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Year Three - Reproductive System > Normal Labour & Delivery > Flashcards

Normal Labour & Delivery Flashcards

1
Q

What is labour?

A

The process in which the foetus and the placenta leave the uterus

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2
Q

At what weeks gestation does labour occur?

A

37 and 42 weeks gestation

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3
Q

What two factors are required for labour to commence?

A

Cervical ripening

Myometrial excitability

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3
Q

What two factors are required for labour to commence?

A

Cervical ripening

Myometrial excitability

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4
Q

What is cervical ripening?

A

It is softening of the cervix that occurs before labour, allowing it to dilate.

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5
Q

What does cervical ripening occur in response to?

A

The breakdown of cervical tissue via oestrogen, relaxin and prostglandin release

Prostaglandins is of particular importance

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6
Q

How does cervical ripening initiate labour?

A

This means that cervix offers less resistance to the presenting part of the foetus during labour

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7
Q

What hormone can be prescribed to induce cervical ripening, and thus labour? What is another name for this?

A

Prostaglandin E2

Dinoprostone

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8
Q

What causes myometrial excitability? Why?

A

A relative decrease in progesterone in relation to oestrogen, that occurs towards the end of pregnancy

This is because progesterone typically inhibits contracts and oestrogen increases the number of gap junctions between smooth muscle cells, increasing contractility

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9
Q

What are Braxton Hicks contractions?

A

They are occasional irregular contractions of the uterus

These are not true contraction and they do not indicate the onset of labour

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10
Q

When do Braxton Hicks contractions?

A

Third and second trimester

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11
Q

When does the first stage of labour occur?

A

It occurs from the onset of labour (true contractions) until the cervix is fully dilated to 10cm

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12
Q

What two processes occurs in the first stage of labour?

A

Cervical dilation

Cervical effacement

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13
Q

What is cervical effacement?

A

Shortening of the cervix

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14
Q

What are the three phases of labour stage one?

A

Latent phase

Active phase

Transition phase

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15
Q

At what cervical dilation does the latent phase of labour stage one occur?

A

The latent phase occurs from 0 to 4cm dilation of the cervix

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16
Q

How fast does the latent phase of labour stage one occur?

A

It progresses at around 0.5cm per hour

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17
Q

What is the longest phase of labour stage one? How long does it typically last?

A

Latent phase

Hours to several days

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18
Q

What type of contractions occur in the latent phase of labour stage one?

A

Irregular

Short lasting, occurring every two to three minutes

Mild in nature

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18
Q

What type of contractions occur in the latent phase of labour stage one?

A

Irregular

Short lasting, occurring every two to three minutes

Mild in nature

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19
Q

At what cervical dilation does the active phase of labour stage one occur?

A

It occurs from 4 to 10cm dilation of the cervix

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20
Q

How fast does the active phase of labour stage one occur?

A

It progresses at around 1cm per hour

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21
Q

How long does the active phase of stage one labour typically last?

A

Eight to twelve hours

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22
Q

What type of contractions occur in the active phase of labour stage one?

A

Stronger

More regular

More painful

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23
Q

What type of contractions occur in the transition phase of labour stage one?

A

It occurs from 8 to 10cm dilation of the cervix

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24
Q

How fast does the transition phase of labour stage one occur?

A

It progresses at around 1cm per hour

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25
Q

What type of contractions occur in the transition phase of labour stage one?

A

Regular

Intense

Strong

Painful, where it is typical for patients to experience physical changes, such as shaking, vomiting or the need to empty their bowels

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26
Q

When does the second stage of labour occur?

A

It lasts from 10cm dilation of the cervix to the delivery of the baby

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27
Q

How long does the second stage of labour last?

A

This stage varies between two to three hours, depending on if the woman is nulliparous or multiparous

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28
Q

What are the two phases of second stage of labour?

A

Passive phase

Active phase

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29
Q

When does the passive phase of the second stage of labour occur?

A

The passive phase occurs when the cervix is fully dilated, however the woman has no urge to push with contractions

This phase lasts until the head of the foetus reaches the pelvic floor

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30
Q

When two cardinal movements occur during the passive, second stage of labour?

A

Rotation

Flexion

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31
Q

When does the active, second stage of labour occur?

A

This occurs when the woman starts to push with contractions. This phase occurs once the head of the foetus reaches the pelvic floor

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32
Q

When does the third stage of labour occur?

A

It is from the completed birth of the baby to the delivery of the placenta

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33
Q

How long does the third stage of labour last?

A

Five to thirty minutes, however, can last as long as an hour

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34
Q

What are the two ways in which the third stage of labour can be managed?

A

Physiological

Active

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35
Q

How do we physiologically manage the third stage of labour?

A

It involves the placenta being delivered by maternal effort without medications or cord traction

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36
Q

How long does physiological management of labour stage three take?

A

60 minutes

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37
Q

How do we actively manage the third stage of labour?

