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Repro > Normal Labour and Peurperium > Flashcards

Normal Labour and Peurperium Flashcards

1
Q

What is labour?

A

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

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2
Q

What are the features of labour?

A

Regular, painful uterine contractions with increasing frequency, intensity and duration and accompanied biochemical changes in the cervical tissue allowing cervical effacement and cervical dilatation.

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3
Q

What are the 3 main factors for labour?

A

Power - uterine contractions
Passage - Maternal pelvis
Passenger - Fetus

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4
Q

In labour, what is the role of progesterone?

A

Keeps the uterus settled
Prevents formation of gap junctions
Hinders the contractibility of myocytes

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5
Q

In labour, what is the role of Estrogen?

A

Makes the uterus contract

Promotes prostaglandin production

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6
Q

In labour, what is the role of Oxytocin?

A

Initiates and sustains contractions
Acts on decidual tissue to promote prostaglandin release
Synthesised directly in decidual and extraembryonic fetal tissues and in the placenta

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7
Q

When does the number of oxytocin receptors increase?

A

In myometrial and decidual tissues near the end of the pregnancy

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8
Q

What Initiates labour?

A

Change in estrogen/progesterone ratio
Fetal adrenals and pituitary hormones may control the timing of onseet of labour
Myometrial stretch increases excitability of myometrial fibres
Mechanical stretch of cervix and stripping of fetal membranes
Fergusons reflex

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9
Q

What has been known to stimulate prostaglandin synthesis?

A

Pulmonary surfactant secreted into amniotic fluid

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10
Q

What happens in the 1st stage of labour?

A

Latent ohase up to 3-4cm dilation
Active stage 4cm - 10cm (full dilation)
Cervix shortens and softens, may be an uncomfortable few days

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11
Q

What happens in the 2nd stage of labour?

A

Full dilation - delivery of baby

Give analgesia

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12
Q

What happens in the 3rd stage of labour?

A

Baby is delivered

Expulsion of placenta and membranes

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13
Q

What active management is done to lower the risk of post partum haemorrhage?

A

Oxytocic drugs

Controlled cord traction

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14
Q

What else can be given in the 3rd stage of labour?

A

Prophylactic administration of syntometerine

1ml ampoule containing 500 micrograms ergometrine maleate and 5IU oxytocin

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15
Q

What causes an increase in molecules among collagen fibres?

A

Increase in hyaluronic acid

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16
Q

What causes cervical ripening?

A

Decrease in collagen fibre alignment
Decrease in collagen fibre strength
Decrease in tensile strength of the cervical matrix
Increase in cervical decorin (Dermatan sulphate proteoglycan 2)

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17
Q

What are Braxton Hicks contractions?

A

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

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18
Q

When can Braxton Hicks start?

A

6 weeks into the pregnancy

Not usually felt till 2nd or 3rd trimester

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19
Q

How far apart do true contractions start?

A

5 mins

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20
Q

How will the abdomen feel during a contraction?

A

Hard

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21
Q

How does a contraction pain manifest itself?

A

Starts low and rises until it peaks and ebbs away

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22
Q

How do Braxton Hicks contractions manifest themselves?

A

Irregular, don’t increase in frequency or intensity
Resolve with ambulation or change in activity
Relatively painless

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23
Q

What are characteristics of Uterine contractions?

A

Smooth muscle (myocyte) in connective tissue (collagen and elastin). Density highest at fundus

24
Q

What are the characteristics of Cervical tissue?

A

Collagen tissue mainly (type 1,2,3,4) smooth muscle, elastin, held together by connective tissue ground substance

25
Q

What does contractions and retraction lead to?

A

Shortening of the muscle fibres

26
Q

What controls the contractions’ power?

A

Pacemaker is the region of tubal ostia - wave spreads in a downward direction

27
Q

What causes polarity of the contractions?

A

Upper segment contracts and retracts, lower segment and cervix stretch, dilate and relax

28
Q

Describe the Anthropoid pelvis

A

There’s an oval shaped inlet with large anterio-posterior diameter and comparatively smaller transverse diameter

29
Q

Describe the Android pelvis

A

Has triangular or heart shaped inlet and is narrower from the front. African-Caribbean women are more at risk of having an android shaped pelvis

30
Q

What is the normal fetal lie?

A

Longitudinal lie

Cephalic presentation

31
Q

What is the normal position?

A

Occipito-anterior; head engages occipito-transverse

Flexed head

32
Q

What is an abnormal presentation?

A

Breech
Oblique
Transverse lie
Position - Occipito-posterior

33
Q

What is crowning?

A

Appearance of a large segment of fetal head at the introitus

34
Q

What happens to the labia during crowning?

A

Stretched to full capacity

35
Q

What can be down to prevent trauma to the anal spinchter and the pudendal nerve?

A

Episiotomy

36
Q

What are the 5 elements of the Bishops score?

A 
Position
Consistency
Effacement
Dilatation
Station in pelvis
37
Q

What is the Bishops score used for?

A

To see whether or not it is safe to induce labour

38
Q

What are options for analgesia?

A 
Paracetamol/Co-codamol
TENS
Entonox
Diamorphine
Epidural
Remientanyl
Combined spinal/epidural
39
Q

What volume of blood loss during pregnancy would be classed as abnormal?

A

Over 500mls

40
Q

When is blood loss during pregnancy classed as significant?

A

Over 1,500mls

41
Q

What should be done if a female loses blood prior to delivery?

A

Refer to a consultant unit

42
Q

What is the plane of placental separation?

A

Spongy layer of decidua basalis

43
Q

What is a Schultz separation?

A

Separation from the central aspect

44
Q

What is a Matthew Duncan separation?

A

Marginal separation - most common

45
Q

What 3 things can give rise to Haemostasis?

A

Tonic contraction: Lattice pattern of uterine muscle strangulates the blood vessels
Thrombosis of the torn vessel ends: Pregnancy is a hyper-coaguable state
Myo-tamponade-opposition of the anterior/posterior walls

46
Q

What is Puerperium?

A

Period of repair and recovery

Return of tissues non-pregnant state

47
Q

What is Lochia?

A

Vaginal discharge containing blood, mucus and endometrial castings

48
Q

What is Rubra?

A

Fresh red

49
Q

What is Serosa?

A

Brownish-red, watery

50
Q

What is Alba?

A

Yellow

51
Q

How long does it take for the endometrium to regenerate?

A

1 week

52
Q

How long does it take for the fundal height to return?

A

2 weeks

53
Q

When does Diuresis occur?

A

2-3 days postnatally

54
Q

What initiates lactation?

A

Placental expulsion
Decreased oestrogen
Decreased progesterone
Prolactin is maintained

55
Q

What is colostrum rich in?

A

Immunoglobulin

Repro (46 decks)

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