Parturition And Labour

Question 1

Define parturition

Answer 1

The scientific term used to describe the transition from the pregnant state to the non-pregnant state at the end of gestation

Question 2

Define labour

Answer 2

The non-scientific term used to describe parturition when both the cervix and uterus have been remodelled

Question 3

What is a spontaneous abortion?

Answer 3

If the products of conception are expelled before 24 weeks

Question 4

Define pre term

Answer 4

< 36 weeks

Question 5

Define term in weeks

Answer 5

37 - 42 weeks

Question 6

Define post term

Answer 6

> 42 weeks

Question 7

What is the biggest cause of mortality mortality in the UK?

Answer 7

Going past 42 + 6

Carries lots of risks

Question 8

Briefly describe what occurs in the first stage of labour

Answer 8

Creation of the birth canal

Question 9

Briefly describe what happens in the second stage of labour

Answer 9

Expulsion of foetus

Question 10

Briefly describe what happens in the third stage of labour

Answer 10

Expulsion of placenta

Contraction of uterus

Question 11

When does the uterus become palpable?

Answer 11

12 weeks

Question 12

Where is the fundus palpable at 20 weeks?

Answer 12

Umbilicus

Question 13

Where is the fundus palpable at 36 weeks?

Answer 13

Xiphisternum

Question 14

When does the foetus orientate itself correctly for birth?

Answer 14

24 weeks

Question 15

Why do we weight the placenta?

Answer 15

Should be around the same weight as the foetus

Too large, too small or calcification - indications that the baby may need extra care

Question 16

What is the ‘lie’ of the foetus?

Answer 16

Relationship to the long axis of the uterus
Normally longitudinal
Foetal spine antiparallel to mothers

Question 17

What is the ‘presentation’ of the foetus?

Answer 17

Which part is adjacent to the pelvic inlet

Normally the head (cephalic)

Question 18

What is the ‘vertex’ of the foetus?

Answer 18

Relationship of foetus along its axis
Head 45 degrees to own spinal cord
Orientation of the presenting part

Question 19

What is the most common description of a presenting foetus?

Answer 19

Longitudinal lie
Cephalic presentation
Vertex to pelvic inlet at minimum diameter

Question 20

What is the average diameter of the foetal head?

Answer 20

9.5 cm

Question 21

What proteins usually expand the soft tissues of the pelvis?

Answer 21

Metalloproteases (type of collagenase)

Question 22

What is effacement?

Answer 22

The internal and external Os come together (of the cervix)

Question 23

What is the medical term for softening of the cervix?

Answer 23

Cervical ripening

Question 24

Which prostaglandins are most responsible for cervical softening?

Answer 24

PGE2

PGF2 alpha

Question 25

Why does hyaluronic acid build up in cervical softening?

Answer 25

Hydrophilic | Water moves into tissues causing expansion

Question 26

What are Braxton Hicks?

Answer 26

Amplitude of contractions increases Less frequent than 'real contractions' Uterus getting ready for labour

Question 27

Define clinical labour

Answer 27

3 contractions within 10 minutes, each lasting at least 1 minute

Question 28

Which hormonal ratio changes PG synthesis?

Answer 28

Oestrogen:progesterone Increased oestrogen = increase PGs Decreased progesterone = increase PGs

Question 29

Where is oxytocin secreted?

Answer 29

Posterior pituitary

Question 30

What do we call the reflex that increases oxytocin release?

Answer 30

Ferguson reflex

Question 31

What are the effects of increased prostaglandins?

Answer 31

Cervix ripens Contractions more forceful Brachystasis

Question 32

What is brachystasis?

Answer 32

Uterus contracts more than relaxes Fibres shorten in body of uterus Drives presenting part into cervix

Question 33

When does the first stage of labour end?

Answer 33

When the cervix is dilated to 10 cm

Question 34

Second stage of labour is usually how long?

Answer 34

Up to an hour

Question 35

What do we call it if the foot presents first?

Answer 35

Footling breech

Question 36

How long does 3rd stage of labour usually last?

Answer 36

Within 10 minutes

Question 37

What are some stimuli that cause baby to take its first breath?

Answer 37

Trauma Cold Light Noise

Question 38

What are the major goals of uterine contractions?

Answer 38

Dilate cervix | Push foetus through birth canal

Question 39

What are the 3 Ps of labour?

Answer 39

Powers Passenger Passage

Question 40

How does the foetus contribute to labour?

Answer 40

Glucocorticoids released to inhibit progesterone | Foetal oxytocin produced

Question 41

How do we induce labour?

Answer 41

Give prostaglandins directly into vagina

Question 42

What does the 'attitude' of the foetus refer to?

Answer 42

Flexion or extension of the foetal head

Question 43

What is the difference between frank and full breech?

Answer 43

``` Frank = knees extended Full = knees flexed ```

Question 44

Why is cord prolapse a problem?

Answer 44

Cools down as comes out of cervix Arteries spasm Stops oxygen to the baby therefore indication for C section

Question 45

What is the latent phase of labour?

Answer 45

1st part of 1st stage Onset of labour with slow cervical dilation up to 4cm Variable duration

Question 46

What is the active phase of labour?

Answer 46

2nd part of 1st stage Faster rate of cervical change 1 - 1.2 cm per hour Regular uterine contractions

Question 47

What are some of the biggest causes of maternal mortality?

Answer 47

Pre-eclampsia/eclampsia Post partum haemorrhage Obstructed labour Unsafe abortion

Question 48

What incision do we use for C section?

Answer 48

Pfannenstiel

Question 49

When would we take a mum to labour AFTER the delivery of the baby?

Answer 49

If placenta hasn't delivered within an hour after brith 3rd stage of labour not complete Risk of infections and heavy bleeding

Question 50

What is the normal blood flow to the placenta?

Answer 50

500 - 800 ml/min

Question 51

How does the body control bleeding post delivery?

Answer 51

Powerful contractions/retraction of uterus Pressure exerted on placental site by walls of uterus Blood clotting mechanism - pregnancy is pro-thrombotic