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Reproductive - Childbirth > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

Labour is a physiological process during which what gets expelled?

A

The foetus, membranes, umbilical cord and placenta

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2
Q

Labour is usually associated with what physical symptom? Describe what happens to this as labour progresses?

A

Painful uterine contractions which increase in frequency, intensity and duration as labour progresses

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3
Q

What are the two main cervical changes which occur during labour?

A

Cervical effacement and dilatation

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4
Q

What are the main options about where to birth?

A

Consultant led unit, midwife led unit or homebirth

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5
Q

What is recommended with regards to making a birth plan?

A

Women are encouraged to make a birth plan but don’t have to

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6
Q

A change in the ratio of which hormones may be responsible for the onset of labour?

A

Oestrogen and progesterone

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7
Q

What foetal factors may control the onset of labour?

A

Foetal adrenal and pituitary hormones, as well as surfactant production secreted into the amniotic fluid

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8
Q

What is Ferguson’s reflex?

A

The positive feedback cycle of uterine contractions initiated by pressure at the cervix or vaginal walls

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9
Q

What are the roles of oestrogen in initiating labour?

A

Promote uterine contractions and prostaglandin production

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10
Q

What are the roles of oxytocin in initiating labour?

A

Initiate and sustain contractions and promote prostaglandin release

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11
Q

Where is oxytocin synthesised at delivery?

A

In decidual and extraembryonic foetal tissue as well as in the placenta

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12
Q

The number of oxytocin receptors where increase towards the end of delivery?

A

In the decidual and myometrial tissue

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13
Q

An increase in foetal cortisol triggers an increase in which maternal hormone?

A

Oestriol

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14
Q

When can the membranes rupture?

A

Pre-term, pre-labour, 1st stage, 2nd stage or baby can be born in a caul

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15
Q

Cervical tissue is formed of what?

A

Mostly collagen 1-4, but also smooth muscle and elastin held together by ground substance

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16
Q

What are the two phases of the first stage of labour? What defines them both?

A

Latent phase (up to 3-4cm dilated) and active phase (4-10cm dilatation)

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17
Q

What defines the timing of the second stage of labour?

A

Full dilatation to delivery of the baby

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18
Q

What defines the timing of the third stage of labour?

A

Lasts from the delivery of the baby to the expulsion of the placenta and membranes

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19
Q

Describe the contractions in the latent first phase of labour?

A

Mild and irregular

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20
Q

What happens to the cervix in the latent first phase of labour?

A

It shortens and softens - by the end of this phase the cervix is fully effaced

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21
Q

What is the duration of the latent first phase of labour?

A

Very variable - can last up to a few days

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22
Q

What happens to the uterine contractions in the active first phase of labour?

A

They become more rhythmic and stronger

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23
Q

What would count as normal progress in the active phase of the 1st stage of labour?

A

Dilating by 1-2cm per hour

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24
Q

What happens to the cervix in the active phase of the 1st stage of labour?

A

It dilates to 10cm (full dilatation)

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25
Q

In nulliparous women, the second stage of labour would be considered prolonged after how long if the woman a) had regional anaesthesia? b) did not have regional anaesthesia?

A

a) 3 hours b) 2 hours

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26
Q

In multiparous women, the second stage of labour would be considered prolonged after how long if the woman a) had regional anaesthesia? b) did not have regional anaesthesia?

A

a) 2 hours b) 1 hour

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27
Q

Are vaginal examinations always carried out to assess the time of full dilatation?

A

No, not always in a low risk case

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28
Q

What is the average duration of the 3rd stage of labour?

A

10 mins

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29
Q

If the placenta hasn’t been delivered within 1 hour of delivering the baby, what should happen?

A

Preparation for removal under GA

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30
Q

What is expectant management for the 3rd stage of labour?

A

Spontaneous delivery of the placenta

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31
Q

What is active management for the 3rd stage of labour?

A

The use of oxytocic drugs and controlled cord traction

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32
Q

What are the 5 elements of the Bishop’s score?

A

Cervical position, consistency, effacement, dilatation and station

33
Q

Describe the cervical positions and what score they would give you in the Bishop’s score?

A

Posterior = 0, mid-position = 1, anterior = 2

34
Q

Describe the cervical consistencies and what score they would give you in the Bishop’s score?

A

Firm = 0, medium = 1, soft = 2

35
Q

Describe the cervical effacements and what score they would give you in the Bishop’s score?

A

0-30% = 0, 30-50% = 1, 60-70% = 2, > 80% = 3

36
Q

Describe the cervical dilatations and what score they would give you in the Bishop’s score?

A

Closed = 0, 1-2cm = 1, 3-4cm = 2, > 5cm, = 3

37
Q

Describe the cervical stations and what score they would give you in the Bishop’s score?

A

-3 = 0, -2 = 1, -1 = 2, 1/2 = 3

38
Q

A Bishop’s score of < 5 indicates what?