A

It involves the midwife or doctor assisting in the delivery of the placenta

It involves the prescription of intramuscular oxytocin to help the uterus contract and expel the placenta

It also involves controlled cord traction

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38
Q

How long does active management of labour stage three take?

A

This shortens the length of this stage to around thirty minutes and reduces the risk of bleeding

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39
Q

What is controlled cord traction?

A

This is traction applied to the umbilical cord to guide the placenta out of the uterus and vagina

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40
Q

In what two circumstances should active management of labour stage three be selected?

A

Haemorrhage

If it prolongs for more than 60 minutes

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41
Q

What are cardinal movements?

A

It involve changes in the position of the foetus’s head during its passage in labour

42
Q

What are cardinal movements described in relation to?

A

Vertex presentation, which is when the baby’s head is down in the birth canal

43
Q

What are the seven cardinal movements of labour?

A

Engagement

Descent

Flexion

Internal Rotation

Extension

Restitution & External Rotation

Expulsion

44
Q

What is engagement?

A

It occurs when the largest diameter of the fetal head enters the largest diameter of the maternal pelvic inlet

As the fetal head engages, the head moves towards the pelvic brim in either the left or right occipto-transverse position

45
Q

What is descent?

A

It occurs when the baby’s head descends past the pelvic inlet into the pelvic cavity

46
Q

What three factors cause descent?

A

Uterine contractions

Amniotic fluid pressure

Voluntary abdominal muscle contraction via maternal effort

47
Q

What is flexion?

A

It occurs when the fetal head comes into contact with the pelvic floor

This causes flexion of the fetal neck, in which the chin flexes towards the chest

In this position, the fetal skull has a smaller diameter, which assists passage through the pelvis, and the narrowest area of the head is presented

48
Q

What is the narrowest part of the baby’s head?

A

The occiput

49
Q

What is internal rotation?

A

It occurs when the baby’s head rotates from a left or right occipto transverse position to an occipto-anterior position

This eventually results in crowning

50
Q

What is crowning?

A

This is when the widest diameter of the fetal head negotiates through the narrowest part of the maternal bony pelvis

51
Q

When is crowning clinically evident?

A

When the head, no longer retreats between contractions

52
Q

What is extension?

A

It occurs when the baby’s head slips beneath the suprapubic arch, extending the fetal head and allowing it to pass through the pelvis outlet

53
Q

What is extension?

A

It occurs when the baby’s head slips beneath the suprapubic arch, extending the fetal head and allowing it to pass through the pelvis outlet

54
Q

What is external rotation?

A

It occurs when the baby’s head rotates to a transverse position, so that it faces the right of left medial thigh of the mother

55
Q

What is external rotation?

A

It occurs when the baby’s head rotates to a transverse position, so that it faces the right of left medial thigh of the mother

56
Q

What is restitution?

A

It occurs when the shoulders are rotating from a transverse position to an anterior-posterior position

This means that the shoulders are realigned with the head

57
Q

What is expulsion?

A

It occurs when the baby’s anterior shoulder, then the posterior shoulder, then the rest of the body are born

58
Q

How can we assist in the delivery of the anterior shoulders during expulsion?

A

The midwife applies downward traction to the fetal head

59
Q

How can we assist in the delivery of the posterior shoulders during expulsion?

A

The midwife applies upward traction to the fetal head

60
Q

What is fetal presentation?

A

A reference to the part of the fetus that is overlying the maternal pelvic inlet

61
Q

How can we predict fetal presentation?

A

Abdominal examination

62
Q

What is the cephalic presentation?

A

It refers to the baby being positioned head down, with chin tucked to its chest and the back of the head ready to enter the pelvis

63
Q

What is the most common fetal presentation?

A

Cephalic presentation

64
Q

What is the breech presentation?

A

It refers to the baby being presenting for delivery with the buttocks of feet first rather than head

65
Q

What are the three types of breech presentation?

A

Complete breech

Frank breech

Footling breech

66
Q

What is complete breech presentation?

A

It refers to both legs being flexed at the hips and knees

67
Q

What is frank breech presentation?

A

It refers to both legs being flexed at the hip and extended at the knee

68
Q

What is the most common breech prevention?

A

Frank breech presentation

69
Q

What is the footling breech presentation?

A

It refers to both legs being extended at the hip, so that the foot is the presenting part

70
Q

What do we do when the fetal presentation is breech?

A

We offer woman a c-section

71
Q

What is the normal fetal heartrate, variability and acceleration?

A

It is between 110bpm and 160bpm

Variability = between 5bpm and 25bpm

Accelerations = 15bpms

72
Q

When do we conduct intermittent ausculation of the fetal heartrate during labour?

A

When woman have a low risk assessment

73
Q

What two methods can be used to intermittently auscultate the fetal heartrate during labour?

