normal labour and puerperium Flashcards
define labour
a physiological process during which the fetus, membranes, umbilical cord and placenta are expelled from the uterus
what are the 3 possible locations for labour
consultant led unit
midwife led unit
home birth
which hormones influence the onset of labour
progesterone
oestrogen
oxytocin
function of progesterone in the onset of labour
keeps the uterus settle
prevents the formation of gap junctions
hinders the contractibility of myocytes
function of oestrogen in the onset of Labour
makes the uterus contract
promotes prostaglandin production
function of oxytocin in the onset of labour
initiates and sustains contractions
acts on decimal tissue to promote prostaglandin release
what is the function of liquor
nurtures and protects the fetus and facilitates movements
cervical tissue is made up of
collagen tissue (types 1-4)
smooth muscle
elastin
connective tissue
what substance causes changes in the firmness of the cervix
increase in hyaluronic acid gives increase in molecules among collagen fibres
the decrease in bridging among collagen fibres gives decrease in firmness
what are the processes involved in cervical ripening
decrease in collagen fibre alignment
decrease in collagen fibre strength
decrease in tensile strength of the cervical matrix
increase in cervical decorin
what are the five elements involved in the bishops score
position consistency effacement dilatation station in pelvis
what does the bishops score determine
if it is safe to induce labour
what are the stages of labour
first stage (latent up to 3-4 cms; active 4-10cms) second stage (delivery of baby) third stage (expulsion of placenta and membranes)
what happens during the latent first stage
mild irregular uterine contractions cervix shortens and softens duration variable (hours to days)
what happens during the active first stage
4cm to full dilation
slow descent of the presenting part
contraction progressively become more rhythmic and stronger
what is normal progress in the active first stage of labour
1-2 cm per hour
when does the second stage of labour start and end
starts with complete dilation of the cervix
ends with birth of baby
what is considered a prolonged second stage in a nulliparous women
3 hours with regional anaesthesia
2 hour without
what is considered prolonged second stage in a multiparous woman
2 hours with regional anaesthesia
1 hour without
when does the third stage start and end
delivery of the baby to the expulsion of the placenta and fetal membranes
what is the average duration of the third stage
10 minutes
what is expectant management of the third stage
spontaneous delivery of the placenta
what is active management of the third stage
use of oxytocic drugs and controlled cord traction
what is the advantage of active management of the third stage
lower risk of PPH
what are Braxton hicks contraction
tightening of the uterine muscles
irregular do not increase in frequency or intensity
what can relieve Braxton hicks contractions
ambulation or change in activity
what are true labour contractions
evenly spaced contractions, with the time between getting shorter and shorter
length of contraction also increases
what are the three factors that influence to labour
power (contractions)
passage (maternal pelvis)
passenger (fetus)
where is the highest density of myoctyes in the uterus
fundus
where is the pacemaker for uterine contractions located
tubal ostia
normal frequency of contractions
up to 3-4 in 10 minutes
duration of contractions
initially 10-15 seconds
builds to max 45 secs
what is an anthropoid pelvis
oval shaped inlet with later anterior-posterior diameter and comparatively smaller transverse diameter
what is a gynaecoid pelvis
most suitable female pelvic shape
what is an android pelvis
triangular or heart-shaped inlet and narrower from the front
what is the normal fetal position for Labou
longitudinal lie
cephalic presentation
abnormal presentations
breech
oblique
transverse lie
analgesia options for birth
paracetamol/co-codamol TENS entonox diamorphine epidural remifentanyl combined spinal/epidural
what is a partogram
graphic record of key data contained on one sheet used to assess the progress of labour
what are the 7 cardinal movements of labour
engagement decent flexion internal rotation crowing and extension restitution and external rotation expulsion, anterior shoulder first
when is the fetal head said to be engaged
when the widest diameter of the head has entered the brim of the pelvis (2 fifths palpable)
which position is the head in during descent
occiput transverse
why des flexion of the head occur
it occurs passively due to the shape of the bony pelvis and resistance from soft tissues
which movement is associated with restitution
external rotation
what is the outcome of restitution
the fetal head returns to the correct anatomic position in relation to the fetal torso
what is crowning
appearance of a large segment of fetal head at the introitus
why is delayed cord clamping beneficial to the baby
a higher red blood cell flow to vital organs in the first week
less anaemia at 2 months and increased duration of early breastfeeding
when is it not appropriate to delay cord clamping
if immediate resuscitation is needed
why should there be skin to skin contact immediately after birth
keeps baby warm and calm and is considered to improve other aspects of baby’s transition to life outside the womb
what is the current guidance regarding skin to skin contact
1 hour of uninterrupted SSC immediately after birth
3 classic signs of placental separation
umbilical cord lengthens permanently
frequently a gush of blood
placenta and membranes appear at introitus
what is involved in active management of the third stage
syntometerine or 10 units of oxytocin
cord clamping and cutting
controlled cord traction
bladder emptying
what is the plane of separation of the placenta
spongy layer of decidua basalis
what is the normal volume of blood loss during labour
<500 ml
how is haemostasis achieved in labour
tonic contraction of uterine muscle strangulate the blood vessels
thrombosis of the torn vessel ends (hyper-coagulable)
what is the puerperium
6 weeks post pregnancy
period when tissues return to non-pregnant state
what is lochia
vaginal discharge containing blood, mucus and endometrial castings
what is rubra
fresh red discharge
contains lots of fresh blood
3-4 days
what is serosa
brownish-red, watery discharge
4-14 days
what is alba
yellow discharge
10-20 days
uterine changes in the puerperium
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)
what triggers lactation
placental expulsion and a decrease in oestrogen and progesterone
what is colostrum
the first secretion from the mammary glands after giving birth
rich in immunoglobulins
