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Reproduction > Normal Labour and Puerperium > Flashcards

Normal Labour and Puerperium Flashcards

1
Q

What is the function of progesteron in labour?

A

keeps uterus settles by hindering contractility of myocytes and preventing formation of gap junctions

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2
Q

what is the function of estrogen in labour?

A

makes uterus contract and promotes prostaglandin production

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3
Q

What is the function of oxytocin in labour?

A

intiate and sustains contractions; acts on decidual tissue to promote prostaglandin release

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4
Q

Where is oxytocin synthesised?

A

directly in decidual and extraembryonic fetal tissues and in the placenta

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5
Q

How is labour initiated?

A

change in oestrogen/progesterone ratio; fetal drenal and pituitary hormones; mymotrial stretch; fergusons reflex

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6
Q

What is Fergusons Reflex?

A

neuroendocrine reflex comprimsing the self-sustaining cycle of uterine contractions initiated by pressure at the cervix or vaginal walls

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7
Q

What does pulmonary surfactant secreted into amniotic fluid caused?

A

stimulates prostaglandin synthesis

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8
Q

What does an increasein fetal cortisol cause?

A

increase in maternal estriol

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9
Q

What is the Bishops score used for?

A

determine whether it is safe to induce labour

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10
Q

what factors are part of Bishops score?

A

position; consistency; effacement; dilatation; station

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11
Q

What is retraction?

A

when muscles relax do not return to theri former length but become progressivley shorter

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12
Q

What is the function of retraction?

A

progressively reduce uterine capacity and increase the thickenss of the uterine wall

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13
Q

What is cervical effacement?

A

thinning and stretching of cervic by retraction

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14
Q

What is “show”?

A

effacemnt and dilatation of cervic loosens the membranes from the internal os with slight bleeding and frees the mucous plug or operculum

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15
Q

What are the 2 phases of the 1st stage of labour?

A

latent and active phase

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16
Q

When does the latent phase of labour last?

A

upto 3-4cms dilatation

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17
Q

When is the active stageo f labour?

A

4-10cms

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18
Q

What happens during hte second stage of labour?

A

full dilatation–delivery of baby

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19
Q

What happens during hte third stage of labour?

A

delivery of baby–expulsion of placenta and membranes

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20
Q

What ar ethe features of the latent phase of labour?

A

mild irregular uterine contractions; cervix shortens and softens; duration varibale

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21
Q

What are the features of active phase?

A

slow decent of the presenting part, contractions progressively bcome more rhythmix and stronger

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22
Q

What is normal progression of active phase?

A

1-2cms per hour

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23
Q

What is the average width of the fetal head?

A

9.5cm

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24
Q

What is prolonged second stage with regional analgesia in nulliparous woman?

A

> 3 hours

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25
Q

what is prolonged second stage in nulliparous woman without regional analgesia?

A

> 2 hours

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26
Q

What is prologned second stage in multiparous woman with regional anlagesia?

A

> 2hours

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27
Q

What is prolonged second stage in multiparous woman wihtout regional anaesthesiaa?

A

> 1hour

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28
Q

What is the average duration of third stage?

A

10 minutes

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29
Q

What is the upper limit of normal duration of thrid stage?

A

<30mins

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30
Q

Why is active managemnt of the thrid stage preferred?

A

lower risk of PPH

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31
Q

What is active managmetn of third stage of labour?

A

prophylactic use of syntometerine or oxytocin; cord clamping and cutting; controlled cord tractio nand bladder emtying

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32
Q

What causes cervical softening in labour?

A

increase in hyaluronic acid increases molecules among collagen fibres; decreased bridging among collagen fibres decreases firmness of cervic

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33
Q

What causes cervical ripening in labour?

A

decrease in collagen fibre alignemnt; fibre strenght; tensile strenght of cervical matrix and increase in cervical decorin

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34
Q

When can Braxton Hicks contractions begin?

A

6 weeks into pregnancy but more usually in 3rd trimester

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35
Q

What is a contraction described as?

A

wave-like

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36
Q

What are the features of Braxton-Hicks contractions?

A

irregular- do not increase infrequency or intensity; resolve iwth ambulation or change in activity; relatively painless

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37
Q

Where is uterine muscle found in the highest density?

A

fundus

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38
Q

Where is the pacemaker of the uterus thought to be?

A

region of tubal ostia; wave spreads in a downward fashion

39
Q

What is the difference between the upper and lower segments of the uterus?

A

upper- contracts and retracts; lower segment and cervix stretch; dilate and relax

40
Q

What is the nromal frequency of contractions?

A

upto 3/4 in 10 minutes

41
Q

What is the max duration of contractions?

A

45s

42
Q

What is engagement?

A

more than 50% of the presenting part has descended into the pelvis

43
Q

What is 5/5th palpable?

A

all of the head can be felt in the abdomen

44
Q

What is zero fifths palpable?

