Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Clinical > Normal Labour and Puerperium > Flashcards

Normal Labour and Puerperium Flashcards

1
Q

Define labour?

A

Physiological process during which the foetus, membranes, umbilical cord and placenta are expelled from the uterus

Usually assoc. with regular, painful uterine contractions with increasing frequency, intensity and duration and accompanied by biochemical changes in the cervical tissue, allowing cervical effacement and cervical dilatation
This results in delivery of the foetus and expulsion of the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is puerperium?

A

6 weeks following labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 key factors allow labour?

A
  1. Power - uterine contractions
  2. Passage - maternal pelvis
  3. Passenger - foetus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Physiological factors that allow labour to occur?

A

Progesterone - keeps the uterus settled; it prevents the formation of gap junctions and hinders the contractability of myocytes

Oestrogen - makes the uterus contract and this promotes PG production

Oxytocin - synthesised in decidual and extra-embryonic foetal tissues and in the placenta; this initiates and sustains contractions and it also acts on decidual tissue to promote PG release
The no. of oxytocin receptors increases in myometrial and decidual tissues near the end of the pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is labour initiated?

A

There is a degree of uncertainty but the following factors may be inv:
• Change in the oestrogen / progesterone ratio
• Foetal adrenals and pituitary hormones may control the timing of the onset of labour
• Myometrial stretch increases excitability of myometrial fibres
• Mechanical stretch of the cervix and stripping of foetal membranes
• Ferguson’s reflex
• Pulmonary surfactant secreted into amniotic fluid has been reported to stimulate PG synthesis
• Increased in production of foetal cortisol stimulates an increase in maternal oestriol
• Increase in myometrial oxytocin receptors and their activation results in phospholipase C activity and subsequent increase in cytosolitic Ca and uterine contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Ferguson’s reflex?

A

Neuroendodrine reflex comprising the self-sustaining cycle of uterine contractions, initiated by P at the cervix or vaginal walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Bishop’s score?

A 
Used to determine whether IOL is required and whether it is safe to do so; equal weight is given to each of the 5 elements:
• Position
• Consistency
• Effacement
• Dilatation
• Station in the pelvis

ADD IMAGE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stages of labour?

A
  1. 1st stage - consists of 2 phases:
    • Latent phase - there is up to 3-4 cm dilatation
    • Active phase - dilatation progresses from 4 to 10 cm, i.e: full dilatation
  2. 2nd stage - with full dilatation, the baby is delivered
  3. 3rd stage - there is expulsion of the placenta and membranes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Features of the latent phase of labour (in the 1st stage)?

A

Mild, irregular uterine contraction, with variable duration

Cervix shortens and softens

This stage is very unpredictable and can vary from being only a few hours to a few days; essentially, the latent phase prepares for labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of the active phase of labour (in the 1st stage)?

A

Cervical dilatation of 4 cm onwards; normal progress is assessed at 1-2 cm per hour

There is slow descent of the presenting part

Contractions progressively become stronger and more rhythmic

NOTE - analgesia, mobility and parity all increase variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Features of the 2nd stage of labour?

A

Begins with complete dilatation of the cervix, i.e: 10cm, to delivery of the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does the timing of the 2nd stage of labour vary between different women?

A

In nulliparous women, this stage is considered prolonged if it:
• Exceeds 3 hours, with regional analgesia
• Exceeds 2 hours, without analgesia

In multiparous women, this stage is considered prolonged if it:
• Exceeds 2 hours with regional analgesia
• Exceeds 1 hours without analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How often are vaginal examinations done during labour?

A

In low risk care, vaginal examinations are not always carried out to assess time of full dilatation (in normal labour, examine 4 hourly)

Should not be done inappropriately just for info

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Features of the 3rd stage of labour?

A

Average duration of 10 minutes, but can be 3 minutes or longer

After 1 hour, preparation is made for removal under general anaesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mx of the 3rd stage of labour?

A

Expectant Mx - spontaneous delivery of the placenta

Active Mx:
• Oxytocic drugs
• Cord clamping and cutting
• Controlled cord traction (preferred due to the lower risk of PPH)
• Bladder emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the oxytocic drugs used for active Mx of the 3rd stage of labour?

