Normal Labour and Puerperium Flashcards
describe the levels of oestrogen and progesterone in labour
progesterone goes down
oestrogen goes up (to contract uterus)
how is labour induced?
myometrial stretch causes pituitary to release oxytocin which contracts uterus and pushes foetal head down more
how does progesterone keep the uterus settled?
prevents formation of gap junctions to hinder the contractability of myocytes
where is oxytocin synthesised?
decidual and extraembryonic fetal tissues and in placenta
what effect does oxytocin have on decidual tissue?
promotes prostaglandin release from it
there is a surge in oestrogen during labour T or F
F, remains higher but constant
what substance from the baby in the amniotic fluid can initiate labour? why?
pulmonary surfactant
stimulates prostaglandin synthesis
what is liquor?
nurtures and protects fetus and facilitates movement
what causes the cervix to lose its firmness in labour?
increase in hyaluronic acid decreases bridging of collagen fibres in the cervix (less strength, alignment)
what does the bishop score determine?
if its safe to induce labour
name the 5 elements of the bishop score of the cervix?
position consistency effacement dilatation station in pelvis
dilatation is __cm in the latent phase
3-4cm
the active stage of labour has a dilation of….
4-10cm
describe the uterine contractions in the latent phase of labour
mild irregular
describe uterine contractions in active labour
rhythmic
strong
normal progress in active labour is about _cm per hr
1-2
what factors decrease labour duration
mobility
no analgesia
parity
how often are vaginal examinations done in labour?
every 4hrs
2nd stage of labour is considered prolonged if it exceeds _ hours in nulliparous women
3 if regional anaesthesia
2 without
2nd stage of labour is considered prolonged if it exceeds _ hours in multiparous women
2 with regional anaesthesia
1 without
average duration of 3rd stage of labour?
10 mins
what marks the start and end of stage 2?
when 10cm dilatation occurs to delivery of the baby
what happens if stage 3 lasts over an hr
prep will be made for removal under anaesthetic
how is risk of PPH lowered in stage 3
use oxytocic drugs
control cord traction
what are braxton hicks contractions?
false sensation of contractions caused by tightening of the uterine muscles
“false labour”
when are braxton hicks contractions felt?
3rd trimester but can start 6 weeks in to pregnancy
describe braxton hicks contractions
irregular with no correlation of frequency or intensity, painless, resolve with change in activity eg lying down
describe true labour contractions
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
how long do true labour contractions last
10-45 secs
name the 3 key factors that affect labour
power eg uterine contractions
passage eg mums pelvis
passenger eg fetus
where is uterine muscle density highest?
at the fundus (top)
where is the pacemaker of the uterus located?
tubal ostia
how many contractions are expected in 10 mins?
3-4
what kind of pelvis is ideal for birth?
gynaecoid
what kind of patients are at risk of an android shaped pelvis?
african-caribbean women
antero-posterior diameter is larger in a gynaecoid/android pelvis
gynaecoid
how can you tell the position of the baby from a vaginal exam?
feel for sutures and fontanelles on baby’s skull
best analgesic for labour?
entonox
what does a partogram measure?
cervical dilatation
fetal heart rate
what analgesic is good as a stronger analgesic for 1st stage of labour
diamorphine
induced labour tends to be more painful T or F
T
name the 7 cardinal movements of the baby in labour
engagement descent flexion internal rotation crowning and extension resitution and external rotation expulsion
what is expelled first in birth
anterior shoulder
what are cardinal movements in labour?
changes in position of babys head in the pelvis in relation to vertex presentation
what happens in engagement and descend
passage of the head to a level below the pelvic inlet
baby passes downwards
where is the sagittal suture located in engagement?
tends to be deflected posteriorly
when is a baby said to be engaged?
3/5 of the head is in the pelvis
internal rotation involves the baby moving its head from what position to what?
from transverse position to anterior
extension occurs once the fetus has reached the level of the ___
interoitus
what is restitution?
baby externally rotates its head back to its anatomic position
what is crowning?
largest diameter of the fetal head is encircled by the vulval ring
what does crowning feel like?
burning and stinging
when should you clamp the cord?
leave it for a while to ensure blood supply unless immediate resus is needed
what is skin to skin?
placing of naked baby on mothers chest, allows transition to life outside of womb
how long after delivery is placenta delivered?
5-10 mins aftery
name the 3 classic signs of placental separation
uterus conrtracts, hardens, rises
umbilical cord lengthens
gush of blood
a blood loss of under __ml is normal
500
pregnancy is a hypo/hypercoaguable state
hyper
what is puerperium?
period of repair and recovery of tissues to a non-pregnant state
how long does puerperium last?
6 weeks
describe discharge in puerperium?
bloody (up to 2 weeks after) to brown to yellow
how long after pregnancy does the endometrium regenerate?
1 week
lactation is initiated by…
placental explulsion
what is effacement?
thinning of the cervix for birth
why does labour take longer with an epidural
anesthesia to S2-S4 will stop supplying the pelvic floor so they cant work as effectively
what happens to the bladder with an epidural?
urinary retention
what is moulding?
folding over of the baby’s skull
how do you measure foetal HR in labour in low risk women?
intermittent auscultation
how do you measure fetal HR in high risk women?
constantly with a CTG
