Physiological Labour And Postpartum Flashcards
What is the first stage of Labour?
Regular contractions until the cervix is fully dilated. Consists of latent and active phases.
What is the second stage of Labour?
Starts from full dilation of the cervix and ends at the delivery of the baby
What is the third stage of Labour?
Starts when the the baby is delivered and ends after delivery of placental membranes and when bleeding is controlled.
What is the latent phase of childbirth?
What is the active phase?
Latent - painful contractions and cervical dilation up to 4cms.
Active - regular painful contractions and dilatation from 4cm to 10 cm.
What are Braxton Hicks contractions?
Practice contractions felt on the sides of the uterus rather than the top. Occur as a part of lightening.
What is lightening?
Occurs two to three weeks prior to Labour. Expansion of lower segments, Symphysis pubis widens, Sacroiliac joints relax, Increased vaginal secretions, Increased frequency of Micturition.
What changes occur in the cervix close to Labour?
Cells take up more water,
Gap junctions form between cells to facilitate coordinated contraction,
Upregulation of oxyctoxin receptors in myometrium cells.
What effect does oxytocin have on Labour?
What effect does adrenaline and noradrenaline have?
Oxytocin - stimulates contraction of myometrial cells and positively feeds back on the pituitary to release more oxytocin - Ferguson’s reflex.
Adrenaline and noradrenalin inhibit oxytocin.
How long does Labour typically last?
8 to 18 hours.
5-12 in multiparous women.
What is fundal dominance?
Contractions begin at the cornea and spread out and down towards the lower uterine segments in waves.
What is special about the myometrium muscle?
Contracts and retracts, permanently partially shortening to tighten the uterus.
What is effacement?
Gradual merging of the cervix into lower uterine segment. Occurs before dilatation and is linked to the release of prostaglandins.
What is show?
Mucus plug (operculum) ejection from the cervix. Often comes out streaked with blood.
What are forewaters?
What are hindwaters?
Forewaters - amniotic fluid trapped in front of the flexed fetal head.
Hindwaters - fluid remaining behind the fetus.
What features depict the transition period?
Maternal restlessness,
Discomfort,
A wish for the process to end.
What is the perineal phase of Labour?
Fetal head crowns and the bladder is pushed up into the abdominal cavity. Rectum is flattened and the head becomes visible at the vulva.
When is diagnosis of delay made?
After two hours for nulliparous women and after one hour for parous women. Referral to an obstetrician should be made.
What signs indicate the second stage of Labour?
Urge to push,
Rhomboid of Michaelas (sacral spine pushed back and visible through skin),
Definitive diagnosis by vaginal examination.
What are the mechanisms of birth?
Descent, Flexion, Internal rotation, Extension of the head, Restitution, Internal rotation of shoulder and external rotation of the head, Lateral flexion.
What observations are done in the second stage?
Auscultation of fetal heart every 5 minutes,
Maternal pulse taken every 15 minutes,
1 or 2 hourly assessment of contractions,
Psychological support.
How does the separation of the placenta occur?
Placenta compressed by myometrial contraction. Constriction of blood vessels causes them to become congested and burst. Blood seeps between the spongy layer and placental surface causing it to separate. Retroplacental clot may occur aiding separation.
What is the Schultze method?
Separation starting at the centre of the placenta, causing it to descend centrally first. Minimal blood loss due to blood containment in amniotic sac.
What is the Mathew Duncan method?
Separation at the lower edge of the placenta, leading to vaginal blood loss.
How is blood loss prevented after placental separation?
Retraction of oblique uterine muscle fibres act to ligate the blood flow.
