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Repro and Sexual Health > Normal Labour > Flashcards

Normal Labour Flashcards

1
Q

definition of labour?

A

physiological process during which the foetus membranes, umblical cord and placenta are expelled from the uterus

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2
Q

3 options of place of birth?

A

consultant lead unit
midwife lead unit
homebirth

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3
Q

what is a birth plan?

A

record of what the woman wants to happen during labour and after the birth
encouraged to make a plan but dont have to

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4
Q

what initiates labour?

A

not 100% sure
change in oestrogen/proegsterone ratio
foetal adrenals and pituitary hormones may control the timing of onset of labour
myometrial stretch increases excitability of myometrial fibres
mechanical stretch of cervix and stripping of fetal membranes
fergusons reflex

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5
Q

what is fergusons reflex?

A

neuroendocrine reflex comprising the self sustaining reflex of uterine contractions initiated by pressure at the vaginal walls or cervix

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6
Q

how does proegsterone influence onset of labour?

A

keeps uterus settles
prevents formation of gap junctions
hinders contractability of myocytes

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7
Q

how does oestrogen influence onset of labour?

A

makes uterus contract

promotes prostaglandin production

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8
Q

how does oxytocin influence onset of labour?

A

initiates and sustains contractions
acts of decidual tissue to promote prostaglandin release
synthesized directly in decidual and extraembryonic foetal tissues and in the placenta

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9
Q

other causes of labour induction?

A

pulmonary surfactant secreted into amniotic fluid has been reported to stimulate prostaglandin release
increase in production of foetal cortisol stimulates an increase in maternal estriol
increase in myometrial oxytocin receptors and their activation results in phospholipase C activity and subsequent increase in cytosolitic calcium and uterine activity

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10
Q

why can early rupture of membranes cause problem?

A

amniotic fluid nurtures and protects foetus and facilitates movement
can stimulate labour as the foetus will drop down into cervix area causing stretch

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11
Q

when can rupture of membranes occur?

A 
pre term
pre labour
first stage
second stage
born in a caul (sac intact)
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12
Q

what cervical changes occur in labour?

A

cervical softening
hyaluronic acid gives increase in molecules among collagen fibres
the decrease in bridging among collagen fibres gives decrease in firmness of cervix
cervical ripening (decrease in collagen fibre alignment and strength, decrease in tensile strength of cervix matrix, increase in cervical decorin)

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13
Q

what makes up cervical tissue?

A

collagen tissue mainly (types 1, 2, 3 and 4)
smooth muscle
elastin
held together by connective tissue ground substance

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14
Q

what is bishops score?

A

determines if its safe to induce labour

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15
Q

5 elements of bishops score?

A 
position
consistency
effacement
dilatation
station in pelvis
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16
Q

what are the stages of labour?

A

first stage
- latent stage (up to 3-4cm dilated, can be a few days)
- active stage (4cm-10cm, full dilation)
second stage
- fully dilated up until delivery of baby, can last quite long, longer in first baby)
third stage
- delivery of baby up until expulsion of placenta and membranes

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17
Q

describe first stage of labour?

A

consists of latent and active phase
latent = mild irregular uterine contractions, cervix shortens and softens, may last a few days
active phase = 4cm onwards to full dilation, slow descent of head, contractions get worse and more rhythmic, dilates 1-2cm per hour

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18
Q

describe second stage of labour?

A

starts with complete dilation of the cervix (10cm) and ends with delivery of baby
in first baby, its considered prolonged is it exceeds 3 hours if there is regional analgesia, or 2 hours if without analgesia
in multiparous women, the second stage is considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without
in low risk care, vaginal examinations not always carried out to assess time of full dilation

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19
Q

describe the third stage of labour?

A

delivery of the baby to the expulsion of the placenta and fetal membranes
takes average 10 mins but can be 3 mins or over 10 mins
after 1 hour, preparation made for removal of placenta under GA
- oxytocic drugs can controlled cord traction is preferred for lowering risk of post partum haemorrhage

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20
Q

how is the placenta expelled?

A

after delivery of baby, the uterus clamps shut to prevent bleeding
cant do this if placenta is sitting in the middle and wont compress, so it is pushed out

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21
Q

what are braxton hicks contractions?

A

AKA false labour
they give women a false sensation that she is having real contractions
tightening of the uterine muscles, thought to aid the body prepare for birth
can start 6 weeks into pregnancy but more frequently felt in 3rd triemster
irregular, do not increase in frequency or intensity
resolve with ambulation or change in activity
relatively painless

22
Q

describe true labour contractions

A

happen under influence of the release of oxytocin which stimulates uterus to contract

when the timing of contractions becomes evenly spaced, and the time between them gets shorter and shorter (3 mins, then 2mins etc)

length of contraction also increases (10 secs - 45 secs etc)

will get more intense and painful overt time

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

this also promotes thinning of cervix

23
Q

3 key factors in labour?

A

power (uterine contractions)
passage (maternal pelvis)
passenger (fetus)

24
Q

analgesia options?

A 
paracetamol/co-codamol
TENS
entonox (gas and air)
morphine
epidural
remifentanyl
combined spinal/epidural
25
Q

how do contractions occur (power)?

