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Repro and Sexual Health > Normal Labour and Puerperium > Flashcards

Normal Labour and Puerperium Flashcards

1
Q

What is the definition of labour?

A

Physiological process during which the foetus, membranes, umbilical cord and placenta are expelled from the uterus
Assoc with regular, painful uterine contractions with increased frequency, intensity and duration

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2
Q

What are the 3 birth options?

A

Consultant led unit
Midwife led unit
Homebirth

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3
Q

What is a birth plan?

A

Record of what the women would like to happen during her labour and afterbirth

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4
Q

What hormonal changes are thought to initiate labour?

A

Change in oestrogen/ progesterone ratio
Foetal adrenals and pituitary hormones
Myometrial stretch increases excitability of myometrial fibres
Mechanical stretch of cervix and stripping of foetal membranes

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5
Q

What is ferguson’s reflex?

A

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

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6
Q

What is the role of progesterone in labour?

A

None; the reduction in progesterone initiates labour
Progesterone will keep the uterus settles, prevent the formation of gap junctions and hinders the contractibility of myocytes

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7
Q

What is the role of oestrogen in labour?

A

Uterine contraction

Promotes prostaglandin production

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8
Q

What is the role of oxytocin in labour?

A

Initiates and sustains contractions
Acts on decidual tissue to promote prostaglandin release
Synthesized directly in decidual and extraembryonic foetal tissues
Number of oxytocin receptors increases in myometrial and decidual tissues near end of pregnancy

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9
Q

What is the role of pulmonary surfactant in labour initiation?

A

Pulmonary surfactant in amniotic fluid stimulates prostaglandin synthesis

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10
Q

What is the role of foetal cortisol in labour initiation?

A

Increases maternal oestriol

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11
Q

What is the role of increased myometrial oxytocin receptors in labour initiation?

A

Increased phospholipase C activity and subsequently increase in calcium and uterine contractility

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12
Q

When can membranes rupture?

A 
Pre-term 
Pre-labour 
First stage
Second stage
Born in caul
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13
Q

What makes up cervical tissue

A

Collagen tissue (1,2,3,4), smooth muscle, elastin, held together by connective tissue ground subtance

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14
Q

What are the factors that lead to cervical softening?

A

Increase in hyaluronic acid gives increase in molecules along collagen fibres
Decrease in bridging among collagen fibres gives decrease in firmness of cervix

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15
Q

What isi cervical ripening?

A

Decrease in collagen fibre alignment
Decrease in collagen fibre strength
Decrease in tensile strength of cervical matrix
Increase in cervical decorin

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16
Q

What are the 5 elements of bishops score?

A 
Position 
Consistency
Effacement 
Dilatation 
Station in pelvis
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17
Q

What is the bishop’s score used for?

A

Safe to induce labour

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18
Q

What does a score of less than 5 on the bishop’s score indicate?

A

Candidate for cervical ripening prior to induction

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19
Q

What are the 2 phases of 1st stage of labour?

A

Latent and active
Latent; mild, irregular contractions, cervix shortens and softens, duration variable
Active phase; 4cm to full dilatation. Slow descent of presenting part. Contractions become rhythmic and strong.

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20
Q

What is normal progress in the active stage of 1st stage of labour?

A

1-2cm per hour

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21
Q

What is the 2nd stage of labour?

A

10cm to delivery of baby

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22
Q

What is a normal length for 2nd stage of labour in a nulliparous woman?

A

Prolonged if over 2 hours

Prolonged if over 3 hours with regional analgesia

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23
Q

What is a normal length for 2nd stage of labour in a multiparous woman?

A

Prolonged if over 1hr

Prolonged if over 2hr with regional analgesia

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24
Q

Should vaginal examinations be carried out in low risk women who are fully dilated?

A

No; high risk of introduction of infection

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25
Q

What is the 3rd stage of labour?

A

Delivery of baby to expulsion of placenta and foetal membranes

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26
Q

What is the average duration of 3rd stage of labour?

A

10 mins

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27
Q

What will occur after 1hr of 3rd stage?

A

Removal under GA

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28
Q

What is active management of 3rd stage?

A

Use of oxytocic drugs and controlled cord traction

Preferred for lowering risk of PPH

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29
Q

What are braxton hicks contractions?

A

“False labour”
Tightening of uterine muscles, to aid body for birth
Irregular, do not increase in frequency or intensity
Resolve with ambulation or change in activity

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30
Q

When can braxton hicks start?

A

6 weeks into pregnancy
Much more likely to be 3rd trim
More likely in multiparous women

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31
Q

What is true labour?

A

Timing of contractions becomes evenly spaces, and time between them gets shorter with the length of contractions increasing

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32
Q

What are the 3 key factors to labour?

A

Power; uterine contractions
Passage; maternal pelvis
Passenger; foetus

33
Q

Where will contractions start and how will they spread?

A

Pacemaker is in the tubal ostia

Wave spreads symmetrically in a wave down the uterus

34
Q

What is polarity of uterine contractions?

A

Upper segment contracts and retracts

Lower segment and cervix stretch, dilate and relax

35
Q

What is normal and sufficient contractions in active labour?

A

3-4 every 10 mins
Initially 10-15 secs to a max of 4 secs
Intensity; degree of uterine systole

36
Q

What is an anthropoid pelvis?

A

Oval shaped inlet with large AP diameter and comparatively smaller transverse diameter

37
Q

What is an android pelvis?

A

Triangular or heart shaped inlet with a narrower front

38
Q

What is the most suitable pelvic shape for labour?

A

Gynaecoid

39
Q

What impact will anthropoid and android pelvices have on labour respectively?

