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Reproduction and Sexual Health > Normal Labour and Puerperium > Flashcards

Normal Labour and Puerperium Flashcards

1
Q

What is labour?

A

A physiological process during which the fetus membranes, umbilical cord and placenta are expelled from the uterus.

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2
Q

During labour, there is an interlay of 3 key factors. What are these?

A

Power – uterine contraction.
Passage – maternal pelvis.
Passenger – foetus.

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3
Q

What is the role of progesterone (in relation to labour)?

A
  • Keeps the uterus settled.
  • Prevents the formation of gap junctions.
  • Hinders the contractibility of myocytes.
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4
Q

What is the role of oestrogen? (think ‘o’ for ooohhh that’s sore)

A
  • Makes the uterus contract.

* Promotes prostaglandin production.

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5
Q

What is the role of oxytocin in relation to labour?

A
  • Initiates and sustains contractions.

* Acts on decidual tissue to promote prostaglandin release.

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6
Q

Where is oxytocin synthesised (aside from in the posterior pituitary)?

A

Directly in decidual and extraembryonic fetal tissues and in the placenta

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7
Q

The number of what receptors where increases near the end of pregnancy?

A

Number of oxytocin receptors increases in myometrial and decidual tissues.

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8
Q

What causes the initiation of labour?

A
  • There is some degree of uncertainty about this.
  • Change in the oestrogen/progesterone ratio may be implicated.
  • Fetal adrenals and pituitary hormones may control the timing of the onset of labour.
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9
Q

What is the effect of the myometrial stretch?

A

It increases excitability of myometrial fibres

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10
Q

What is the Ferguson reflex?

A

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

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11
Q

What has pulmonary surfactant secreted into amniotic fluid been reported to stimulate?

A

Prostaglandin synthesis

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12
Q

What does an increase in production of fetal cortisol stimulate?

A

An increase in maternal estriol

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13
Q

What does an increase in myometrial oxytocin receptors and their activation result in?

A

Phospholipase C activity, and subsequent increase in cytosolitic calcium and uterine contractility.

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14
Q

In Bishops score, Equal weight is give to each of the 5 elements. What are these?

A
  • Position.
  • Consistency.
  • Effacement. (thinning of the cervix)
  • Dilatation.
  • Station in pelvis.
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15
Q

What does the Bishops score remain?

A

The best and simplest method available to determine if it is safe to induce labour.

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16
Q

What is the 1st stage of labour?

A

Latent phase: 3-4cms dilatation.

Active stage: 4-10cms (full dilatation).

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17
Q

What is the 2nd stage of labour?

A

Full dilatation – Delivery of baby.

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18
Q

What is the 3rd stage of labour?

A

Delivery of baby – Expulsion of placenta and membranes.

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19
Q

What are the uterine contractions like in the latent stage of labour?

A

Mild and irregular.

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20
Q

What happens to the cervix during the latent stage of labour?

A

It shortens and softens

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21
Q

What is the duration of the latent stage of labour like?

A

Variable - usually lasts a few days

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22
Q

When does the active stage of labour occur?

A

From 4cms onwards to full dilatation

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23
Q

SLOW DESCENT OF THE PRESENTING PART - occurs in which stage of labour?

A

Active stage

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24
Q

What happens to contractions during the active stage of labour?

A

They become progressively more rhythmic and stronger.

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25
Q

What is normal progress during the active stage of labour classified as?

A

1-2cm per hour.

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26
Q

What increase variability of progression during the active phase of labour?

A

Analgesia, mobility and parity.

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27
Q

When does the second stage of labour begin and end?

A

Begins with complete dilatation of the cervix (10cm).

To delivery of the baby.

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28
Q

When is the 2nd stage of labour considered prolonged in a nulliparous woman?

A

If it exceeds 3 hours if there is multiregional analgesia, or 2 hours without.

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29
Q

When is the 2nd stage of labour considered prolonged in a multiparous woman?

A

If it exceeds 2 hours with regional analgesia, or 1 hour without.

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30
Q

When does the third stage of labour occur?

A

From delivery of the baby to expulsion of the placenta and foetal membranes.

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31
Q

When does the 3rd stage of labour occur?

A

From delivery of the baby to expulsion of the placenta and foetal membranes.

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32
Q

How long does the 3rd stage of labour last?

A

Average duration 10 minutes but can be 3 minutes or longer.

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33
Q

What happens after 1 hour in the 3rd stage of labour?

A

Preparation is made for removal under GA.

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34
Q

What is the expected management in removal?

A

Spontaneous delivery of the placenta.

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35
Q

What is the active management after removal?

A

Use of oxytocic drugs and controlled cord traction is preferred for lowing risk of post-partum haemorrhage.