A

Prophylactic administration of:
• Syntometerine (1ml ampoule containing 500 micrograms ergometrine maleate and 5iu oxytocin)
• Oxytocin 10 units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do the cervical changes occur in labour?

A

Complex biochemical process causes cervical softening and ripening

Cervical softening due to:
• Increase in hyaluronic acid increases the molecules among the collagen fibres
• Decrease in bridging among collagen fibres gives decrease in firmness of cervix

Cervical ripening due to:
• Decrease in collagen fibre alignment
• Decrease in collage fibre strength
• Decrease in tensile strength of the cervical matrix
• Increase in cervical decorin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are Braxton Hicks contractions?

A

AKA false labour, practice contractions, etc

Tightening of the uterine muscles, which aid the body to prepare for birth; the woman has a false sensation of real contractions

They can thin the cervix but they will not ultimately lead to delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When do Braxton Hicks contractions begin?

A

Can start 6 weeks into pregnancy but are more usually felt in the 3rd trimester

Not usually felt until the 2ND OR 3RD TRIMESTER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Characteristics of Braxton Hicks contractions?

A

Irregular; they do not increase in frequency or intensity

Resolve with ambulation or a change in activity

Relatively painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Characteristics of true labour contractions?

A

Contractions are evenly spaced, e.g: 5 minutes apart; the time between gets SHORTER and the DURATION INCREASES (from 10 to 45 seconds)

Generally, they are painful

They also become MORE INTENSE and painful over time

Contractions do not resolve with a change in position

Accompanying cervical changes, softening, effacement and dilatation

Feeling of a true contraction is described as a WAVE, starting low and then rising until it peaks before ebbing away; if the mother’s abdomen is felt, it hardens during the contraction and this can be timed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Duration of true labour contractions?

A

Start about 5-10 minutes apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Mechanics of uterine contractions?

A

Uterine muscle - smooth muscle in CT; the density is highest at the fundus

Cervical tissue - mainly collagen tissue, smooth muscle and elastin held together by CT ground substance

Contraction and retraction leads to shortening of the muscle fibres; this propels the baby down the birth canal and exerts P on the cervix

24
Q

Power of uterine contractions?

A

Pacemaker is in the region of the tubal ostia and the wave spreads in the downward direction; as waves come from both ostia, the contractions are synchronised

25
Q

Explain polarity with relation to uterine contractions

A

Upper segment contracts and retracts

Lower segment and cervix stretch, dilate and relax

Normal contractions have a fundal dominance with a regular pattern and an adequate ‘resting tone’

26
Q

Define the intensity of contractions?

A

Degree of uterine systole; it is maximum in the 2nd stage

Graded mild, moderate and strong

27
Q

Frequency of contractions?

A

Normal up to 3-4 in 10 minutes

28
Q

Duration of contractions?

A

Initially, 10-15 seconds

Maximum of 45 seconds and they slowly build up

29
Q

Summarise how contractions progress?

A

Progressively more intense, frequent and longer-lasting

30
Q

What are abdominal fifths?

A

If head is mobile above the symphisis pubis = 5/5
NOTE - the head accommodates full width of five fingers above the symphisis pubis

If the head is 2/5ths above the symphisis pubis, this means the head accommodates 2 fingers above the symphisis pubis

31
Q

5 parameters that are evaluated during cervical assessment?

A
  1. Effacement
  2. Dilatation
  3. Firmness
  4. Position
  5. Level of the presenting part or station

NOTE - these are all assessed during a vaginal examination in labour, as there is a relationship between the clinical state of the cervix and onset of labour

32
Q

To assess descent of the head, what can be used?

A

Ask the mother - maternal discomfort and feeling of P

Abdominal fifths - used as reference points

Frontal synciput and occipital eminences

Vaginal examinations for cervical assessment (should be carried out 4 hourly in normal labour)

33
Q

Types of pelvis?

A

Gynaecoid pelvis (most suitable female pelvis type)

Anthropoid pelvis - oval shaped inlet with large anterio-posterior diameter and comparatively smaller transverse diameter

Android pelvis - triangular or heart-shaped inlet and is narrower from the front; Afro-Caribbean women are more at risk of having an android shaped pelvis

34
Q

Foetal positions in the pelvis?

