involve?

A

Regular, painful contractions that result in progressive effacement and cervical dilatation from 4cm (WHO says 5cm)

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10
Q

How long does the established stage last in primigravida mothers?

A

On average 8 hours

Unlikely to last longer than 18 hours

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11
Q

How long does the established stage last in multigravida mothers?

A

On average 5 hours

Unlikely to last over 2 hours

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12
Q

Where do the uterine contractions start?

A

The fundus of the uterus

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13
Q

How does the cervix dilate?

A

Uterine contractions move across
This exerts pressure on the foetal pole which encourages flexion and a well applied presenting part
Which in turn puts pressure on the cervix to thin and dilate

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14
Q

Anticipated progress of cervix dilation

A

0.5-1.0cm per hour

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15
Q

How often do you do a vaginal exam during labour?

A

every 4 hours

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16
Q

The cervix is fully dilated at….

A

10cm

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17
Q

When is the established first stage of labour complete?

A

When the cervix is fully dilated at 10cm

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18
Q

Substages of the second stage of labour

A

Passive stage

Active stage

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19
Q

Definition of Stage II of Labour

A

From full cervical dilatation to the birth of the baby

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20
Q

Passive Second stage of Labour involves

A

Finding of full dilatation of the cervix before or in the absence of involuntary expulsive contractions

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21
Q

What may women want to do in the passive second stage of labour?

A

May want to move around/change position

This means the baby is about to descend

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22
Q

How does the passive stage last?

A

1 hour to allow further foetal descent

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23
Q

The active second stage of labour involves

A

Active maternal effort (expulsive contractions) following confirmation of full dilatation of the cervix in the absence of expulsive contractions

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24
Q

Which substage of the second stage of labour is the presenting part visible?

A

Active stage

25
Q

How long does the active stage of stage II of labour last in primigravida women?

A

Within two hours of the active stage commencing

26
Q

How long does the active stage of II of labour last in multigravida women?

A

Within one hour of the active stage commencing

27
Q

Definition of the Stage III of Labour

A

The time of birth of the baby to the expulsion of the placenta and membranes

28
Q

What happens to the placenta as the baby is born?

A

It folds in on itself and is covered by the membranes

29
Q

What can happen to the membranes in the third stage of labour?

A

Can rupture spontaneously

Can be ruptured artificially e.g. by a hook

30
Q

Two types of management for stage III

A

Active management

Physiological management

31
Q

Active management of stage III involves

A

Routine use of uterotonic drugs
Deferred clamping and cutting of the cord
Controlled cord traction after signs of separation of the placenta

32
Q

Physiological management of Stage III involves

A

No clamping of the cord until pulsating has stopped
No use of uterotonic drugs
Delivery of placenta by maternal effort

33
Q

How long does it take to diagnose a prolonged third stage of labour?

A

In active management = within 30 mins of birth

In physiological management = within 60 mins of birth

34
Q

MOEWS

A

Modified obstetric early warning score

35
Q

Progress and monitoring of labour done by

A 
MOEWS
BP
HR
Temp
Respirations, O2 sats
urine output and urinalysis
abdominal palpation (PRIOR TO VE)
Vaginal examination 
Monitoring of liquor (colour, smell, volume) once rupture of membranes has occurred 
Auscultation of foetal heart 
Palpation of uterine muscle contractions 
External signs e.g. Rhomboid of Michaelis and Anal cleft line
36
Q

Before what does abdominal palpation ALWAYS have to be done

A

Vaginal Examination

37
Q

What does abdominal palpation look at?

A 
Foetal lie
presentation 
altitude
denominator
position 
engagement
38
Q

What does vaginal exam look at?

A 
Presentation 
engagement
station 
position 
cervical effacement and dilatation 
presence/absence of membranes
39
Q

How to auscultate the foetal heart

A

Intermittedly with hand held doppler
pinards
continuously with CIG (cardiotocograph)

40
Q

How often to intermittendly monitor the babys heart

A

1st stage of labour = every 15 mins

2nd stage of labour = every 5 mins

Active phase = try after every contraction

41
Q

If the baby’s heart increases from baseline, this means….

A

Infection

42
Q

If the baby’s heart decreases from baseline, this means…..

A

Stress

43
Q

How many contractions are normal?

A

3-4 every 10 mins, lasting 40-60 seconds

Moderate to strong in strength

44
Q

What is the Rhomboid of Michaelis?

A

The baby puts pressure on the lower sacrum and you can see this - its easier to see in slimmer women

45
Q

What is the anal cleft line?

A

Purple line that appears in the second stage due to the pressure (from a reddish colour)

46
Q

Different possible presentations of the foetus

A 
Face
Brow
Vertex
Breach 
Shoulder
47
Q

Position in normal labour is the position in relation to the

A

Occiput (posterior fontanelle)

48
Q

The mechanism of labour and changes of the position of the body

A
  1. Descent and flexion
  2. Internal rotation of the head
  3. Crowning and extension of the head
  4. Restitution (turns)
  5. Internal rotation of the shoulders
  6. External rotation of the head
  7. Lateral flexion
49
Q

Position of normal labour

A

LOA or ROA

50
Q

Lie of normal labour

A

Longitudinal lie

51
Q

Presentation of normal labour

A

Vertex and cephalic presentation

52
Q

Denominator in normal labour is the….

A

Occiput

53
Q

Which bone is meant to be the presenting part of the foetus?

A

Anterior parietal bone

54
Q

Analgesics used in labour

A 
Breathing, massage, paracetamol 
dihydrocodeine 
Water
Entonox (nitrous oxide + oxygen inhaled)
Opoids (morphine, diamorphine, pethidine)
Epidural 
Reminifentanil patient controlled analgesia 
Maternal position and mobility
Continous midwifery  
Birthing balls, baths and pools
55
Q

Mechanisms of labour

A 
Engagement
Descent 
Flexion 
Internal rotation 
Extension 
Restitution and external rotation 
Expulsion
56
Q

Indications for C section

A 
Absaloute CPD
Placenta praevia grades 3 / 4
Pre eclampsia
Post maturity 
IUGR
Foetal distress in labour / prolapsed cord
Failure to progress in labour
Malpresentations; brow
Placental abruption if foetal distress
Vaginal infection e.g. active herpes
Cervical cancer
57
Q

Serious complications of C sections

A 
Emergency hysterectomy
Need for further surgery at a later date
Thromboembolic disease
ITU admission 
Bladder or ureteric injury 
Death 1 in 12 000
Future pregnancies
- Increased risk of uterine rupture
- increased risk of antepartum stillbirth 
- increased risk of pregancies with placenta praevia and placenta accreta
58
Q

Frequent complications of C sections

A

Persistent wound and abdo discomfort in 1st few months
Increased risk of C section in subsequent pregnancies
Readmission to hosp
Haemorrhage
Infection
Foetal lacerations 1 - 2 babies per 100

Reproduction Physiology (13 decks)

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