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36
Q

What does active management during the 3rd stage involve prophylactic administration of?

A

Syntometerine (1ml ampoule containing 500 micrograms ergometrine maleate and 5iu oxytocin)
OR
Oxytocin 10units.

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37
Q

Explain how cervical softening happens.

A
  • Increase in hyaluronic acid gives increase in molecules among collagen fibres.
  • The decrease in bridging among collagen fibres gives decrease in firmness of the cervix.
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38
Q

Explain how cervical ripening comes about.

A
  • Decrease in collagen fibre alignment.
  • Decrease in collagen fibre strength.
  • Decrease in tensile strength of cervical matrix.
  • Increase in cervical decorin (dermatan sulphate proteoglycan).
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39
Q

What causes Braxton Hick’s contractions?

A

Tightening of the uterine muscles.

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40
Q

Braxton hicks contractions are _____ contractions

A

FALSE

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41
Q

What is this tightening of the uterine muscles thought to do?

A

Prepare the body for birth

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42
Q

When do Braxton Hick’s contractions occur?

A

Can start 6 weeks into pregnancy, but not usually felt until the second or third trimester

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43
Q

What has the feeling of a true contraction been described as?

A

A wave

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44
Q

Describe the pain which occurs during true labour contractions.

A

Pain starts low, rises until it peaks and finally ebbs away.

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45
Q

If you touch a patient’s abdomen during a contraction, how will it feel?

A

Hard

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46
Q

How far apart are contractions?

A

About 5-10 minutes apart.

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47
Q

What are Braxton Hicks contractions sometimes called? Why?

A

‘False labour’ – because they give the woman a false sensation that she is having real contractions.

48
Q

Although Braxton Hick’s contractions can thin the cervix (the opening of the uterus), what do they not do?

A

Induce labour

49
Q

Describe Braxton Hick’s contractions.

A

Irregular, do not increase in frequency or intensity.
Resolve with ambulation or change in activity.
Relatively painless

50
Q

When do real contractions happen?

A

When your body releases a hormone called oxytocin, which stimulates your uterus to contract.

51
Q

What are contractions a sign of?

A

Your body being in labour

52
Q

What is ‘true labour’?

A

When the contractions are evenly spaced (e.g. 5 mins apart), and the time between them gets shorter and shorter (3 mins apart, then 2, then 1)

53
Q

As labour progresses, what happens to length of time of contraction?

A

Increases – 10 secs to 45 secs

54
Q

Real contractions will also get more intense and painful over time

A

TRUE

55
Q

What do contractions do?

A

Tighten the top part of the uterus, pushing the baby downward into the birth canal, in preparation for delivery

This also promotes thinning of the cervix

56
Q

How do contractions start?

A

Start infrequently, and may be noticed at 10-15 minute intervals.

57
Q

True labour contractions always get longer and more intense feeling. What accompany these?

A

Cervical changes, softening, effacement and dilatation.

58
Q

What do ‘true contractions’ not resolve with?

A

A change of position

59
Q

Are true contractions painful?

A

YES

60
Q

Describe the uterine muscle.

A 
Smooth muscle (myocyte) in connective tissue (collagen and elastin). 
Density highest at the fundus.
61
Q

Describe cervical tissue.

A

Collagen tissue (mainly types 1, 2, 3, 4) smooth muscle, elastin, held together by connective tissue ground substance.

62
Q

What leads to shortening of the muscle fibres?

A

Contraction and retraction

63
Q

What do uterine contractions do?

A

Propel the baby down the birth canal, exerting pressure on the cervix.

64
Q

Where is the pacemaker for uterine contractions in the region of? What does this facilitate?

A

The tubal ostia – facilitates a wave which spreads in a downward direction.

65
Q

Describe the polarity of uterine contractions.

A

Upper segment contracts and retracts, while the lower segment and cervix stretch, dilate and relax.

66
Q

What is intensity of contractions determined by?

A

Degree of uterine systole

67
Q

When is the intensity of contraction maximum?

A

2nd stage of labour

68
Q

Power of contractions can be graded as . . .

A

Mild, moderate of strong

69
Q

What is the normal frequency of contractions?

A

Up to 3-4 in 10 minutes.

  • allows time for resting tone.
70
Q

What is the duration of contractions initially?

A

10-15 seconds.

71
Q

What is the max duration of contractions?

A

45 seconds (slowly builds up).

72
Q

What becomes

PROGRESSIVLEY MORE INTENSE, FREQUENT AND LONGER LASTING ?

A

Contractions

73
Q

5/5

A

Head is mobile above the symphysis pubis

74
Q

How can the cervix be characterized?

