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3 Reproduction > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

what is labour

A

physiological process during which the fetus membranes, umbilical cord and placenta are expelled from the uterus

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2
Q

when do you have women going through the consultant led unit for labour

A

abnormal growth
complications
most women

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3
Q

when do you go through the midwife led unit for labour

A

more homely
no complications
simple birth

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4
Q

what is a birth plan

A

record of what women would like to happen during labour and after the birth

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5
Q

what induced labour

A

change in oestrogen/progesterone ratio

fetal adrenals and pituitary hormones

mechanical stretch of cervix - positive feedback on oxytocin

Ferguson reflex

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6
Q

what does progesterone do in labour

A

keeps uterus settled

hinders contractibility of myocytes

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7
Q

what does oestrogen do in labour

A

makes uterus contract

promotes prostaglandin production

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8
Q

what does oxytocin do in labour

A

oxytocin initiates and sustains contractions

acts of decimal tissue to promote prostaglandin release

number of oxytocin receptors increases in myometrial and decidual tissues near the end of pregnancy

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9
Q

what happens after rupture of membranes

A

baby moves down and presses on the cervix

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10
Q

what happens to the cervix in labour

A

softens (decrease in collagen fibre alignment and strength, decrease in tensile strength of the cervical matrix, increase in cervical decorin)

dilates - about 10cm

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11
Q

what is bishops score

A

determines if it is safe to induce labour

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12
Q

what are the 5 elements of the bishops score

A 
Position 
Consistency 
Effacement 
Dilation 
Station in pelvis
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13
Q

what are the stages of labour

A

First stage:
latent phase - up to 3-4cms
active stage - 4-10cms

Second stage:
Full dilatation - deliver of the baby

Third stage
Delivery of baby - expulsion of placenta and membranes

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14
Q

what is the second stage of labour

A

from complete dilatation of the cervix (10cm) to delivery of the baby

if 1st baby -considered prolonged if it exceeds 3 hours with regional analgesia or 2 hours without

if 2nd baby - considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without

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15
Q

what is the third stage of labour

A

delivery of the baby to expulsion of the placenta and fetal membranes

average duration 10 minutes but can be 3 minutes or longer

after 1 hours preparation made for removal under general anaesthetic

expectant management - spontaneous delivery of placenta

active management - oxytocin drugs and controlled cord traction is preferred for lowering risk of post partum haemorrhage

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16
Q

what are Braxton Hicks Contractions

A

tightening of the uterine muscles, though to aid the body prepare for brith

can start 6 weeks into pregnancy - more often felt in the third trimester

irregular, do not increase in frequency or intensity

resolve with ambulation or change in activity

relatively painless

17
Q

what are true labour contractions

A

timing of contractions become evenly spaced and the time between gets shorter and shorter

length of time the contraction lasts will also increase

real contractions will also get more intense and painful over time

tighten the top part of your uterus pushing the baby downward into the birth canal in preparation for delivery

also promotes thinning of cervix

very painful!!

18
Q

what are the analgesia options for birth

A 
Paracetamol/co-codamol 
TENS 
Entonox 
Diamorphine 
Epidural 
Remifentanyl 
Combined spinal/epidural
19
Q

what is a partogram

A

a graphic record of key data (both maternal and fetal) contained on one sheet used to asses the progress of labour

20
Q

what are the 3 key factors at play in labour

A

Power - uterine contractions
Passage - maternal pelvis
Passenger - fetus

21
Q

what happens to the uterus in contractions

A

Uterine muscle (smooth muscle in connective tissue) - density is highest at the fungus

Pacemaker - region of tubal Ostia - wave spreads in downward direction

synchronisation of contractions waves from both Ostia

upper segment contracts and retracts, lower segment and cervix are stretched - dilate and relax

22
Q

what is the normal rate of contractions before birth

A

3-4 in 10 mins

duration 10-15 seconds - max 45 seconds

23
Q

what is the normal fetal position

A

longitudinal lie
cephalic presentation

presenting part: vertex

position: occipito-anterior, head engages occipito-transverse
flexed head

24
Q

what is abnormal fetal position

A

breech
oblique
transverse lie

position: occipto-posterior

25
Q

how do you describe the position of the fetus

A

left or right

where the occipital is joining

26
Q

1st cardinal movement of labour

A

Engagement

passage of widest diameter of the presenting part to a level below the plane of the pelvic inlet

3/5ths of the fetal head have entered the pelvis

2/5ths still felt abdominally

27
Q

2nd movement of labour

A

Descent - downward passage of presenting part through the pelvis

maternal discomfort, feeling of pressure

vaginal examination should be carried out approximately 4 hourly in normal labour - see how dilated/how dar down the baby’s head is

28
Q

3rd movement of labour

A

flexion:

fetal head flexes as it descends due to the shape of the bony pelvis

29
Q

4th movement of labour

A

Internal rotation

rotation of presenting part from its original position to the anterior position as it passes through the pelvis

30
Q

5th movement of labour

A

extension

occurs once the fetus has reached the level of the interotius bringing the base of the occiput in contact to the inferior margin at the symphysis pubis

31
Q

6th movement of labour

A

external rotation is return of the fetal head to the correct anatomic position in relation to the fetal torso

32
Q

7th movement of labour

A

Expulsion

delivery of the rest of the fetal body

33
Q

what is crowning

A

appearance of a large segment of fetal head at the Introits

labia are stretched to full capacity

largest diameter of fetal head is encircled by vulval ring

burning and stinging feeling for mother

care of the perineum is vital to reduce trauma

head delivery should be down slowly with hands guiding

episiotomy may be required

34
Q

why is delayed cord clamping done

A

leaving it to pulse for up to 3 mins after expulsion allows the baby to get more blood and reduce anaemia at 2 months and increases duration of earl y breast feeding

35
Q

why is skin to skin contact needed immediately after birth

A

helps keep the baby warm and calm and considered to improve other aspects of transition to life outside the womb

recommendation says uninterrupted SSC for 1 hour following birth

36
Q

what are the signs of the third stage of labour

A

uterus contracts, hardens and rises

Umbilical cord lengthens permeently

gush of blood in variable amount

placenta and membranes appear at introitus

37
Q

what is active management of the third stage

A

prophylactic Syntometerine

OR

oxytoxin

Cord clamping and cutting

Controlled cord traction

Bladder emptying

38
Q

what is the puerperium

A

period of repair and recovery

return of tissues to non-pregnant state

6 weeks

loch: vaginal discharge containing blood, mucus and endometrial casting

3 Reproduction (49 decks)

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