Physiological labour

Question 1

What is the normal position of the uterus?

Answer 1

anteverted and anteflexed

Question 2

What is the biological term for labour?

Answer 2

parturition

Question 3

What environment is best for normal physiological birth?

Answer 3

needs to be private, oxygenated, calm, with partner

- need high levels of oxytocin - replicate the setting you conceived the baby

Question 4

What is spontaneous abortion (miscarriage) ?

Answer 4

labour before 24 weeks

Question 5

What is pre-term labour?

Answer 5

labour before the 37th week

Question 6

What processes does the expulsion of the foetus require?

Answer 6

1. creation of the birthing canal
2. the release of the structures which normally retain the fetus in utero
3. The enlargement and realignment of the cervix and vagina
4. expulsion of the fetus
5. expulsion of the placenta and changes to minimise the blood loss from the mother

Question 7

What is labour?

Answer 7

the process where the foetus placenta and membranes are expelled through the birth canal

Question 8

What are the 3 stages of labour?

Answer 8

1 - onset of regular contractions until the cervix is fully dilated - 10cm
2 - begins when the cervix is fully dilated and ends with the birth of the baby
3 - from the birth of the baby to the delivery of the placenta and membranes and bleeding is controlled

Question 9

What happens in the first stage of labour?

Answer 9

• foetus, placental membranes and uterus increase in size
• minimum of 2 contractions every 5 minutes
• painful enough to stop talking

Question 10

What is the preferred position of the fetus?

Answer 10

head first - cephallic

Question 11

What is the latent phase?

Answer 11

cervix dilation up to 4cm

Question 12

What is active labour?

Answer 12

4cm-10cm

Question 13

How does the foetus present?

Answer 13

presentation describes which part of the fetus is adjacent to the pelvic inlet
-if the baby lies longitudinally, the presenting part may be the head (cephalic) or the breech (podalic)

Question 14

What is engagemnt>

Answer 14

around 36 weeks - fundal height is high in the ribs but it drops lower down as the head starts to engage into the pelvis

Question 15

What occurs in pre-labour? (getting ready for the baby)

Answer 15

• Expansion of the lower segment
• foetal head engages
• symphysis pubis widens and scare-iliac joints relax
• pelvis floor relaxes
• increased vaginal secretions
• frequency of micturition
• Braxton hicks
• high levels of relaxin and progesterone cause pregnancy gait - softening of ligaments and muscles

Question 16

What changes in the gap junctions?

Answer 16

Gapa junctions increase in number and act as electro-chemical signalling system between cells which sets up the braxton hicks contraction

Question 17

What does oxytocin do?

Answer 17

• Acts on the myometrium to make it more sensitive and allow it to contract
• postivie feedback loop occurs when the foetal head presses on the cervix causing more oxytocin to be released from the posterior pituitary gland to get contractions

Question 18

What does cervical softening involve?

Answer 18

The cervix has a high connective tissues content of collagen fibres embedded in a proteoglycan matrix - in ripening, you get a reduction in collagen and increase GAG which decreases the aggregation of collagen fibres which get loosened

Question 19

What is the pelvic inlet bound by?

Answer 19

posteriorly - sacral promontory
laterally - ilio-pectinal line
anteriorly - superior pubic rams and pubic symphysis

Question 20

What happens if you have too much adrenaline?

Answer 20

It will work against the oxytocin hence why you need a calm environment

Question 21

How is the birth canal formed?

Answer 21

-pelvic ligaments soften
-dilation of the cervix and retracted anteriorly
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