A

Pinard stethoscope

Handheld doppler

74
Q

How often do we intermittently ausuclate the fetal heartrate during the first stage of labour?

A

Every fifteen minutes for a full minute - following a contraction

75
Q

How often do we intermittently ausuclate the fetal heartrate during the second stage of labour?

A

We increase the frequency of auscultation to every five minutes or after every contraction

76
Q

In what three circumstances do we step up from intermittent fetal heartrate auscultation to continuous auscultation?

A

An abnormality is detected on intermittent auscultation

Intrapartum complications arise

The woman is high risk

77
Q

Which method is used to continuously auscultate the fetal heartrate?

A

Cardiotocograph (CTG) machine

78
Q

What two things does a CTG machine measure?

A

Baby’s heart rate

Contractions in the uterus

79
Q

How do we conduct a CTG externally?

A

There are two transducers being placed onto the abdomen of the mother

The first transducer is placed above the fetal heart to monitor the fetal heartbeat

The second transducer is placed near the fundus of the uterus to monitor the uterine contractions

80
Q

How do we conduct a CTG internally?

A

It involves a fetal scalp electrode being inserted through the vagina and neck of the woman and placed on the baby’s scalp

81
Q

When do we conduct a CTG internally?

A

Baby’s who present cephalically

Over 34 weeks gestation

Those without blood disorders

82
Q

What mnemonic is used to interpret a CTG?

A

DR C BRaVADO

83
Q

What does DR in DR C BRaVADO mean? (CTG interpretation)

A

Define Risk

This involves defining the risk based on the individual woman and pregnancy before assessing the CTG

84
Q

What does C in DR C BRaVADO mean? How do we find this information on a CTG chart? (CTG interpretation)

A

Contractions

This involves assessing how many contractions occur within ten minutes

This information is located at the bottom of the CTG chart, where twenty boxes represents ten minutes, and a peak represents a contraction.

85
Q

What does BR in DR C BRaVADO mean? How do we find this information on a CTG chart? (CTG interpretation)

A

Baseline Rate

This involves assessing the baseline fetal heart rate

This information is located at the top of the CTG chart

86
Q

What does V in DR C BRaVADO mean? (CTG interpretation)

A

This involves assessing how the fetal heart rate varies up and down around the baseline

87
Q

What does A in DR C BRaVADO mean? What do we expect to see? (CTG interpretation)

A

Accelerations

This involves assessing periods where the fetal heart rate spikes

This is a good sign that the fetus is healthy, particularly when they occur alongside contraction of the uterus

88
Q

What does D in DR C BRaVADO mean? What do we expect to see? (CTG interpretation)

A

Decelerations

This involves assessing periods where the fetal heart rate drops

This is often a normal feature of labour. However, if they are prolonged or late, they can indicate fetal hypoxia

89
Q

What is the next step if CTG monitoring shows prolonged or late decelerations?

A

A fetal blood sampling should be conducted

90
Q

What does O in DR C BRaVADO mean? (CTG interpretation)

A

This involves assessing whether the CTG is normal, non-reassuring or abnormal

91
Q

What is fetal blood sampling?

A

A procedure used to remove a small amount of blood from the fetus’ scalp

The blood sample is then run through a blood gas machine

92
Q

When do we conduct a fetal blood sample?

A

CTG readings are abnormal

AND

The cervix is 8cm dilated

93
Q

What are the three measurements checked in a fetal blood sample?

A

pH

Base level

Lactic acid level

94
Q

What does a fetal blood sample assess for? What pH level indicates this? How do we manage this?

A

Whether the baby is suffering from hypoxaemia

A pH less than 7.2

Immediate delivery

95
Q

What do we examine during labour to montior its progression?

A

Abdominal Palpation

Vaginal Examination

Amniotic Fluid

Contraction Palpations

External Signs

96
Q

Why do we conduct abdominal palpation during labour?

A

It allows the assessment of the fetal lie, position, presentation and engagement

97
Q

Why do we conduct vaginal examination during labour?

A

It allows the assessment of cervical dilatation and the position of the baby

98
Q

What is the normal colour of amniotic fluid?

A

Clear, yellow or pink

99
Q

What is an abnormal colour of amniotic fluid? What does this indicate?

A

Dark green or black

The presence of meconium

100
Q

What is meconium?

A

It is the first faeces of the newborn and when present in amniotic fluid can indicate fetal distress

101
Q

What do we palpate contractions during labour?

A

It allows labour progression to be estimated – with stronger and more regular contractions indicating a further progression into labour

102
Q

How often do we palpate contractions during labour?

A

Ten minutes every thirty minutes during both the first and second stages of labour

103
Q

What external sign do we look for during labour? What is this? What does it indicate?

A

Rhomboid of Michaelis

A rhomboid-shaped contour visible on the mother’s lower back

This indicates that the fetus head has progressed into the pelvis

Year Three - Reproductive System (52 decks)

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