A

uterine muscles contract (smooth muscle myocytes most dense at top of fundus)
originates at pacemaker in tubal ostia and wave spreads down (contraction waves from both ostia are synchronised)
polarity of contractions (upper segment contracts and retracts while lower segment and cervix stretch, dilate and relax)

26
Q

types of pelvis? which is best for birth?(passage)

A

anthropoid (oval inlet with large AP diameter and smaller transverse diameter)
android (triangle/heart shaped inlet and narrower in the front, common in african-caribbean women)
gynaecoid pelvis = best

27
Q

what cervical assessment is done in labour? (passage)?

A 
affacement
dilation
firmness
position
level of presenting part (head) or station
28
Q

abnormal fetal position?

A

breech
oblique
transverse (needs C section)
occipito-posterior position of head

29
Q

abnormal fetal position?

A

breech
oblique
transverse (needs C section)
occipito-posterior position of head

30
Q

how can head position be determined in labour?

A

via vaginal examination
feel for fontanelles
- anterior = large, open, made of 4 bones
- posterior = smaller, narrower, made of 3 bones

31
Q

7 cardinal movement sin labour?

A 
engagement
decent
flexion
internal rotation
crowning and extension
restitution and external rotation (head adopts optimal position for shoulder)
expulsion, anterior shoulder first
32
Q

describe engagement?

A

passage of widest diameter of the head to a level below the pelvic inlet
AKA 3/5 of the head has entered the pelvis and 2/5 still felt abdominally

33
Q

describe descent?

A

downward passage of the presenting part through the pelvis
abdominal fifths used as reference
causes maternal discomfort and pressure
frontal synciput and occipital eminences
do vaginal examinations for cervical assessment (4 hourly)

34
Q

describe flexion

A

flexion of the fetal head occurs passively as the head descends due to the shape of the bony pelvis and the resistance offered by the soft tissues

35
Q

describe internal rotation

A

rotation of the presenting part from its original position (usually transverse with regard to birth canal) to anterior position as it passes through pelvis

36
Q

describe extension

A

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

37
Q

describe external rotation (restitution)

A

return of the fetal head to the correct anatomical position in relation to the fetal torso

38
Q

describe expulsion

A

delivery of the rest of the fetal body

39
Q

describe crowning

A

appearance of a large segment of foetal head at the introitus
labia stretched to full capacity
largest diameter of head encircled by vulval ring
burning/stinging feeling in mother

40
Q

describe the process of cord clamping after baby is delivered

A

immediate clamping of umbilical cord can reduce RBCs the infant receives by 50% resulting in potential short and long term problems
clamping should be delayed for at least 1 min (up to 3 mins) unless immediate resuscitation necessary

41
Q

why is skin to skin immediately after birth so important?

A

early placing of naked baby on mothers chest helps keep babies warm and calm and improves other aspects of baby’s transition to life

42
Q

3 classic signs which indicate separation of placenta from uterus after delivery?

A

uterus contracts, hardens and rises
umbilical cord lengthens permanently
frequently a gush of blood variable in amount
placenta and membranes then appear at introitus

43
Q

normal time limit after delivery of baby for expulsion of placenta?

A

usually 5-10 mins

considered normal up to 30 mins

44
Q

active management of 3rd stage of labour?

A 
prophylactic administration of syntometerine (1 ampuole containing 500mcg ergometrine maleate)
or
oxytocin 10 units
cord clamping and cutting
controlled cord traction
bladder emptying
45
Q

how does placental separation occur?

A

shearing force
matthew duncan method most common
schults separation from central aspect
plane of separation = spongy later of decidua basalis

46
Q

normal vs abnormal blood loss in childbirth?

A 
normal = <500ml
abnormal = >500ml or any bleeding before delivery apart from "show" bleeding
significant = >1000ml
47
Q

how is bleeding stopped after childbirth?

A

tonic contraction of uterine muscles strangles the blood vessels and clamps them shut
pregnancy is a hypercoagulable state which allows thrombosis of the torn vessel ends
myo-tampanade opposition of the anterior/posterior walls

48
Q

what is the puerperium and what happens?

A

perior of repair and recovery lasting 6 weeks after birth
- lochia (discharge containing blood, mucous and endometrial castings)
- rubra (fresh red blood for 3-4 days)
- serosa (brown-red watery discharge from 4-14 days)
- alba (yellow discharge from 10-20 days)
shouldnt really have blood for more than 14 days after birth

49
Q

what is a partogram?

A

record of key data (maternal and foetal) contained on one sheet, used to asses the progress of labour (dilation, foetal HR etc)

50
Q

describe normal pattern of contractions?

A

up to 3-4 in 10 mins
- allows time for resting tone
last 10-15 sec initially then build up to max 45 secs
get gradually more intense

51
Q

what uterine changes occur in puerperium?

A

uterine involution
weight drops from 1000gms to 50-100 gms
height drops from umbilicus to within pelvis within 2 weeks
endometrium regenerates by end of week 1 (not at placental site)
regression but never back to original state
physiological diuresis commences 2-3 post natal

52
Q

how does lactation occur?

A

initiated by placental expulsion and a decrease in oestrogen and proegstrone which inhibit milk secretion by blocking release of prolactin and making mammary glands unresponsive to it

Repro and Sexual Health (63 decks)

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