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REPRO > Normal Labour & Pueperium > Flashcards

Normal Labour & Pueperium Flashcards

1
Q

Define labour.

A
  • physiological process during which the Fetus, membranes, umbilical cord and placenta are EXPELLED from the uterus
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2
Q

What occurs during labour ?

A
  • regular, painful uterine contractions
  • increasing freq., intensity, duration
  • biochem. changes in the cervical tissue allowing cervical dilatation
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3
Q

Where can on one give birth?

A
  • consultant led unit
  • Midwife led unit
  • homebirth
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4
Q

Does a woman require a birth plan?

A
  • no

- it is her personal choice (just so she knows what to expect)

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5
Q

What takes part in the initiation of labour?

A
  • change in estrogen/proges. ratio
  • fetal adrenals and pituitary hormones CONTROL the timing of the labour onset
  • myometrial stretch INCREASES excitability
    of myometrial fibres
  • mechanical stretch of cervix and strips fetal membranes
  • Fergusons Reflex
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6
Q

How does progesterone affect the onset of labour?

A
  • keeps the uterus settled
  • prevents formation of gap junctions
  • HINDERS myocyte contractility
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7
Q

What are gap jxns?

A
  • contractions in the the myometrium is said to be caused by the flow of positive ions into a muscle cell via small protein complexes called gap jxns.
  • these multiply near the END of Labour
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8
Q

The role of estrogen in Labour?

A
  • makes the uterus contract

- promotes PROSTAGLANDIN prodn

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9
Q

What is the role of oxytocin during labour?

A
  • initiates and sustains contractions
  • acts on decidual tissue to promote prostaglandin release
  • —–oxytocin is synthesized directly in decidual, extraembryonic fetal tissues and in the placenta
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10
Q

Apart from oxytocin, name another stimulant for prostaglandin release.

A
  • pulmonary surfacant secreted in to the Amniotic fluid

- —also a basis of knowing the fetus’ lung maturity

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11
Q

What does the increase in detal cortisol stimulate?

A
  • an incr. in maternal estriol
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12
Q

Oxytocin receptors increase in numbers in the myometrium when reaching term.

What occurs with their activation?

A
  • results in phospholipase C activity

- subsequent increase in cytosolitic calcium and uterine contractility

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13
Q

What is the role of liquor?

A
  • nurtures, protects and facilitates movement
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14
Q

What biochemical changes allow cervical softening to occur?

A
  1. incr. in hyaluronic acid increases molecules among the collagen fibres
  2. decr. the bridging among collagen fibres = decr. the firmness of the cervix
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15
Q

What is the cervical tissue made of?

A
  • collagens type 1,2,3,4
  • smooth muscle
  • elastin
  • —-all held together by connective tissue ground substance
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16
Q

What occurs in cervical ripening?

A
  1. decr. in collagen fibre alignment
  2. decr. in collagen fibre strength
  3. decr. in tensile strength of the cervical matrix
  4. incr. in cervical decorin (dermatin sulphate proteoglycan 2)
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17
Q

What does the Bishops score take into account?

When is the cervix considered to be ripe for delivery?

A
    • best method to determine if its safe to INDUCE labour
  • considers: cervical POSITION (post. mid. ant.) / Cervical CONSISTENCY/ EFFACEMENT/ DILATATION/ STATION IN PELVIS
  • GOOD chance of vaginal delivery if score is >8 (ripe for labour)
  • unripe, if <6
  • labour within a few days if >10
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18
Q

List the stages of labour.

A
  1. First stage
  2. Latent stage (3-4 cm dilated)
  3. Active stage (4-10cm “full dilatation”)
  4. Second Stage
  5. Full dilatation—delivery of bby
  6. third stage
  7. delivery + expulsion of placenta and membranes
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19
Q

What occurs in the first stage?

A
  1. Latent phase: mild contractions, cervix shortens and softens (can last a few days)
  2. Active phase: 4cm onwards; slow descent of baby; more rhythmic and strong contractions. (1-2cm. hr)
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20
Q

What occurs with the second stage of labour?

A
  • complete 10cm cervical dilatation > delivery of baby

-

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21
Q

When is the 2nd stage of labour considered to be prolonged in nulliparous and multiparous women?

A

Nulliparous: prolonged if exceeds 3 hrs with regional analgesia/ 2hrs w.o

Multiparous: prolonged if it exceeds 2 hrs with analgesia or 1hr w.o

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22
Q

What occurs in the third stage of labour?

A
  • delivery + expulsion of placenta and fetal membranes

- avg. time is 10 mins (>3mins)

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23
Q

What management is in place with the 3rd stage of labour?

A

Expectant managem.: Spontaneous delivery of the placenta

Active management: use of OXYTOCIC drugs and controlled cord traction(to lower risk of PPH)

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24
Q

What are Braxton-Hicks contrxns?

A
  • FALSE labour; false sensation of having real contractions
  • tightening of uterine muscles (aid body for birth)
  • —-starts 6 wks into preg. (felt in 3rd trimester usually)
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25
Q

How does the BHC feel and relieved?

A
  • resolved with ambulation/ change in activity

- relatively painLESS

26
Q

How is true labour contractions different?

A
  • occurs with release of oxytocin
  • —these are evenly spaced timings between the contractions (w. time gets shorter and MORE intense)
  • —contrxns tighten the TOP part of the uterus pushing the baby downward
27
Q

What are the 3 key factors during labour?

A

Power: Uterine Contraction
Passage: Maternal Pelvis
Passenger: fetus

28
Q

Where is the uterine pacemaker located?