A

none of the head can be felt in the abdomen

45
Q

What parameters are involved in the cervical assessment?

A

effacement; dilatation; firmness; position; station

46
Q

What features are felt vaginally to assess the position of the fetal head?

A

posterior fontanelle

47
Q

How often should vaginal examination be carried out during labour?

A

every 4 hours

48
Q

What is an anthropoid pelvis?

A

oval shaped inlet with large AP diameter and comparitively smaller transverse diameter

49
Q

What is an android pelvis?

A

heart-shaped inlet and narrower from the front

50
Q

what race tends to have android pelvis

A

afro-carribean

51
Q

What type of pelvis is most suited to childbirth?

A

gynaecoid pelvis

52
Q

What is the normal fetal lie?

A

longitudinal

53
Q

what is the normal fetal presentation?

A

cephalic

54
Q

What is the normal fetal head position?

A

occipito-anterior

55
Q

What is the ideal fetal head position for engagment?

A

occipito-transverse

56
Q

What are the seven cardinal movements of the babies head in the pelvis?

A

engagement; descent; flexion; internal rotation; crowning and extension; external rotation (optiomal position for shoulder) and expulsion

57
Q

Which shoulder should come first?

A

anterior

58
Q

What is crowning?

A

appearance of a large segment of fetal head at the introitus

59
Q

What does crowning feel like?

A

burning and stinging feeling for mother

60
Q

What 3 signs indicate placental separation?

A

uterus contracts; hardens and rises

umbilical cordlengthens permanently and gush of blood variable in amount

61
Q

What is the plane of placental separation?

A

spongy layer of decidua basalis

62
Q

What causes the placenta to separate?

A

shearing force of uterine contractions

63
Q

What is normal blood loss during labour?

A

less than 500mls

64
Q

When is blood loss during labour significantly abnormal?

A

more than 1500mls

65
Q

How is haemostasis after delivery achieved?

A

tonic contraction- uterine muscles strangulate the blood vessels; thrombosis of the torn vessel ends- hypercoaguable

66
Q

How long does it take tissues to return to non-pregnant state?

A

6 weels

67
Q

How long does bloodstained discharge continue after birth?

A

10-14 days

68
Q

What is lochia?

A

vaginal discharge containing blood, mucus and endometrial castings

69
Q

How long does it take the endometrium to regenerate?

A

end of a week

70
Q

What initiates lactation?

A

placental expulsion

71
Q

What is the widest diameter of the pelvis at the pelvic inelt?

A

transverse diameter

72
Q

what is the widest diameter at the pelvic outlet?

A

AP

73
Q

What are the maternal indications for IOL?

A

pre-eclampsia; poor obstetric history; medical disorders-renal /CTD; post-dates; DM; obstetric cholestasis

74
Q

What are the fetal indications for IOL?

A

suspected IUGR; rhesus isoimmunisation; antepartum haemorrhage; PROM

75
Q

What is premature rupture of membranes defined as?

A

rupture of membranes more than an hour before the onset of labour

76
Q

What is used to assess if it safe to induce labour?

A

Bishop’s score

77
Q

What medication can be used to induce labour?

A

prostaglandins- prostin gel/ pessary

78
Q

What ar ethe mechanical methods of IOL?

A

membrane sweep; foley balloon catheter

79
Q

What is the surgical IOL?

A

amniotomy

80
Q

What is the latent phase of labour defined as?

A

<4cm dilated

81
Q

What is the managemtn of the latent phase?

A

triage and assessment; look at pain relief; encourage to be at home

82
Q

How often should VE be done in labour?

A

4hrly

83
Q

How often should temp and BP be done during labour?

A

4hrly

84
Q

How often should the pulse be taken in labour?

A

hourly

85
Q

How often should fetal heart monitoring take place in the 1st stage?

A

1min after a contraction every 15 mins

86
Q

How often should fetal heart monitoring take place in hte 2nd stage?

A

every 5 mins

87
Q

Waht are the interventions for failure to progress in the second stage?

A

episiotomy; instrumental delivery; C/s

88
Q

What is active managemnt of the thrid stage?

A

routine use of uterotonic drugs; deferred clamping and cutting of the cord; controlled cord traction after signs of separation

89
Q

Why is the third stage managed actively vs passively?

A

shortens it; reduces the risk of serious haemorrhage and transufions

90
Q

What are the risks associated with active amangemtn of the thrid stage?

A

nausea and vomiting; haemorrhage of more than a litre; blood transfusion

91
Q

What is delay in the third stage defined as with active mx?

A

more than 30 mins

92
Q

What is delay in third stage with physiological mx?

A

more than 60 minutes

93
Q

What is the management of delay in the third stage?

A

manual removal of placenta under GA

94
Q

What is the treatment for PPH?

A

empty bladder; uterine massage; uretotonic drugs; IV fluids; controlled cord traction; give O2

Reproduction (52 decks)

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