Physiological Labour And Postpartum

Question 1

What is the first stage of Labour?

Answer 1

Regular contractions until the cervix is fully dilated. Consists of latent and active phases.

Question 2

What is the second stage of Labour?

Answer 2

Starts from full dilation of the cervix and ends at the delivery of the baby

Question 3

What is the third stage of Labour?

Answer 3

Starts when the the baby is delivered and ends after delivery of placental membranes and when bleeding is controlled.

Question 4

What is the latent phase of childbirth?

What is the active phase?

Answer 4

Latent - painful contractions and cervical dilation up to 4cms.
Active - regular painful contractions and dilatation from 4cm to 10 cm.

Question 5

What are Braxton Hicks contractions?

Answer 5

Practice contractions felt on the sides of the uterus rather than the top. Occur as a part of lightening.

Question 6

What is lightening?

Answer 6

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.

Question 7

What changes occur in the cervix close to Labour?

Answer 7

Cells take up more water,
Gap junctions form between cells to facilitate coordinated contraction,
Upregulation of oxyctoxin receptors in myometrium cells.

Question 8

What effect does oxytocin have on Labour?

What effect does adrenaline and noradrenaline have?

Answer 8

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.

Question 9

How long does Labour typically last?

Answer 9

8 to 18 hours.

5-12 in multiparous women.

Question 10

What is fundal dominance?

Answer 10

Contractions begin at the cornea and spread out and down towards the lower uterine segments in waves.

Question 11

What is special about the myometrium muscle?

Answer 11

Contracts and retracts, permanently partially shortening to tighten the uterus.

Question 12

What is effacement?

Answer 12

Gradual merging of the cervix into lower uterine segment. Occurs before dilatation and is linked to the release of prostaglandins.

Question 13

What is show?

Answer 13

Mucus plug (operculum) ejection from the cervix.
Often comes out streaked with blood.

Question 14

What are forewaters?

What are hindwaters?

Answer 14

Forewaters - amniotic fluid trapped in front of the flexed fetal head.
Hindwaters - fluid remaining behind the fetus.

Question 15

What features depict the transition period?

Answer 15

Maternal restlessness,
Discomfort,
A wish for the process to end.

Question 16

What is the perineal phase of Labour?

Answer 16

Fetal head crowns and the bladder is pushed up into the abdominal cavity. Rectum is flattened and the head becomes visible at the vulva.

Question 17

When is diagnosis of delay made?

Answer 17

After two hours for nulliparous women and after one hour for parous women. Referral to an obstetrician should be made.

Question 18

What signs indicate the second stage of Labour?

Answer 18

Urge to push,
Rhomboid of Michaelas (sacral spine pushed back and visible through skin),
Definitive diagnosis by vaginal examination.

Question 19

What are the mechanisms of birth?

Answer 19

Descent,
Flexion,
Internal rotation,
Extension of the head,
Restitution,
Internal rotation of shoulder and external rotation of the head,
Lateral flexion.

Question 20

What observations are done in the second stage?

Answer 20

Auscultation of fetal heart every 5 minutes,
Maternal pulse taken every 15 minutes,
1 or 2 hourly assessment of contractions,
Psychological support.

Question 21

How does the separation of the placenta occur?

Answer 21

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.

Question 22

What is the Schultze method?

Answer 22

Separation starting at the centre of the placenta, causing it to descend centrally first. Minimal blood loss due to blood containment in amniotic sac.

Question 23

What is the Mathew Duncan method?

Answer 23

Separation at the lower edge of the placenta, leading to vaginal blood loss.

Question 24

How is blood loss prevented after placental separation?

Answer 24

Retraction of oblique uterine muscle fibres act to ligate the blood flow.

Question 25

When should administration of an oxytocic drug be considered?

Answer 25

After birth of the babies anterior shoulder, to avoid shoulder dystocia.

Question 26

What oxytocic drugs are available?

Answer 26

Oxcytocin IM,

Syntometrine - ergometrine plus oxytocin.

Question 27

What is the difference between oxytocin and ergometrine?

Answer 27

Oxytocin acts in 2.5 mins and has a short half life.

Ergometrine acts in 6 minutes for 2 to 4 hours. Side effects include chronic headaches and sickness

Question 28

How long is the postpartum period?

Answer 28

6 weeks after delivery of the placenta.

Question 29

What is Lockhart rubria?

Answer 29

Heavy flow bleeding occurring in the postpartum period. Changes from red-brown to white - Lockhart Alba. Passage of clots is not normal.

Question 30

What abnormalities may be seen on a blood test in the postpartum period?

Answer 30

High white blood cell count.

Question 31

What is the let down reflex?

Answer 31

Contraction of myoepithelial cells around the alveolar cause expulsion of milk in response to sensory inputs such as suckling hearing or seeing the baby.

Question 32

What immunological components of breatmilk are there?

Answer 32

Lactoferrin - binds iron and prevents proliferation of iron dependant organisms.
Bacteriocidal enzymes,
Lymphocyte polymorphism and plasma cells.
IgA.

Question 33

What are contraindications of breastfeeding?

Answer 33

Severe maternal illness,
Maternal HIV,
Contraindicated medications.

Question 34

What breast problems might prevent lactation?

Answer 34

Nipple sensitivity,
Mastitis,
Engorgement,
Breast abscess,
Breast lumps - benign or malignant.

Question 35

What are the causes of postpartum haemorrhage?

Answer 35

Uterine atony (most common),
Trauma,
Coagulopathy
Remaining placental tissue.

Question 36

How is postpartum haemorrhage managed?

Answer 36

Bimanual compression,
Oxytocic drug administration (Syntocinon, ergometrine etc)
Surgical management.

Question 37

What is the definition of postpartum haemorrhage?

Answer 37

Primary -Loss of 500ml or more from the genital tract within 24 hours of birth.

Secondary - excessive bleeding from 24 hours postnatal until 12 weeks postnatally.