A
  • region of the tubal ostia (wave spreads in downward direction)
29
Q

Normal contractions occur________

A

up to 3-4 times in 10 mins

30
Q

How long do contractions last initially then later?

A
  • —initially 10-15 s

- —max 45 s; slowly builds up

31
Q

What is the most suitable pelvis for delivery? What is not right with the other types of pelvis?

A
  • Gynaecoid pelvis
  • —Anthropoid: oval inlet (large AP diameter and smaller transverse diameter)
  • —-Android Pelvis (triangular/heart-shaped inlet) —–common in african-caribbean
32
Q

What is evaluated under “passenger” during labour?

A
  1. cervical assessment (effacement/position/dilatation/ firmness)
  2. fetal position (feel for the fontanelles and sutures)
33
Q

What is considered to be normal fetal position?

A
  • longitudinal lie
  • cephalic
  • vertex; the presenting part
  • Occipito-anterior (head engages occipito-transverse)
34
Q

What is considered to be abnormal fetal position?

A
  • breech
  • oblique
  • transverse lie
  • —-OP
35
Q

What are some analgesic options for birth?

A
  • PCM/ Co-codamol
  • TENS
  • etonox
  • diamorphine
  • epidural
  • remifentanyl
  • combine spinal/ epidural
36
Q

What is a partogram?

A
  • a graphic record of key data contained on one sheet to assess the progress of the labour
37
Q

What are the 7 cardinal movements for the fetus’ head during labour whilst in the pelvis, IF in VERTEX position?

A
  1. engagement
  2. Descent
  3. Flexion (passively)
  4. Internal Rotation
  5. Crowning and extension
  6. Restitution and external rotation (head adopts optimal position)
  7. expulsion, anterior should first
38
Q

When is the head said to be engaged?

A
  • when the WIDEST part of the fetal head has entered the brim of the pelvis (3/5s engaged)
39
Q

What is observed on descent of fetal head?

A
  • maternal discomfort
  • frontal synciput and occipital eminences
  • vaginal examinations ( 4hrly and for cervical assessment)
40
Q

What is the position of the fetal head on descent?

A
  • occiput transverse position
41
Q

What occurs on internal rotation?

A
  • rotation from transverse to anterior position
42
Q

On extension of the fetal head during the descent of the fetal head; what maternal body part does the fetal occiput come in contact with?

A
  • inferior margin of the pubic symphysis
43
Q

What is meant by crowning?

A
  • appearance of large segment of fetal head at the introitus
  • labia stretched to the max
  • —burning and stinging for mum
44
Q

What is recommended when guiding the delivery of the head with hands?

A
  • done slowly with hands NOT leading the exit at crowning to prevent rapid extension of tissues
45
Q

Is delayed clamping a good thing and why?

A

YES

  • a higher RBC flow to vital organs in the 1st week is noted
  • less anemia at 2 months + incr. duration of early breastfeeding
46
Q

What benefits are shown with delayed cord clamping ?

A
  • higher infant hematocrit and Hb levels
  • higher blood volume and BP
  • improved cardiopulmonary adaptation
  • —–fewer days of oxygen and ventilation and blood transfusions
47
Q

Why is skin-to-skin contact important post delivery?

A
  • helps keep bbies warm and calm
  • improves transition to life
  • studies have shown that these women breastfeed MORE successfully
48
Q

What occurs in the 3rd stage?

A
  • expulsion of the placenta (5-10mins after delivery) —-normal for up to 30 mins
49
Q

What are signs of placental expulsion?

A
  • uterus HARDENS and rises
  • umbilical cord LENGTHENS
  • freq. gush of blood
  • placenta and membranes at the introitus
50
Q

WHat is done during ACTIVE management during the 3rd stage?

A
  • prophylactive administr. of Syntometerine (1ml ampoule containg 500 mcg ergometrine maleate and 5IU oxytocin)

OR

  • 10 units of oxytocin
  • cord clamping and cutting
  • bladder emptying
51
Q

Most common type of placental separation ?

A
  • Matthew Duncan
52
Q

What is the plane of separation?

A
  • spongy layer of decidua basalis
53
Q

What is an abnormal amount of blood loss after delivery?

A
  • > 500ml

- any blood loss in labour (prior to delivery) is abnormal

54
Q

How is hemostasis achieved?

A
  • by tonic contraction (uterine m. strangulates the BV)

- thrombosis of torn vessel ends: as preg. is a hypercoaguable state

55
Q

WHat is puerperium?

A
  • period of repair and recovery

- -return of tissues to non-pregnant state (6 wks)

56
Q

What to expect with pueperium?

A
  1. lochia (vaginal discharge= blood+ mucus+ endometrial)
  2. Rubra (fresh red) 3-4 days
  3. Serosa (bronwish red, watery) 4-14 days
  4. Alba (yellow) 10-20 days
    - —blood stained discharge for 10-14 days
57
Q

How does the body rid the excess body fluid collected during pregnancy?

A
  • by diuresis
  • commences 2-3 days postnatal
  • 3000ml per day
58
Q

How long does it take it for the fundal height to go back to normal?

A
  • umbilicus to within the pelvis in 2 weeks

- —endometrium regenerates by end of the week (except placenta)

59
Q

What initiates lactation?

A
  • placental expulsion
  • decr. in estrogen and progesterone

—estro. and progest. acc INHIBITS milk secretion by blocking prolactin release

60
Q

What is significant about colostrum?

A
  • rich in immunoglobin

- protective for bby

61
Q

What may cause trouble in breastfeeding?

A
  • psychological trauma post delivery

- physical debility

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