A

ADD IMAGE

35
Q

Normal foetus in the pelvis?

A

Longitudinal lie

Cephalic presentation

OA position; the head engages occipito-transverse and is flexed

Presenting part is the vertex

36
Q

Abnormal foetus in the pelvis?

A

Presentation that are abnormal:
• Breech

Oblique and transverse lies are abnormal

OP position is abnormal

37
Q

What is liquor?

A

AKA amniotic fluid

Amniotic fluid that leaks once the membranes have ruptured; it is the fluid that nurtures and protects the foetus, as well as facilitating movement

38
Q

Timing of membrane rupture?

A 
Can occur:
• Preterm
• Pre-labour
• 1st stage
• 2nd stage
• Born in a caul (rare) - this is harmless and the membrane can be removed from the newborn's head and face
39
Q

Mechanism of labour?

A

Changes in position of the baby’s head in the pelvis, described in relation to vertex presentation

  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Crowning and extension
  6. Restitution and rotation,
  7. Expulsions (anterior shoulder first)
40
Q

Define crowning?

A

Appearance of a large segment of foetal head at the introitus

Labia are stretched to full capacity

Largest diameter of the foetal head is encircled by the vulval ring

41
Q

Why might an episiotomy be required during crowning?

A

To prevent trauma to the anal sphincters

42
Q

When might placental separation occur?

A

During the 3rd stage

43
Q

3 classic signs of placental separation?

A
  1. Uterus contracts, hardens and rises
  2. Umbilical cord lengthens permanently
  3. Gush of blood is variable in amount

Expulsion of placenta is usually within 5-10 minutes of delivery; it is considered normal up to 30 minutes

44
Q

How does placental separation occur?

A

Due to shearing force and this causes separation in the spongy layer of the decidua basalis

Inelastic placenta reduces surface area on the placental bed, due to the sustained contraction of the uterus

Methods of separation:
• Matthew Duncan - marginal is the most common type of separation
• Schultz - separation from central aspect

45
Q

Options for analgesia during labour?

A

Generally, progress in a step-wise manner:

  1. Paracetamol / co-codamol
  2. TENS
  3. Entonox
  4. Diamorphine
  5. Epidural
  6. Remifentanyl
  7. Combined spinal / epidural
46
Q

How much blood loss occurs during blood loss?

A

Normal - volume of <500mls

Abnormal if the volume is >500mls; this is more significant if it is >1500mls

Any blood loss prior to delivery, apart from ‘show’, is abnormal and requires referral to consultant unit

47
Q

How is haemostasis achieved during labour?

A
  1. Tonic contraction - lattice pattern of uterine muscle strangulates the blood vessels
  2. Thrombosis of the torn vessel ends, as pregnancy is a hypercoagulable state
  3. Myo-tamponade opposition of the anterior / posterior walls
48
Q

What is puerperium?

A

Period of repair and recovery; there is a return of the tissue to a non-pregnant state, within 6 weeks

During this period, patient have discharge

49
Q

Define lochia?

A

Vaginal discharge after giving birth (puerperium) containing blood, mucus, and endometrial castings

50
Q

3 stages of lochia?

A
  1. Lochia rubra - fresh red
  2. Lochia serosa - brownish-red and watery
  3. Lochia alba - yellow

Bloodstained discharge lasts for about 10-14 days following birth

51
Q

What is uterine involution?

A

Physiological process by which the uterus is transformed from pregnant to non-pregnant state

52
Q

Changes that occur with uterine involution?

A

Weight reduces

Fundal height falls from the umbilicus to within the pelvis, in 2 weeks

Endometrium regenerates by the end of the week, except the placental site

Regression of the cervix, vagina and perineum but never back to the pre-pregnancy state

Physiological diuresis commences 2-3 days post-natally

53
Q

How is lactation initiated?

A

By placental expulsion

Oestrogen and progesterone decrease but prolactin is maintained

54
Q

How is colostrum protective for the baby?

A

Rich in Ig, which has a long-term protective effect for the baby

55
Q

Why is breastfeeding initially problematic?

A

Due to physical debility, esp. after surgical intervention and psychological effects following the trauma of delivery

Year 3 Clinical (100 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions