Normal Labour and Puerperium Flashcards
what is labour?
the physiological process in which the foetus, membranes, umbilical cord and placenta are expelled from the uterus
what are the three options for where a patient can give birth?
consultant led unit
midwife led unit
home
what is Ferguson’s reflex?
the foetal distension onto the cervix stimulates neuroendocrine responses, resulting in oxytocin production
what is the role of progesterone in labour?
keeps the uterus settled
what is the role of oestrogen in labour?
causes the uterus to contract
promotes prostaglandin production
what is the role of oxytocin in labour?
initiates and sustains contractions
promotes prostaglandin release
where is oxytocin synthesised?
pituitary
what is the role of liquor?
nurtures and protects the foetus
facilitates movement
also known as amniotic fluid
what does it mean if a baby is born in a caul?
still in the membranes
what is cervical tissue made of?
collagen, smooth muscle and elastin held together by ground substance
what causes reduced firmness of the cervix?
increased hyaluronic acid
what histological changes are involved in cervical ripening?
decrease in collagen fibre alignment and strength
decrease in tensile strength of the cervical matrix
what scoring system is used to determine if it is safe to induce labour?
Bishop’s score
what are the five elements included in the Bishop’s score?
position consistency effacement dilatation foetal station
what do the results of the bishop’s score mean?
higher score = more likely that induction will be successful
> 8 = good
4 or less = cervix needs ripening
what are the two phases of the first stage of labour?
latent phase - up to 4cm dilated
active phase - from 4cm to full dilation (10cm)
what occurs in the second stage of labour?
delivery of the baby
when is the second stage of labour considered to be prolonged in nulliparous women?
> 3 hours with regional analgesia
> 2 hours without
when is the second stage of labour considered to be prolonged in multiparous women?
> 2 hours with regional analgesia
> 1 hour without
what is the third stage of labour?
expulsion of placenta and membranes
what is the average duration of the third stage of labour?
ten minutes
when does the third stage of labour require intervention?
if lasting over an hour
can do this via oxytocic drugs, controlled cord traction or surgical removal
what are Braxton hicks contractions?
tightening of the uterine muscles to prepare the body for birth
irregular, do not increase in frequency or intensity
relatively painless
when do Braxton hicks contractions occur?
can start as early as six weeks
usually felt more in the third trimester
what can relieve Braxton hicks contractions?
ambulation
what causes true labour contractions?
oxytocin stimulating contraction of the uterus
what is true labour?
when the timing of contractions becomes evenly spaced and the time between them gets shorter and shorter
duration and intensity of contractions also increases
what do contractions achieve?
tighten the top of the uterus, pushing the baby into the birth canal - this also promotes thinning of the cervix
what is normal frequency of contractions?
3-4 in 10 minutes
what is a normal duration for contractions?
initially 10-15 seconds
can build up to 45
what are the three grades of intensity of contractions?
mild
moderate
strong
name three types of pelvis
anthropoid
gynaecoid
android
which pelvic shape is the most suitable for birth?
gynaecoid
what is a partogram?
a graphic record of key data used to assess the progress of labour
what are the seven cardinal movements involved in labour?
engagement decent flexion internal rotation crowning + extension external rotation expulsion
what is engagement?
passage of the widest diameter of the presenting part to a level below the pelvic inlet
what is decent?
downward passage of the presenting part through the pelvis
what is internal rotation?
rotation of the presenting part to the anterior position as it passes through the cervix
what occurs in crowning and extension n?
brings the base of the occiput into contact with the pubic symphysis
when does crowning occur?
when the foetus has reached the level of the introitus
what is external rotation?
return of the foetal head to the correct anatomical position
aka restitution
what is expulsion?
delivery of the rest of the foetal body
what is crowning?
the appearance of a large segment of foetal head at the Introitus
what may be required to prevent trauma during crowning?
episiotomy
why is delayed cord clamping beneficial?
higher RBC to vital organs - less neonatal anaemia
what should be administered as prophylaxis in the third stage of labour?
syntometrine or oxytocin
what is the main method for placental separation?
Matthew Duncan
what is a normal amount of blood loss in labour?
<500mls
>500 = abnormal >1000 = very significant
what is puerperium?
a period of repair and recovery after delivery where tissues return to the non pregnant state
how long does puerperium take?
six weeks
what is lochia?
vaginal discharge containing blood, mucous and endometrial castings after birth
what is lochia rubra?
fresh red discharge
3-4 days after delivery
what is lochia serosa?
browny-red watery discharge
4-14 days after deliver y
what is lochia alba?
yellow discharge
10-20 days after delivery
what are the three types of lochia?
rubra
serosa
alba
