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3 REPRO > normal labour and puerperium > Flashcards

normal labour and puerperium Flashcards

1
Q

define 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

what are the 3 possible locations for labour

A

consultant led unit
midwife led unit
home birth

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3
Q

which hormones influence the onset of labour

A

progesterone
oestrogen
oxytocin

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4
Q

function of progesterone in the onset of labour

A

keeps the uterus settle
prevents the formation of gap junctions
hinders the contractibility of myocytes

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5
Q

function of oestrogen in the onset of Labour

A

makes the uterus contract

promotes prostaglandin production

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6
Q

function of oxytocin in the onset of labour

A

initiates and sustains contractions

acts on decimal tissue to promote prostaglandin release

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7
Q

what is the function of liquor

A

nurtures and protects the fetus and facilitates movements

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8
Q

cervical tissue is made up of

A

collagen tissue (types 1-4)
smooth muscle
elastin
connective tissue

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9
Q

what substance causes changes in the firmness of the cervix

A

increase in hyaluronic acid gives increase in molecules among collagen fibres
the decrease in bridging among collagen fibres gives decrease in firmness

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10
Q

what are the processes involved in cervical ripening

A

decrease in collagen fibre alignment
decrease in collagen fibre strength
decrease in tensile strength of the cervical matrix
increase in cervical decorin

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11
Q

what are the five elements involved in the bishops score

A 
position 
consistency 
effacement 
dilatation 
station in pelvis
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12
Q

what does the bishops score determine

A

if it is safe to induce labour

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13
Q

what are the stages of labour

A 
first stage (latent up to 3-4 cms; active 4-10cms)
second stage (delivery of baby)
third stage (expulsion of placenta and membranes)
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14
Q

what happens during the latent first stage

A 
mild irregular uterine contractions
cervix shortens and softens 
duration variable (hours to days)
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15
Q

what happens during the active first stage

A

4cm to full dilation
slow descent of the presenting part
contraction progressively become more rhythmic and stronger

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16
Q

what is normal progress in the active first stage of labour

A

1-2 cm per hour

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17
Q

when does the second stage of labour start and end

A

starts with complete dilation of the cervix

ends with birth of baby

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18
Q

what is considered a prolonged second stage in a nulliparous women

A

3 hours with regional anaesthesia

2 hour without

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19
Q

what is considered prolonged second stage in a multiparous woman

A

2 hours with regional anaesthesia

1 hour without

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20
Q

when does the third stage start and end

A

delivery of the baby to the expulsion of the placenta and fetal membranes

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21
Q

what is the average duration of the third stage

A

10 minutes

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22
Q

what is expectant management of the third stage

A

spontaneous delivery of the placenta

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23
Q

what is active management of the third stage

A

use of oxytocic drugs and controlled cord traction

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24
Q

what is the advantage of active management of the third stage

A

lower risk of PPH

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25
Q

what are Braxton hicks contraction

A

tightening of the uterine muscles

irregular do not increase in frequency or intensity

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26
Q

what can relieve Braxton hicks contractions

A

ambulation or change in activity

27
Q

what are true labour contractions

A

evenly spaced contractions, with the time between getting shorter and shorter
length of contraction also increases

28
Q

what are the three factors that influence to labour

A

power (contractions)
passage (maternal pelvis)
passenger (fetus)

29
Q

where is the highest density of myoctyes in the uterus

A

fundus

30
Q

where is the pacemaker for uterine contractions located

A

tubal ostia

31
Q

normal frequency of contractions

A

up to 3-4 in 10 minutes

32
Q

duration of contractions

A

initially 10-15 seconds

builds to max 45 secs

33
Q

what is an anthropoid pelvis

A

oval shaped inlet with later anterior-posterior diameter and comparatively smaller transverse diameter

34
Q

what is a gynaecoid pelvis

A

most suitable female pelvic shape

35
Q

what is an android pelvis

A

triangular or heart-shaped inlet and narrower from the front

36
Q

what is the normal fetal position for Labou

A

longitudinal lie

cephalic presentation

37
Q

abnormal presentations

A

breech
oblique
transverse lie

38
Q

analgesia options for birth

A 
paracetamol/co-codamol 
TENS 
entonox 
diamorphine 
epidural 
remifentanyl 
combined spinal/epidural
39
Q

what is a partogram

A

graphic record of key data contained on one sheet used to assess the progress of labour

40
Q

what are the 7 cardinal movements of labour

A 
engagement 
decent 
flexion 
internal rotation 
crowing and extension 
restitution and external rotation
expulsion, anterior shoulder first
41
Q

when is the fetal head said to be engaged

A

when the widest diameter of the head has entered the brim of the pelvis (2 fifths palpable)

42
Q

which position is the head in during descent

A

occiput transverse

43
Q

why des flexion of the head occur

A

it occurs passively due to the shape of the bony pelvis and resistance from soft tissues

44
Q

which movement is associated with restitution

A

external rotation

45
Q

what is the outcome of restitution

A

the fetal head returns to the correct anatomic position in relation to the fetal torso

46
Q

what is crowning

A

appearance of a large segment of fetal head at the introitus

47
Q

why is delayed cord clamping beneficial to the baby

A

a higher red blood cell flow to vital organs in the first week
less anaemia at 2 months and increased duration of early breastfeeding

48
Q

when is it not appropriate to delay cord clamping

A

if immediate resuscitation is needed

49
Q

why should there be skin to skin contact immediately after birth

A

keeps baby warm and calm and is considered to improve other aspects of baby’s transition to life outside the womb

50
Q

what is the current guidance regarding skin to skin contact

A

1 hour of uninterrupted SSC immediately after birth

51
Q

3 classic signs of placental separation

A

umbilical cord lengthens permanently
frequently a gush of blood
placenta and membranes appear at introitus

52
Q

what is involved in active management of the third stage

A

syntometerine or 10 units of oxytocin
cord clamping and cutting
controlled cord traction
bladder emptying

53
Q

what is the plane of separation of the placenta

A

spongy layer of decidua basalis

54
Q

what is the normal volume of blood loss during labour

A

<500 ml

55
Q

how is haemostasis achieved in labour

A

tonic contraction of uterine muscle strangulate the blood vessels
thrombosis of the torn vessel ends (hyper-coagulable)

56
Q

what is the puerperium

A

6 weeks post pregnancy

period when tissues return to non-pregnant state

57
Q

what is lochia

A

vaginal discharge containing blood, mucus and endometrial castings

58
Q

what is rubra

A

fresh red discharge
contains lots of fresh blood
3-4 days

59
Q

what is serosa

A

brownish-red, watery discharge

4-14 days

60
Q

what is alba

A

yellow discharge

10-20 days

61
Q

uterine changes in the puerperium

A

weight reduces
fundal height drops to within pelvis
endometrium regenerates by end of a week (except placental site)
regression but never back to pre-pregnancy state (cervix, vagina and perineum)

62
Q

what triggers lactation

A

placental expulsion and a decrease in oestrogen and progesterone

63
Q

what is colostrum

A

the first secretion from the mammary glands after giving birth
rich in immunoglobulins

3 REPRO (40 decks)

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