A

Labour is unlikely to start without induction

39
Q

A Bishop’s score of > 9 suggests what?

A

Labour will most likely commence spontaneously

40
Q

Braxton-Hicks contractions can also be known as what? Why?

A

False labour - because they give the woman a false sensation that she is in real labour

41
Q

What causes Braxton-Hicks contractions?

A

Tightening of the uterine muscles which is thought to aid the body to prepare for birth

42
Q

When can Braxton-Hicks contractions occur?

A

Can start 6 weeks into pregnancy but are usually more commonly felt in the 3rd trimester

43
Q

Describe a Braxton-Hicks contraction?

A

Irregular, do not increase in frequency or intensity, relatively painless

44
Q

What can make Braxton-Hicks contractions better?

A

Light activity

45
Q

True labour contractions occur under the influence of what?

A

Release of oxytocin

46
Q

What is true labour?

A

When the contractions become evenly spaced and the time between them gets shorter and shorter

47
Q

What are the 3 key factors of labour?

A

Power, passage and passenger

48
Q

Where is the highest density of uterine smooth muscle found? Waves from uterine contractions pass in which direction?

A

At the fundus / in a downward direction

49
Q

Up to how many uterine contractions in 10 minutes is normal?

A

3-4

50
Q

What is the normal duration of a uterine contraction? What is the duration when it reaches its maximum?

A

10-15 secs / 45 secs

51
Q

When do maximum intensity uterine contractions occur?

A

In the second stage

52
Q

What is the most suitable female pelvic shape for vaginal delivery?

A

Gynaecoid

53
Q

Describe what an anthropoid pelvis looks like?

A

Oval shaped inlet with large AP diameter and small transverse diameter

54
Q

Describe what an android pelvis looks like?

A

Triangular or heart shaped inlet and is narrower at the front

55
Q

Women of which ethnic origin are more at risk of an android pelvis?

A

Afro-Caribbean

56
Q

What would be the normal/ideal way for each of the following to be: a) foetal lie? b) foetal presentation? c) presenting part? d) foetal position?

A

a) longitudinal b) cephalic c) vertex d) OA

57
Q

How should the baby’s head ideally be during delivery?

A

Flexed

58
Q

What would be the abnormal way for each of the following to be at delivery: a) foetal lie? b) foetal presentation? c) foetal position?

A

a) transverse or oblique b) breech c) OP

59
Q

How can the baby’s position be determined during labour?

A

Fontanelles can be felt on vaginal examination

60
Q

What are the 7 cardinal movements of labour?

A

Engagement, descent, flexion, internal rotation, extension (crowning), restitution and external rotation, expulsion

61
Q

What is engagement?

A

The passage of the widest part of the foetal head to a level below the pelvic inlet

62
Q

The foetal head is engaged when?

A

3/5ths of foetus has entered the pelvis and 2/5ths are still in the abdomen

63
Q

What is descent?

A

Downward passage of the presenting part through the pelvis

64
Q

As the foetal head engages and descends, what pelvic diameter is the largest? For this reason, what position should the baby’s head be in?

A

Transverse diameter of the pelvis is larger at the pelvic inlet / baby’s head should be in an occiput-transverse position

65
Q

In normal labour, how often should vaginal examinations be carried out?

A

Every 4 hours

66
Q

Why does flexion of the foetal head occur?

A

Occurs passively as the head descends due to resistance from the pelvic floor

67
Q

Describe the internal rotation that occurs as a foetus passes through the birth canal?

A

Rotation from the transverse to anterior position (i.e. facing mother’s back)

68
Q

Why does the foetus internally rotate during delivery?

A

As it reaches the pelvic outlet, the AP diameter is wider than the transverse diameter

69
Q

When is crowning said to occur? What foetal movement does this trigger?

A

When the foetus has reached the level of the introitus, allows foetal head extension

70
Q

What part of the foetal head delivers first?

A

Occiput

71
Q

Once the baby’s head has been delivered, what movement occurs?

A

External rotation (away from the mother’s back)

72
Q

What happens in expulsion?

A

The rest of the foetal body is delivered: anterior shoulder first, then posterior shoulder and then the rest of the body

73
Q

When the baby is crowning, how will this feel for the mother?

A

Burning and stinging

74
Q

How should delivery of the head be managed?

A

You should be guiding but not leading to prevent rapid extension of tissues and perineal tearing

75
Q

What may be required to prevent trauma to the anal sphincter?

A

An episiotomy

76
Q

What is a partogram?

A

A graphic record of key data contained on one sheet

77
Q

What factors are comprised on a partogram?

A

Maternal observations, cervical dilatation and foetal wellbeing

78
Q

How often should each of the following be measured during delivery: a) frequency of contractions? b) maternal pulse? c) maternal BP and temp?

A

a) every 30 mins b) hourly c) 4 hourly

Reproductive - Childbirth (9 decks)

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