Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Normal Labour and Puerperium > Flashcards

Normal Labour and Puerperium Flashcards

1
Q

What is labour?

A

Physiological process during which foetal membranes, placenta and umbilical cord are expelled from uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three options available for where to deliver?

A

Consultant-led unit, midwife-led unit or homebirth = 96% of women in UK still give birth in hospital setting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are birth plans?

A

Record of what women would like to happen during her labour and after birth = depend on individual medical history and circumstances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes the initiation of labour?

A

Change in oestrogen:progesterone ratio

Myometrial stretch increases excitability of myometrial fibres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What hormones may control the timing of labour onset?

A

Foetal adrenal and pituitary hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the Feguson reflex in labour?

A

Pressure on internal end of cervix causes oxytocin release = stimulates uterine contractions which increase cervical pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the functions of progesterone in labour?

A

Keeps uterus settled, prevents formation of gap junctions, hinders myocyte contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the functions of oestrogen during labour?

A

Makes uterus contract, promotes prostaglandin production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the functions of oxytocin during labour?

A

Initiates and sustains contractions, acts on decidual tissue to promote prostaglandin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where is oxytocin synthesised?

A

Directly in decidual tissue and extra-embryonic foetal tissues and placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What happens to the number of oxytocin receptors as pregnancy goes on?

A

Number of receptors in myometrial and decidual tissues increases near end of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does pulmonary surfactant influence labour onset?

A

Secreted into amniotic fluid which stimulates prostaglandin synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does an increase in foetal cortisol during labour stimulate in th mother?

A

Stimulates increase in maternal oestriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does the increase in myometrial oxytocin receptors and their activation during labour result in?

A

Causes phospholipase C activity and subsequent increase in cytosolitic calcium and uterine contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the purpose of liquor during pregnancy?

A

Nurtures and protects foetus and facilitates movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the different timings for membrane rupture?

A

Preterm, prelabour, first stage, second stage, born in caul

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does cervical tissue compose of?

A

Collagen tissue mainly (types 1-4), smooth muscle and elastin = held together by connective tissue ground substance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What cervical changes occur during labour?

A

Cervical softening and ripening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes cervical softening during labour?

A

Increase in hydraluronic acid gives increase in molecules among collagen fibres = decrease in bridging among fibres decreases cervical firmness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What happens in cervical ripening during labour?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the advantages of the Bishops score?

A

Simple, easy to reproduce, good at predicting successful inductions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the Bishops score?

A

Assesses whether it’s safe to induce labour

Five elements = position, consistency, effacement, dilation, station in pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the two components of the first stage of labour?

A

Latent and active phases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What occurs in the latent phase of the first stage of labour?

A

Up to 3-4cm dilation, mild irregular uterine contractions, cervix shortens and softens, duration variable (may be days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What occurs in the active phase of the first stage of labour?

A

4cm to full dilation (10cm), slow descent of presenting part, contractions progressively become stronger and more rhythmic, normal progress is 1-2cm per hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What contribute to the variability in the active phase of the first stage of labour?

A

Analgesia, mobility and parity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When is the second stage of labour?

A

From complete dilation of cervix to the delivery of the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When would the second stage of labour be considered prolonged in nulliparous women?

A

If it exceeds 3 hours with regional analgesia or 2 hours without

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When would the second stage of labour be considered prolonged in multiparous women?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When is the third stage of labour?

A

From delivery of baby to expulsion of placenta and foetal membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the average duration of the third stage of labour?

A

10 minutes = can be as little as 3 minutes or much longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When would you prepare for removal in the third stage of labour?

A

After 1 hour duration = give general anaesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the management of the third stage of labour?

A 
Expectant = spontaneous delivery of placenta
Active = use of oxytocic drugs and controlled cord traction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are Braxton-Hicks contractions?

A

Tightening of uterine muscles to aid body’s preparation for birth = sometimes called false labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When do Braxton-Hicks contractions occur?

A

Can start from as early as 6 weeks gestation but more usually felt in third trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the features of Braxton-Hicks contractions?

