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3 Reproduction and Sexual Health > Normal Labour and Puerperium > Flashcards

Normal Labour and Puerperium Flashcards

1
Q

describe the levels of oestrogen and progesterone in labour

A

progesterone goes down

oestrogen goes up (to contract uterus)

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2
Q

how is labour induced?

A

myometrial stretch causes pituitary to release oxytocin which contracts uterus and pushes foetal head down more

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3
Q

how does progesterone keep the uterus settled?

A

prevents formation of gap junctions to hinder the contractability of myocytes

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4
Q

where is oxytocin synthesised?

A

decidual and extraembryonic fetal tissues and in placenta

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5
Q

what effect does oxytocin have on decidual tissue?

A

promotes prostaglandin release from it

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6
Q

there is a surge in oestrogen during labour T or F

A

F, remains higher but constant

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7
Q

what substance from the baby in the amniotic fluid can initiate labour? why?

A

pulmonary surfactant

stimulates prostaglandin synthesis

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8
Q

what is liquor?

A

nurtures and protects fetus and facilitates movement

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9
Q

what causes the cervix to lose its firmness in labour?

A

increase in hyaluronic acid decreases bridging of collagen fibres in the cervix (less strength, alignment)

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10
Q

what does the bishop score determine?

A

if its safe to induce labour

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11
Q

name the 5 elements of the bishop score of the cervix?

A 
position
consistency
effacement
dilatation
station in pelvis
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12
Q

dilatation is __cm in the latent phase

A

3-4cm

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13
Q

the active stage of labour has a dilation of….

A

4-10cm

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14
Q

describe the uterine contractions in the latent phase of labour

A

mild irregular

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15
Q

describe uterine contractions in active labour

A

rhythmic

strong

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16
Q

normal progress in active labour is about _cm per hr

A

1-2

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17
Q

what factors decrease labour duration

A

mobility
no analgesia
parity

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18
Q

how often are vaginal examinations done in labour?

A

every 4hrs

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19
Q

2nd stage of labour is considered prolonged if it exceeds _ hours in nulliparous women

A

3 if regional anaesthesia

2 without

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20
Q

2nd stage of labour is considered prolonged if it exceeds _ hours in multiparous women

A

2 with regional anaesthesia

1 without

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21
Q

average duration of 3rd stage of labour?

A

10 mins

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22
Q

what marks the start and end of stage 2?

A

when 10cm dilatation occurs to delivery of the baby

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23
Q

what happens if stage 3 lasts over an hr

A

prep will be made for removal under anaesthetic

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24
Q

how is risk of PPH lowered in stage 3

A

use oxytocic drugs

control cord traction

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25
Q

what are braxton hicks contractions?

A

false sensation of contractions caused by tightening of the uterine muscles
“false labour”

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26
Q

when are braxton hicks contractions felt?

A

3rd trimester but can start 6 weeks in to pregnancy

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27
Q

describe braxton hicks contractions

A

irregular with no correlation of frequency or intensity, painless, resolve with change in activity eg lying down

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28
Q

describe true labour contractions

A

timing of contractions become evenly spaced and get shorter eg 2 min in between then 1, can last 10-45 secs, get more intense and painful over time

29
Q

how long do true labour contractions last

A

10-45 secs

30
Q

name the 3 key factors that affect labour

A

power eg uterine contractions
passage eg mums pelvis
passenger eg fetus

31
Q

where is uterine muscle density highest?

A

at the fundus (top)

32
Q

where is the pacemaker of the uterus located?

A

tubal ostia

33
Q

how many contractions are expected in 10 mins?

A

3-4

34
Q

what kind of pelvis is ideal for birth?

A

gynaecoid

35
Q

what kind of patients are at risk of an android shaped pelvis?

A

african-caribbean women

36
Q

antero-posterior diameter is larger in a gynaecoid/android pelvis

A

gynaecoid

37
Q

how can you tell the position of the baby from a vaginal exam?

A

feel for sutures and fontanelles on baby’s skull

38
Q

best analgesic for labour?

A

entonox

39
Q

what does a partogram measure?

A

cervical dilatation

fetal heart rate

40
Q

what analgesic is good as a stronger analgesic for 1st stage of labour

A

diamorphine

41
Q

induced labour tends to be more painful T or F

A

T

42
Q

name the 7 cardinal movements of the baby in labour

A 
engagement
descent
flexion
internal rotation
crowning and extension
resitution and external rotation
expulsion
43
Q

what is expelled first in birth

A

anterior shoulder

44
Q

what are cardinal movements in labour?

A

changes in position of babys head in the pelvis in relation to vertex presentation

45
Q

what happens in engagement and descend

A

passage of the head to a level below the pelvic inlet

baby passes downwards

46
Q

where is the sagittal suture located in engagement?

A

tends to be deflected posteriorly

47
Q

when is a baby said to be engaged?

A

3/5 of the head is in the pelvis

48
Q

internal rotation involves the baby moving its head from what position to what?

A

from transverse position to anterior

49
Q

extension occurs once the fetus has reached the level of the ___

A

interoitus

50
Q

what is restitution?

A

baby externally rotates its head back to its anatomic position

51
Q

what is crowning?

A

largest diameter of the fetal head is encircled by the vulval ring

52
Q

what does crowning feel like?

A

burning and stinging

53
Q

when should you clamp the cord?

A

leave it for a while to ensure blood supply unless immediate resus is needed

54
Q

what is skin to skin?

A

placing of naked baby on mothers chest, allows transition to life outside of womb

55
Q

how long after delivery is placenta delivered?

A

5-10 mins aftery

56
Q

name the 3 classic signs of placental separation

A

uterus conrtracts, hardens, rises
umbilical cord lengthens
gush of blood

57
Q

a blood loss of under __ml is normal

A

500

58
Q

pregnancy is a hypo/hypercoaguable state

A

hyper

59
Q

what is puerperium?

A

period of repair and recovery of tissues to a non-pregnant state

60
Q

how long does puerperium last?

A

6 weeks

61
Q

describe discharge in puerperium?

A

bloody (up to 2 weeks after) to brown to yellow

62
Q

how long after pregnancy does the endometrium regenerate?

A

1 week

63
Q

lactation is initiated by…

A

placental explulsion

64
Q

what is effacement?

A

thinning of the cervix for birth

65
Q

why does labour take longer with an epidural

A

anesthesia to S2-S4 will stop supplying the pelvic floor so they cant work as effectively

66
Q

what happens to the bladder with an epidural?

A

urinary retention

67
Q

what is moulding?

A

folding over of the baby’s skull

68
Q

how do you measure foetal HR in labour in low risk women?

A

intermittent auscultation

69
Q

how do you measure fetal HR in high risk women?

A

constantly with a CTG

3 Reproduction and Sexual Health (51 decks)

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