Normal Labour And Puerperium Flashcards
Effect of oestrogen on uterus?
Makes it contract
Effect of progesterone on uterus ?
Keeps it settled
Oxytocin a relationship with contractions?
Initiates and sustains contractions
What is the fergusons reflex?
Neuroendocrine reflex comprising self-sustaining cycle of uterine contractions initiated by pressure at cervix or vaginal wall
What is bishops score and what does it comprise of?
Method of determining if safe to induce labour. Position Consistency Affacement Dilatation Station in pelvis
What happens in 1st latent stage of labour?
Mild irregular uterine contractions
Cervix shortens and softens
Duration variable
What Happens in 1st active phase of labour?
4cm to full dilatation
Slow decent of presenting part
Contractions become more rhythmic and stronger
What happens in 2nd stage of labour?
Complete dilatation of cervix (10cm) to delivery of baby
Nullparous - up to 3hrs with analgesia and 2 hrs without
Multiparous- up to 2 hrs with analgesia and 1 hr without
What happens in the 3rd stage of delivery?
Delivery of baby to expulsion of placenta and fetal membranes.
Lasts about 10mins - if longer than 1 hour, removal under GA
What changes happen to cervix?
Softening
Ripening
What causes cervical softening?
Increase in hyaluronic acid - increase in molecules among collagen fibres.
Decrease in bridging among collagen fibres -> decreases firmness of cervix
What are Braxton-hicks contractions?
Tightening of uterine muscles - false labour.
Felt in 2nd and 3rd trimester.
Irregular, don’t increases in frequency or intensity.
Quite painless.
What hormone stimulates contractions?
Oxytocin
What happens to contractions and labour progresses?
Evenly spaced but get closer together.
Get more intense and painful.
Where the contractions originate?
Pacemaker region of tubal Ostia
What is the most suitable pelvis shape?
Gynaecoid pelvis
What is an anthropoid pelvis?
Oval shaped inlet with large anterio-posterior diameter and smaller transverse diameter
What is an android pelvis?
Triangular/ heart shaped inlet and is narrower from front.
Afro-Caribbean
What are the cardinal movements?
Engagement Decent Flexion Internal rotation crowing and extension Restitution and external rotation Expulsion
When does expulsion of placenta occur?
About 5-10 mins after delivery - normal up until 30 mins
Analgesic option during delivery?
Paracetamol/ co-codamol TENS Entomox Diamorphine Epidural Remifentanyl Combined spinal/ epidural
Normal blood loss during delivery?
<500mls
Abnormal blood loss during delivery ?
> 500mls
Significant blood loss during delivery?
> 1500mls
What is puerpeurium?
Period of Repair and recovery
How long does it take for tissues to return to non-pregnant state?
6 weeks
What is Lochia?
Vaginosis discharge containing blood, mucus and endometrial castings
Rubra Lochia?
Fresh red
Serosa lochia?
Brownish red, watery
Alba Lochia?
Yellow
How long after delivery does flood stained discharge last?
10-14 days
How long does it take for endometrium to regenerate after delivery?
About a week
What is lactation initiated by?
Placental expulsion
For lactation, what are the change in hormones?
Decrease in oestrogen
Decrease in progesterone
Prolactin is maintained
