Physiology

Question 1

after fertilisation what does the zygote do?

Answer 1

divides into the blastocyst

Question 2

what happens on day 3-5 post-fertilisation?

Answer 2

zygote is transported to the uterus

Question 3

what happens on day 5-8 post-fertilisation?

Answer 3

zygote attaches to the lining of the uterus via trophoblast cells penetrating the endometrium

Question 4

what is the placenta made up of?

Answer 4

trophoblasts and decidual tissue

Question 5

role of trophoblasts in the placenta?

Answer 5

they invade and break down capillaries to form cavities filled with maternal blood

Question 6

how does the maternal blood transfer things to the foetus?

Answer 6

diffusion via the thin membrane separating their circulations

Question 7

role of the hormone human placental lactogen/ human chorionic somatomammotropin?

Answer 7

protein formation

decreases insulin sensitivity in the mother

Question 8

which hormone relaxes ligaments?

Answer 8

oestrogen

Question 9

how often should hCG double?

Answer 9

every 48 hours

Question 10

what does a static/ slow rising hCG level indicate?

Answer 10

ectopic pregnancy

Question 11

specific nutritional needs in pregnancy

Answer 11

folic acid
vitamin D
protein
iron
B vitamins

Question 12

what initiates labour?

Answer 12

oestrogen inducing oxytocin receptors

Question 13

what does oestrogen acting on oxytocin receptor cause?

Answer 13

stimulates uterus contraction and makes prostaglandins

Question 14

stages of labour

Answer 14

1. cervical dilation (8-24 hours)
2. passage of foetus through the birth canal
3. expulsion of placenta and membranes

Question 15

latent stage of cervical dilation

Answer 15

3-4cm

Question 16

active stage of cervical dilation

Answer 16

4-10cm

Question 17

how often should the cervix dilate?

Answer 17

> 2 cm every 4 hours

Question 18

when is stage 2 considered prolonged?

Answer 18

> 3 hours (2 if multiparous)

Question 19

when should surgery be done in stage 3?

Answer 19

> 1 hour

Question 20

active management of stage 3

Answer 20

uterine massage
empty bladder
syntometerine or oxytocin
carboprost or misoprostol

Question 21

what score is used to assess whether it is safe to induce labour?

Answer 21

Bishop’s score

Question 22

three factors that can stop labour progressing?

Answer 22

power
passage
passenger

Question 23

ideal passage?

Answer 23

gynaecoid

Question 24

what can FTP in labour cause?

Answer 24

sepsis
AKI
PPH
fistula formation
foetal asphyxia

Question 25

what is a partogram

Answer 25

used to assess progress of labour (foetal HR, amniotic fluid, cervical dilation, contractions, etc.)

Question 26

7 cardinal movements of the baby

Answer 26

``` engagement descent flexion internal rotation crowning and extension restitution and external rotation expulsion of anterior shoulder first ```

Question 27

what is considered normal blood loss in labour?

Answer 27

<500mls

Question 28

analgesic options in labour

Answer 28

``` massage techniques water immersion paracetamol/ co-codamol IM opiates TENS entonox (O2 + NO) diamorphine epidural IV remifentanil PCA and spinal ```

Question 29

what is an epidural made up of?

Answer 29

levobupivacaine +/- opiate

Question 30

what can an epidural inhibit?

Answer 30

progress in stage 2

Question 31

complications of epidural

Answer 31

hypotension due to vasodilation dural puncture (CSF leak, HA) atonic bladder

Question 32

what does prolactin stimulate?

Answer 32

milk production

Question 33

what does oxytocin stimulate?

Answer 33

let-out reflex

Question 34

what is the puerperium?

Answer 34

6-week period following birth that involves the return of tissues to the non-pregnancy state

Question 35

how long does lochia last?

Answer 35

10-14 days

Question 36

how long does it take BP to return to normal

Answer 36

6 weeks