normal labour and puerperium

Question 1

define labour

Answer 1

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

Question 2

what are the 3 possible locations for labour

Answer 2

consultant led unit
midwife led unit
home birth

Question 3

which hormones influence the onset of labour

Answer 3

progesterone
oestrogen
oxytocin

Question 4

function of progesterone in the onset of labour

Answer 4

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

Question 5

function of oestrogen in the onset of Labour

Answer 5

makes the uterus contract

promotes prostaglandin production

Question 6

function of oxytocin in the onset of labour

Answer 6

initiates and sustains contractions

acts on decimal tissue to promote prostaglandin release

Question 7

what is the function of liquor

Answer 7

nurtures and protects the fetus and facilitates movements

Question 8

cervical tissue is made up of

Answer 8

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

Question 9

what substance causes changes in the firmness of the cervix

Answer 9

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

Question 10

what are the processes involved in cervical ripening

Answer 10

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

Question 11

what are the five elements involved in the bishops score

Answer 11

position 
consistency 
effacement 
dilatation 
station in pelvis

Question 12

what does the bishops score determine

Answer 12

if it is safe to induce labour

Question 13

what are the stages of labour

Answer 13

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

Question 14

what happens during the latent first stage

Answer 14

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

Question 15

what happens during the active first stage

Answer 15

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

Question 16

what is normal progress in the active first stage of labour

Answer 16

1-2 cm per hour

Question 17

when does the second stage of labour start and end

Answer 17

starts with complete dilation of the cervix

ends with birth of baby

Question 18

what is considered a prolonged second stage in a nulliparous women

Answer 18

3 hours with regional anaesthesia

2 hour without

Question 19

what is considered prolonged second stage in a multiparous woman

Answer 19

2 hours with regional anaesthesia

1 hour without

Question 20

when does the third stage start and end

Answer 20

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

Question 21

what is the average duration of the third stage

Answer 21

10 minutes

Question 22

what is expectant management of the third stage

Answer 22

spontaneous delivery of the placenta

Question 23

what is active management of the third stage

Answer 23

use of oxytocic drugs and controlled cord traction

Question 24

what is the advantage of active management of the third stage

Answer 24

lower risk of PPH

Question 25

what are Braxton hicks contraction

Answer 25

tightening of the uterine muscles | irregular do not increase in frequency or intensity

Question 26

what can relieve Braxton hicks contractions

Answer 26

ambulation or change in activity

Question 27

what are true labour contractions

Answer 27

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

Question 28

what are the three factors that influence to labour

Answer 28

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

Question 29

where is the highest density of myoctyes in the uterus

Answer 29

fundus

Question 30

where is the pacemaker for uterine contractions located

Answer 30

tubal ostia

Question 31

normal frequency of contractions

Answer 31

up to 3-4 in 10 minutes

Question 32

duration of contractions

Answer 32

initially 10-15 seconds | builds to max 45 secs

Question 33

what is an anthropoid pelvis

Answer 33

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

Question 34

what is a gynaecoid pelvis

Answer 34

most suitable female pelvic shape

Question 35

what is an android pelvis

Answer 35

triangular or heart-shaped inlet and narrower from the front

Question 36

what is the normal fetal position for Labou

Answer 36

longitudinal lie | cephalic presentation

Question 37

abnormal presentations

Answer 37

breech oblique transverse lie

Question 38

analgesia options for birth

Answer 38

``` paracetamol/co-codamol TENS entonox diamorphine epidural remifentanyl combined spinal/epidural ```

Question 39

what is a partogram

Answer 39

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

Question 40

what are the 7 cardinal movements of labour

Answer 40

``` engagement decent flexion internal rotation crowing and extension restitution and external rotation expulsion, anterior shoulder first ```

Question 41

when is the fetal head said to be engaged

Answer 41

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

Question 42

which position is the head in during descent

Answer 42

occiput transverse

Question 43

why des flexion of the head occur

Answer 43

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

Question 44

which movement is associated with restitution

Answer 44

external rotation

Question 45

what is the outcome of restitution

Answer 45

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

Question 46

what is crowning

Answer 46

appearance of a large segment of fetal head at the introitus

Question 47

why is delayed cord clamping beneficial to the baby

Answer 47

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

Question 48

when is it not appropriate to delay cord clamping

Answer 48

if immediate resuscitation is needed

Question 49

why should there be skin to skin contact immediately after birth

Answer 49

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

Question 50

what is the current guidance regarding skin to skin contact

Answer 50

1 hour of uninterrupted SSC immediately after birth

Question 51

3 classic signs of placental separation

Answer 51

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

Question 52

what is involved in active management of the third stage

Answer 52

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

Question 53

what is the plane of separation of the placenta

Answer 53

spongy layer of decidua basalis

Question 54

what is the normal volume of blood loss during labour

Answer 54

<500 ml

Question 55

how is haemostasis achieved in labour

Answer 55

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

Question 56

what is the puerperium

Answer 56

6 weeks post pregnancy | period when tissues return to non-pregnant state

Question 57

what is lochia

Answer 57

vaginal discharge containing blood, mucus and endometrial castings

Question 58

what is rubra

Answer 58

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

Question 59

what is serosa

Answer 59

brownish-red, watery discharge | 4-14 days

Question 60

what is alba

Answer 60

yellow discharge | 10-20 days

Question 61

uterine changes in the puerperium

Answer 61

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)

Question 62

what triggers lactation

Answer 62

placental expulsion and a decrease in oestrogen and progesterone

Question 63

what is colostrum

Answer 63

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