A

By evaluating 5 parameters (Bishop’s score):

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

We need to assess all of these factors during a vaginal examination in labour.

75
Q

Anterior fontanelle shape?

A

Diamond

76
Q

Posterior fontanelle shape?

A

Triangle

77
Q

What are used as references for the descend of the head?

A

Abdominal fifths

78
Q

In normal labour, how often should vaginal examinations be carried out?

A

4 hourly

79
Q

What is the most suitable pelvic shape?

A

Gynaecoid pelvis.

80
Q

Describe the anthropoid pelvis.

A

There is an oval shaped inlet with large anterio-posterior diameter and comparatively smaller transverse diameter.

81
Q

Describe the android pelvis.

A

Triangular or heart-shaped inlet and is narrower from the front. African-Caribbean women are more at risk of having an android shaped pelvis.

82
Q

What does liquor do?

A

Nurtures and protects the fetus, and facilitates movement.

83
Q

Outline the different timings of rupture of the membranes.

A
  • Pre-Term.
  • Pre-Labour.
  • First Stage.
  • Second Stage.
  • Born in a caul.
84
Q

Outline the key stages of labour, in terms of foetal movement.

A 
Engagement 
Descent
Flexion
Internal Rotation
Crowning and extension
Restitution and external rotation (head adopts optimal position for shoulder)
Expulsion, anterior shoulder first
85
Q

What is crowning?

A

The appearance of a large segment of the fetal head at the introitus.

86
Q

What is stretched to full capacity during crowning?

A

The labia

87
Q

What is the largest diameter of the fetal head encircled by during crowning?

A

The vulval ring

88
Q

What does the mother experience during crowning?

A

Burning and stinging.

89
Q

What may be required to prevent trauma to anal sphincters?

A

Episiotomy

90
Q

3 classic signs indicate separation. What are these?

A
  • Uterus contracts, hardens and rises.
  • Umbilical cord lengthens permanently.
  • Gush of blood variable in amount.
91
Q

When, after delivery, does expulsion of the placenta usually occur? What is considered normal?

A

5-10 minutes.

Considered normal up to 30 minutes.

92
Q

What is the plane of separation?

A

The spongy layer of decidua basalis.

93
Q

What type of mechanical force does separation involve?

A

Shearing force.

94
Q

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

A

TRUE

95
Q

What is the method of separation?

A

Matthew Duncan method – marginal most common type of separation

96
Q

What type of separation occurs from the central aspect?

A

Schultz.

97
Q

What are the analgesic options during labour?

A 
Paracetamol/ Co-codamol
TENS
Entonox
Diamorphine
Epidural
Remifentanyl
Combined spinal/epidural
98
Q

What is entonox?

A

‘Gas and air’ - a mix of nitric oxide and oxygen

99
Q

What volume of blood loss is normal?

A

<500 ml

100
Q

What amount of blood loss is abnormal?

A

> 500 ml

101
Q

What amount of blood loss is significantly abnormal?

A

> 1000 ml

102
Q

How is haemostasis achieved naturally?

A

Tonic contraction: Lattice pattern of uterine muscle strangulates the blood vessels

Thrombosis of the torn vessel ends: pregnancy is a hyper-coaguable state

Myo-tamponade-opposition of the anterior/posterior walls.

103
Q

What is puerperium?

A

A period of repair and recovery.

104
Q

Puerperium - The return of tissues to a non-pregnant state in __ weeks.

A

6 weeks

105
Q

What is lochia?

A

Vaginal discharge containing blood, mucous and endometrial castings.

Vaginal discharge in weeks following birth

106
Q

Rubra

A

fresh red

107
Q

Serosa

A

Brownish -red and watery

108
Q

Alba

A

Yellow

109
Q

How long following birth does bloodstained discharge last?

A

For around 10-14 days

110
Q

Outline the uterine weight change which occurs.

A

1000g reduces to 50-100g.

111
Q

What change occurs in relation to fundal height during uterine involution?

A

Umbilicus to within pelvis in 2 weeks.

112
Q

When does the endometrium regenerate by?

A

The end of 1 week – except the placental site.

113
Q

What commences 2-3 days postnatally?

A

Physiological diuresis.

114
Q

What is lactation initiated by?

A

Placental expulsion.

115
Q

What is lactation initiated by?

A

Placental expulsion
+
* DECREASE in oestrogen and progesterone.
* PROLACTIN is maintained

116
Q

What is colostrum rich in? What is the main advantage of this?

A

Immunoglobulin – has a long-term protective effective.

117
Q

Why can breastfeeding be problematic at the beginning?

A

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

Reproduction and Sexual Health (51 decks)

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