A

Anthropoid; long 2nd stage

Android; long 1st stage

40
Q

How is thee cervix assessed in labour to determine passage?

A 
Effacement
Dilatation 
Firmness
Position 
Station
41
Q

What is the normal position of the foetus?

A

Longitudinal lie
Cephalic presentation with the vertex presenting
OA, head engages occipito transverse
Flexed head

42
Q

What are abnormal presentations and positions of the foetus?

A

Presentation; breech, oblique, transverse lie

Position; occipito posterior

43
Q

How can the position of the foetus be determined on vaginal exam?

A

Fontanelles
Anterior; diamond shaped with 4 sutures coming off
Posterior; triangular with 3 sutures

44
Q

What are the analgesia option for birth?

A 
Paracetamol
TENS
Entonox
Diamorphine 
Epidural 
Combined spinal/ epidural
45
Q

What is a partogram?

A

Graphic record of key data contained on one sheet, used to assess the progress of labour i.e. cervical dilation, foetal heart rate

46
Q

What are the 7 cardinal movements of labour?

A 
Engagement
Descent
Flexion 
Internal rotation 
Crowning and extension 
Restitution and external rotation 
Expulsion
47
Q

What is engagement?

A

Passage of occipitofrontal diameter transversely past pelvic inlet

48
Q

What is descent?

A

Downward passage of presenting part through pelvis

49
Q

How is engagement described in terms of fifths?

A

3 fifths with engaged

50
Q

What needs to be observed in decent of the foetus?

A

Abdominal fifths
Maternal discomfort and feeling of pressure
Frontal synciput and occiput eminences
Vaginal examination for cervical assessment

51
Q

What is flexion of the foetal head in labour?

A

Occurs passively as the head descends due to shape of bony pelvis and resistance of soft tissues

52
Q

What is internal rotation of the foetal head in labour?

A

Rotation of presenting part from transverse position to AP position to allow passage through pelvic outlet

53
Q

What is extension of the foetal head in labour?

A

Occurs once the foetus has reached level of introitus, bringing the base of the occiput in contact to the inferior margin at the symphysis pubis

54
Q

What is external rotation (restitution) of the foetus in labour?

A

Return of foetal head to correct anatomical position in relation to foetal torso

55
Q

What is the role of external rotation?

A

Allows delivery of shoulder; anterior shoulder first

56
Q

What is crowning?

A

Appearance of large segment of foetal head at introitus
Labia are stretched to full capacity
Largest diameter of foetal head is encircles by vulvar ring

57
Q

Why should delivery of head by managed carefully?

A

Prevent rapid extension and perineal tearing

58
Q

What is the rationale behind delayed cord clamping?

A

Higher red blood cell flow to vital organs in first week, less anaemia, increased duration of breastfeeding
Higher infant haematocrit, Hb levels, BP, BV
Improved cardiopulmonary adaptation

59
Q

When will delayed cord clamping not be performed?

A

If immediate resuscitation is required

60
Q

Why is immediate skin to skin recommended?

A

Keeps babies warm
Improve babies transition to life outside womb
Increased breastfeeding

61
Q

What is the current recommendation regarding skin to skin after birth?

A

Uninterrupted SSC for 1 hour following birth

62
Q

What are the 3 classical signs of separation of placenta?

A

Uterus contracts, hardens and rises
Umbilical cord lengthens permanent
Gush of blood
Placenta and membranes appear at introitus

63
Q

What is included in active management of the 3rd stage of labour?

A 
Prophylactic administration of syntometrine and oxytocin 
OR just oxytocin 
Cord clamping and cutting
Controlled cord traction 
Bladder emptying
64
Q

What is the plane of separation for the placenta?

A

Spongy layer of decidua basalis

65
Q

What is the most common method of separation?

A

Matthew duncan; detachment of the leading edge of the placenta, and the entire organ slips down and out of the uterus sideways

66
Q

What is the schultz method of separation?

A

Separation begins in the center of the placenta (the fetal surface), and this part descends first, with the remainder following

67
Q

What is a normal amount of blood loss post birth?

A

Less than 500ml

68
Q

How is haemostasis achieved in the postpartum period?

A

Tonic contraction; lattice pattern of uterine muscles strangulates blood vessels
Thrombosis of torn vessels; pregnancy is a hypercoagulable state
Myo-tamponade-opposition of AP walls

69
Q

What is lochia?

A

Vaginal discharge containing blood, mucus and endometrial castings

70
Q

Describe the vaginal discharge in the puerperium stage?

A

Rubra; fresh red; 3-4 days
Serosa; brown/ red, watery; 4-14 days
Alba; yellow; 10-20 days

71
Q

At what time will the tissues be returned to the non-pregnant state?

A

6 weeks

72
Q

When will the fundal height return to normal post birth?

A

Umbilicus to within pelvis by 2 weeks

73
Q

When will the endometrium regenerate post birth?

A

By the end of the week; except the placental site

74
Q

What areas of the reproductive system of women will never return to pre-pregnancy state?

A

Cervix
Vagina
Perineum

75
Q

When will physiological diuresis occur post birth?

A

2-3 days

76
Q

What is lactation initiated by?

A

Placental expulsion

Decrease in oestrogen and progesterone

77
Q

Why is milk not produced in pregnancy?

A

Oestrogen and progesterone act negatively on pituitary gland to prevent prolactin release
Render mammary glands unresponsive to prolactin

78
Q

What is colostrum rich in?

A

Immunoglobulin; has long term protective effect for baby

Repro and Sexual Health (77 decks)

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