A

Irregular, don’t increase in frequency or intensity, relatively painless, resolve with ambulation or change in activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the features of true labour contractions?

A

Timing of contractions become evenly spaced and time between them gets progressively shorter
Duration of contraction increases and they become more intense and painful over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What effect do contractions have?

A

Tighten the top part of the uterus = promotes cervical thinning, pushes baby downward into birth canal in preparation for delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Where is the smooth muscle density of uterine muscle highest?

A

At the fundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the pacemaker for uterine contractions?

A

Region of tubal ostia = wave spreads downwards, waves from both ostia are synchronised

41
Q

How does the uterus display polarity during contractions?

A

Upper segment contracts and retracts

Lower segment and cervix stretch, relax and dilate

42
Q

What is the normal power of true labour contractions?

A

They have fundal dominance with regular pattern and adequate resting tone

43
Q

What is the normal frequency and duration of labour cotractions?

A 
Frequency = 3-4 in 10 minutes (allows time for resting tone)
Duration = initially 10-15s, slowly builds to max of 15s
44
Q

What determines the intensity of labour contractions?

A

Degree of uterine systole = greatest in second stage

45
Q

What are the grades of labour contraction?

A

Mild, moderate, strong

46
Q

What are the different types of pelvis?

A

Anthropoid, gynaecoid, android

47
Q

What are the features of an anthropoid pelvis?

A

Oval shaped inlet with large antero-posterior diameter and relatively smaller transverse diameter

48
Q

What is the most suitable pelvic shape for labour?

A

Gynaecoid

49
Q

What are the features of an android pelvis?

A

Triangular or heart shaped inlet and narrower front

More common in Afro-Caribbean women

50
Q

What are the five parameters used to assess the cervix?

A

Effacement, dilatation, firmness, position, level of presenting part

51
Q

What are the normal positions for the foetus during labour?

A

Longitudinal lie with cephalic presentation = flexed head, presenting part is vertex
Position is occipito-anterior, head engages occipito-transverse

52
Q

What are the abnormal foetal positions during labour?

A

Breech, oblique or transverse lie

Position is occipito-posterior

53
Q

How can you determine foetal position?

A

Fontanelles can be felt on vaginal examination

54
Q

What are the analgesia options during labour?

A

Paracetamol, co-codamol, TENS, entonox, remifentanyl, diamorphine, epidural or combined spinal/epidural

55
Q

What is a partogram?

A

Graphic record of key maternal and foetal data contained in one sheet = used to assess progress of labour

56
Q

What do the 7 cardinal movements refer to?

A

Changes in position of baby’s head in the pelvis = described in relation to vertex position

57
Q

Do the cardinal movements occur in sequence?

A

Yes = continuous process with movements occurring one after the other

58
Q

What are the seven cardinal movements?

A

Engagement, descent, flexion, internal rotation, crowning and extension, restitution and external rotation, expulsion

59
Q

What occurs in restitution and external rotation?

A

Head adopts optimal position for shoulder = foetal head returns to correct anatomical position for torso

60
Q

What foetal body part comes first in expulsion?

A

Anterior shoulder

61
Q

What occurs in engagement?

A

Passage of widest diameter of presenting part to the level below the plane of the pelvic inlet

62
Q

What occurs in descent?

A

Downward passage of presenting part through pelvis

63
Q

When is the foetal head said to be engaged?

A

When widest diameter of head has entered brim of pelvis = also described as 3/5 of head entered pelvis and 2/5 still felt abdominally

64
Q

What are used as reference points during descent?

A

Abdominal fifths

65
Q

What should you observe during descent?

A

Maternal discomfort, feeling of pressure, frontal synciput and occipital eminences

66
Q

How often are vaginal examinations carried out during descent in a normal labour?

A

Carried out 4 hourly for cervical assessment

67
Q

What position does the foetal head assume during descent?

A

Occiput transverse position = widest pelvic diameter for widest part of head

68
Q

When does extension occur?

