Normal Labour and Puerperium

Question 1

what is labour?

Answer 1

the physiological process in which the foetus, membranes, umbilical cord and placenta are expelled from the uterus

Question 2

what are the three options for where a patient can give birth?

Answer 2

consultant led unit
midwife led unit
home

Question 3

what is Ferguson’s reflex?

Answer 3

the foetal distension onto the cervix stimulates neuroendocrine responses, resulting in oxytocin production

Question 4

what is the role of progesterone in labour?

Answer 4

keeps the uterus settled

Question 5

what is the role of oestrogen in labour?

Answer 5

causes the uterus to contract

promotes prostaglandin production

Question 6

what is the role of oxytocin in labour?

Answer 6

initiates and sustains contractions

promotes prostaglandin release

Question 7

where is oxytocin synthesised?

Answer 7

pituitary

Question 8

what is the role of liquor?

Answer 8

nurtures and protects the foetus
facilitates movement

also known as amniotic fluid

Question 9

what does it mean if a baby is born in a caul?

Answer 9

still in the membranes

Question 10

what is cervical tissue made of?

Answer 10

collagen, smooth muscle and elastin held together by ground substance

Question 11

what causes reduced firmness of the cervix?

Answer 11

increased hyaluronic acid

Question 12

what histological changes are involved in cervical ripening?

Answer 12

decrease in collagen fibre alignment and strength

decrease in tensile strength of the cervical matrix

Question 13

what scoring system is used to determine if it is safe to induce labour?

Answer 13

Bishop’s score

Question 14

what are the five elements included in the Bishop’s score?

Answer 14

position 
consistency 
effacement 
dilatation 
foetal station

Question 15

what do the results of the bishop’s score mean?

Answer 15

higher score = more likely that induction will be successful

> 8 = good
4 or less = cervix needs ripening

Question 16

what are the two phases of the first stage of labour?

Answer 16

latent phase - up to 4cm dilated

active phase - from 4cm to full dilation (10cm)

Question 17

what occurs in the second stage of labour?

Answer 17

delivery of the baby

Question 18

when is the second stage of labour considered to be prolonged in nulliparous women?

Answer 18

> 3 hours with regional analgesia

> 2 hours without

Question 19

when is the second stage of labour considered to be prolonged in multiparous women?

Answer 19

> 2 hours with regional analgesia

> 1 hour without

Question 20

what is the third stage of labour?

Answer 20

expulsion of placenta and membranes

Question 21

what is the average duration of the third stage of labour?

Answer 21

ten minutes

Question 22

when does the third stage of labour require intervention?

Answer 22

if lasting over an hour

can do this via oxytocic drugs, controlled cord traction or surgical removal

Question 23

what are Braxton hicks contractions?

Answer 23

tightening of the uterine muscles to prepare the body for birth

irregular, do not increase in frequency or intensity

relatively painless

Question 24

when do Braxton hicks contractions occur?

Answer 24

can start as early as six weeks

usually felt more in the third trimester

Question 25

what can relieve Braxton hicks contractions?

Answer 25

ambulation

Question 26

what causes true labour contractions?

Answer 26

oxytocin stimulating contraction of the uterus

Question 27

what is true labour?

Answer 27

when the timing of contractions becomes evenly spaced and the time between them gets shorter and shorter duration and intensity of contractions also increases

Question 28

what do contractions achieve?

Answer 28

tighten the top of the uterus, pushing the baby into the birth canal - this also promotes thinning of the cervix

Question 29

what is normal frequency of contractions?

Answer 29

3-4 in 10 minutes

Question 30

what is a normal duration for contractions?

Answer 30

initially 10-15 seconds can build up to 45

Question 31

what are the three grades of intensity of contractions?

Answer 31

mild moderate strong

Question 32

name three types of pelvis

Answer 32

anthropoid gynaecoid android

Question 33

which pelvic shape is the most suitable for birth?

Answer 33

gynaecoid

Question 34

what is a partogram?

Answer 34

a graphic record of key data used to assess the progress of labour

Question 35

what are the seven cardinal movements involved in labour?

Answer 35

``` engagement decent flexion internal rotation crowning + extension external rotation expulsion ```

Question 36

what is engagement?

Answer 36

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

Question 37

what is decent?

Answer 37

downward passage of the presenting part through the pelvis

Question 38

what is internal rotation?

Answer 38

rotation of the presenting part to the anterior position as it passes through the cervix

Question 39

what occurs in crowning and extension n?

Answer 39

brings the base of the occiput into contact with the pubic symphysis

Question 40

when does crowning occur?

Answer 40

when the foetus has reached the level of the introitus

Question 41

what is external rotation?

Answer 41

return of the foetal head to the correct anatomical position aka restitution

Question 42

what is expulsion?

Answer 42

delivery of the rest of the foetal body

Question 43

what is crowning?

Answer 43

the appearance of a large segment of foetal head at the Introitus

Question 44

what may be required to prevent trauma during crowning?

Answer 44

episiotomy

Question 45

why is delayed cord clamping beneficial?

Answer 45

higher RBC to vital organs - less neonatal anaemia

Question 46

what should be administered as prophylaxis in the third stage of labour?

Answer 46

syntometrine or oxytocin

Question 47

what is the main method for placental separation?

Answer 47

Matthew Duncan

Question 48

what is a normal amount of blood loss in labour?

Answer 48

<500mls ``` >500 = abnormal >1000 = very significant ```

Question 49

what is puerperium?

Answer 49

a period of repair and recovery after delivery where tissues return to the non pregnant state

Question 50

how long does puerperium take?

Answer 50

six weeks

Question 51

what is lochia?

Answer 51

vaginal discharge containing blood, mucous and endometrial castings after birth

Question 52

what is lochia rubra?

Answer 52

fresh red discharge 3-4 days after delivery

Question 53

what is lochia serosa?

Answer 53

browny-red watery discharge 4-14 days after deliver y

Question 54

what is lochia alba?

Answer 54

yellow discharge 10-20 days after delivery

Question 55

what are the three types of lochia?

Answer 55

rubra serosa alba