Normal Labour and Puerperium

Question 1

Labour deifnition?

Answer 1

Process whereby products of conception are expelled from uterine cavity after 24th week of gestation

Question 2

Braxton hicks is what?

Answer 2

Tightening of uterine muscles thought to help body prepare for birth

Question 3

When can Braxton Hicks happen?

Answer 3

6 weeks into pregnancy but usually 3rd trimester
Irregular
Resolve with ambulation or activity change

Question 4

Onset of labour involves what?

Answer 4

Progesterone withdrawal and increase in oestrogen and prostaglandin action

Question 5

Clinical signs of labour onset?

Answer 5

Regular, painful contractions which increase in frequency and duration and that produce progressive cervical dilatation

Question 6

Rupture of membranes known as?

Answer 6

Water breaking

Although onset is variable and may occur without uterine contractions

Question 7

If period between ROM and oainful uterine conractions is greater than 4 hours it is called?

Answer 7

Pre labour rupture of membranes (PROM)

Question 8

how many stages of labour?

Answer 8

3

Question 9

First stage of labour?

Answer 9

Onset of regular painful contractions and cervical changes until it reaches full dilatation and cervix is no longer palpable

Question 10

Second stage of labour?

Answer 10

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

Question 11

Third stage of labour?

Answer 11

Duration from delivery of newborn to delivery of placenta and membranes

Question 12

What influences progression of 2nd stage of labour?

Answer 12

3 key factors (3 Ps)

1) Power
2) Passage
3) Passenger

Question 13

What shape of pelvis is best for child birth?

Answer 13

Gynaecoid pelvis but some women have anthropoid or android

Question 14

7 cardinal movements of labour?

Answer 14

Engagement 
Descent 
Flexion 
Internal Rotation 
Extension 
External rotation 
Expulsion

Question 15

What is engagement?

Answer 15

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

Question 16

Descent?

Answer 16

Downward movement of presenting part through pelvis

Question 17

Flexion?

Answer 17

Flexion of foetal head occurs passively as head descends due to shape of bony pelvis and resistance offered by soft tissues

Question 18

Internal rotation?

Answer 18

Rotation of presenting part from its original position to the anterior position as it passes through pelvis

Question 19

Extension?

Answer 19

Occurs once foetus has reached the introitus and base of occiput is in contact to inferior margin of the pubic symphysis

Question 20

External rotation?

Answer 20

Return of foetal head to correct anatomical position in relation to foetal torso and shoulders

Question 21

Expulsion?

Answer 21

Delivery of rest of foetal body

Question 22

Entering the pelvis the foetus should be lying?

Answer 22

Transverse

Question 23

What is corwning?

Answer 23

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

Question 24

What stage of labour does crowning occur in?

Answer 24

Extension

Question 25

In 3rd stage of labour uterus ____, _______ and _______?

Answer 25

Contracts
Hardens
Rises

Question 26

Whole process of 3rd stage of labour lasts?

Answer 26

5-10 minutes

Question 27

Diagnosis of retained placenta menas?

Answer 27

Placenta is not expelled within 30mins or 60 mins if no active management

Question 28

What does active management of 3rd stage of labour invovle?

Answer 28

Uterotonic drugs

Ergometrine maleate or oxytocin, cord clamping and cutting and bladder catheterization

Question 29

What does active management prevent?

Answer 29

XS bleeding

Question 30

Blood loss of less than _______ is normal in this stage of labour?

Answer 30

500mls

Question 31

What is puerperium?

Answer 31

Postpartum period from birth of baby through to involution of uterus at 6 weeks
-Period of recovery and repair

Question 32

If lactation continues what happens to menstruation?

Answer 32

May be deferred for longer than 6 weeks

Question 33

Discharge from uterus term and character in days 2-14?

Answer 33

Fresh or altered blood

Lochia Rubia

Question 34

Lochia serosa is?

Answer 34

Brownish discharge

Question 35

Slight white discharge is called?

Answer 35

Lochia alba

Question 36

Persistence of lochia rubia may imply?

Answer 36

Presence of retained placental tissue or foetal membranes

Question 37

Hormones which influence labour onset?

Answer 37

Progesterone
Oestrogen
Oxytocin

Question 38

What is progesterones role?

Answer 38

Keeps uterus settled

-Prevents formation of gap junctions

Question 39

Oestrogens function?

Answer 39

Makes uterus contract

Question 40

Oxytocin function?

Answer 40

Initiates and sustains contractions

Question 41

Bishop score tells us what?

Answer 41

If it is safe to induce labour

Question 42

Bishops score of 4 or less?

Answer 42

Indicates unfavourable cervix and requires opening

Question 43

Summary of second stage of labour?

Answer 43

Full dilation- delivery of baby

Question 44

What happens if cord is immediately clamped?

Answer 44

Reduce RBCs, potentia short term and long term neonatal problems