A

Once foetus has reached level of interoitus = brings base of occiput in contact with inferior margin at symphysis pubis

69
Q

What occurs during expulsion?

A

Delivery of rest of foetal body

70
Q

What does crowning describe?

A

Appearance of large segment of foetal head at interoitus = labia stretched to full capacity, largest diameter of foetal head encircled by vulval ring

71
Q

What may the mother feel during crowning?

A

Burning and stinging

72
Q

How should the head be delivered during crowning?

A

Carefully and slowly with hands guiding exit to prevent rapid extension of tissues and perineal tearing = care of perineum vital to reduce trauma

73
Q

Why may an episiotomy be required after crowning?

A

To prevent anal sphincter trauma

74
Q

Why can immediate cord clamping cause neonatal problems?

A

Can reduce red blood cells received by the infant at birth by >50%

75
Q

When should you delay clamping until?

A

Cessation of pulsations or up to three minutes post-expulsion

76
Q

How long should babies have skin to skin contact with mother after birth?

A

Uninterrupted contact for 1 hour immediately after birth = keeps baby warm and calm, improves other aspects of transition to life outside womb

77
Q

How long does it take for the placenta to be expelled after birth?

A

Usually occurs 5-10 minutes after delivery = considered normal up to 30 minutes

78
Q

What are the signs of the third stage of labour?

A

Uterus contracts, hardens and rises
Permanent lengthening of umbilical cord
Gush of blood (variable in amount)
Placenta and membranes appear at introitus

79
Q

What is the active management of the third stage of labour?

A

Prophylactic syntometrine OR oxytocin 10 units

Cord clamping and cutting, controlled cord traction and bladder emptying

80
Q

How is syntometrine given in the third stage of labour?

A

1ml ampoule = 500mg ergometrine inaleate and 5IU oxytocin

81
Q

What causes placental separation?

A

Shearing force = separates spongy layer of decidua basalis

82
Q

What is the underlying pathophysiology of placental separation?

A

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

83
Q

What are some categories of placental separation?

A

Matthew Duncan = most common

Schultz = separation from central aspect

84
Q

How much blood can be lost in the third stage?

A

Normal <500ml
Abnormal >500ml
Significant if >1000ml

85
Q

Is blood loss during labour considered normal?

A

No = any blood loss during labour prior to delivery apart from “show” is abnormal and requires referral to consultant unit

86
Q

How is haemostasis achieved during pregnancy?

A

Tonic contraction = lattice pattern of uterine muscle strangulates vessels
Thrombosis of torn vessel ends
Myotamponade-opposition to anterior/posterior walls

87
Q

What is puerperium?

A

Period of repair and recovery = return of tissue to non-pregnant state, takes 6 weeks

88
Q

What are the discharges that can occur in puerperium?

A 
Lochia = contains blood, mucus and endometrial castings 
Rubra = fresh red, 3-4 days
Serosa = brownish red and watery, 4-14 days 
Alb = yellow, 10-20 days
89
Q

How long would you expect blood stained discharge after birth?

A

10-14 days

90
Q

What uterine changes occur during puerperium?

A

Uterine involution = reduction in weight from 1kg to 50-100g

91
Q

How long does it take the fundal height to move from the umbilicus after delivery?

A

Moves from umbilicus to within pelvis within 2 weeks

92
Q

How long does it take the endometrium to regenerate after birth?

A

Occurs by 7 days (except placental site)

93
Q

What happens to the cervix, vagina and perineum after birth?

A

They regress, but never back to pre-pregnancy state

94
Q

When does physiological diuresis commence after delivery?

A

Commences 2-3 days postnatally

95
Q

What initiates lactation?

A

Placental expulsion and decrease in oestrogen and progesterone

96
Q

What effect to oestrogen and progesterone have during pregnancy to prevent lactation?

A

Block prolactin release during pregnancy and make mammary gland cells unresponsive to prolactin

97
Q

What happens to prolactin during puerperium?

A

Prolactin is maintained

98
Q

What are the benefits of colostrum?

A

Rich in immunoglobulin = long term protective effect for foetus

Reproduction (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions