Normal Labour and Puerperium Flashcards
Labour deifnition?
Process whereby products of conception are expelled from uterine cavity after 24th week of gestation
Braxton hicks is what?
Tightening of uterine muscles thought to help body prepare for birth
When can Braxton Hicks happen?
6 weeks into pregnancy but usually 3rd trimester
Irregular
Resolve with ambulation or activity change
Onset of labour involves what?
Progesterone withdrawal and increase in oestrogen and prostaglandin action
Clinical signs of labour onset?
Regular, painful contractions which increase in frequency and duration and that produce progressive cervical dilatation
Rupture of membranes known as?
Water breaking
Although onset is variable and may occur without uterine contractions
If period between ROM and oainful uterine conractions is greater than 4 hours it is called?
Pre labour rupture of membranes (PROM)
how many stages of labour?
3
First stage of labour?
Onset of regular painful contractions and cervical changes until it reaches full dilatation and cervix is no longer palpable
Second stage of labour?
Duration from full cervical dilation to delivery of foetus
-Subdivided into pelvic or passive phase when head descends in the pelvis
and
-Active or perineal phase when mother gets stronger urge to push and foetus is delivered with force of uterine contractions and maternal bearing down effort
Third stage of labour?
Duration from delivery of newborn to delivery of placenta and membranes
What influences progression of 2nd stage of labour?
3 key factors (3 Ps)
1) Power
2) Passage
3) Passenger
What shape of pelvis is best for child birth?
Gynaecoid pelvis but some women have anthropoid or android
7 cardinal movements of labour?
Engagement Descent Flexion Internal Rotation Extension External rotation Expulsion
What is engagement?
Passage of widest diameter of presenting part to a level below plane of the pelvic inlet, described in terms of station which refers to level of presenting part above or below mums ischial spine in CM
Descent?
Downward movement of presenting part through pelvis
Flexion?
Flexion of foetal head occurs passively as head descends due to shape of bony pelvis and resistance offered by soft tissues
Internal rotation?
Rotation of presenting part from its original position to the anterior position as it passes through pelvis
Extension?
Occurs once foetus has reached the introitus and base of occiput is in contact to inferior margin of the pubic symphysis
External rotation?
Return of foetal head to correct anatomical position in relation to foetal torso and shoulders
Expulsion?
Delivery of rest of foetal body
Entering the pelvis the foetus should be lying?
Transverse
What is corwning?
Refers to appearance of large segment of foetal head at introitus- at this point labia are stretched to full capacity and largest diameter of foetal head is encircled by Vulval ring
What stage of labour does crowning occur in?
Extension
In 3rd stage of labour uterus ____, _______ and _______?
Contracts
Hardens
Rises
Whole process of 3rd stage of labour lasts?
5-10 minutes
Diagnosis of retained placenta menas?
Placenta is not expelled within 30mins or 60 mins if no active management
What does active management of 3rd stage of labour invovle?
Uterotonic drugs
Ergometrine maleate or oxytocin, cord clamping and cutting and bladder catheterization
What does active management prevent?
XS bleeding
Blood loss of less than _______ is normal in this stage of labour?
500mls
What is puerperium?
Postpartum period from birth of baby through to involution of uterus at 6 weeks
-Period of recovery and repair
If lactation continues what happens to menstruation?
May be deferred for longer than 6 weeks
Discharge from uterus term and character in days 2-14?
Fresh or altered blood
Lochia Rubia
Lochia serosa is?
Brownish discharge
Slight white discharge is called?
Lochia alba
Persistence of lochia rubia may imply?
Presence of retained placental tissue or foetal membranes
Hormones which influence labour onset?
Progesterone
Oestrogen
Oxytocin
What is progesterones role?
Keeps uterus settled
-Prevents formation of gap junctions
Oestrogens function?
Makes uterus contract
Oxytocin function?
Initiates and sustains contractions
Bishop score tells us what?
If it is safe to induce labour
Bishops score of 4 or less?
Indicates unfavourable cervix and requires opening
Summary of second stage of labour?
Full dilation- delivery of baby
What happens if cord is immediately clamped?
Reduce RBCs, potentia short term and long term neonatal problems
