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Year 2 RE > Pregnancy and Birth > Flashcards

Pregnancy and Birth Flashcards

1
Q

What 2 of the following make up the definition of labour?

1 - patient feels a contraction
2 - regular uterine contractions
3 - progressive effacement (stretching and thinning of the cervix) and dilatation of the cervix
4 - progressive dilation of the cervix

A

2 - regular uterine contractions

3 - progressive effacement (stretching and thinning of the cervix) and dilatation of the cervix

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2
Q

What generally occurs to the 3 hormones below during labour:

  • estrogen
  • progesterone
  • oxytocin
A
  • estrogen = increase as pro-labour hormone
  • progesterone = reduces as is a pre-labour hormone
  • oxytocin = large increase
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3
Q

Where is oxytocin released from?

1 - posterior pituitary gland
2 - anterior pituitary gland
3 - adrenal gland
4 - thyroid gland

A

1 - posterior pituitary gland

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4
Q

Prostaglandins are a group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness. During labour there is an increase in prostaglandins. What is the role of prostaglandin in labour?

1 - cause placenta detachment
2 - soften the cervix and help open the cervix
3 - induce uterine contractions
4 - induce an increase in oxytocin

A

2 - soften the cervix and help open the cervix

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5
Q

Prostaglandins are a group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness. During labour there is an increase in prostaglandins to help soften the cervix and help open the cervix. Where is prostaglandin secreted from?

1 - corpus luteum
2 - anterior pituitary gland
3 - adrenal gland
4 - decidua

A

4 - decidua

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6
Q

Prostoglandin levels are increased during labour and are produced and released by the decidua. What is the decidua?

1 - small organ next to cervix
2 - part of endometrium
3 - part of myometrium
4 - part of the fundus

A

2 - part of the endometrium

- undergoes special modifications in preparation for and during pregnancy and is cast off at parturition

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7
Q

During labour the following changes occur

  • estrogen = small increase
  • progesterone = decrease
  • oxytocin = large increase
  • prostoglandins = increase

What is the purpose of these changes?

A
  • dilate the cervix and initiate uterine contractions
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8
Q

During labour there is a mechanical change that initiates uterine contractions and dilation of the cervix. What causes the mechanical stimulation that initiates labour?

A
  • babies head or other body (presenting part) part pressing on cervix
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9
Q

The stages of labour can be divided into 3 stages. The first stage is split into the latend phase and the established 1st phase. What is the latent phase of labour?

1 - cervix becomes soft and thin as it gets ready to dilate
2 - cervix is fully dilated, head descends the vagina, delivery of the baby
3 - delivery of the placenta & membranes
4 - regular painful contractions with progressive cervical dilatation from 4cm

A

1 - cervix becomes soft and thin as it gets ready to dilate

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10
Q

The stages of labour can be divided into 3 stages. The first stage is split into the latend phase and the established 1st phase. What is the established 1st phase of labour?

1 - cervix becomes soft and thin as it gets ready to dilate
2 - cervix is fully dilated, head descends the vagina, delivery of the baby
3 - delivery of the placenta & membranes
4 - regular painful contractions with progressive cervical dilatation from 4cm

A

4 - regular painful contractions with progressive cervical dilatation from 4cm

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11
Q

What are the 2nd and 3rd stages of normal labour?

1 - cervix becomes soft and thin as it gets ready to dilate
2 - cervix is fully dilated, head descends the vagina, delivery of the baby
3 - delivery of the placenta & membranes
4 - regular painful contractions with progressive cervical dilatation from 4cm

A 
2nd  = cervix is fully dilated, head descends the vagina, delivery of the baby
3rd = delivery of the placenta & membranes
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12
Q

Do nulliparous women (1st time mother) or multiparous women (previous deliveries) generally deliver quickest?

A
  • multiparous women
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13
Q

When the uterus contracts and relaxes what happens to the uterine muscle fibres, and how does this relate to pain?

A
  • contraction = muscle fibres shorten and pain is felt

- relaxation = muscle fibres relax and pain subsides

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14
Q

What is progress of labour determined by?

1 - babies head in relation to the ASIS
2 - babies head in relation to the ischial spine
3 - babies shoulders in relation to the ischial spine
4 - babies shoulders in relation to the ASIS

A

2 - babies head in relation to the ischial spine

  • a score of -5 indicates the baby is not that progressed
  • a score of +5 indicates a baby is very progressed
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15
Q

What is amniotic fluid?

A
  • protective liquid contained by the amniotic sac
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16
Q

Amniotic fluid is the fluid that is contained within the amniotic sac. What are the 4 main functions of amniotic fluid?

A
  • allow foetus to move around ensuring bone growth
  • development of the lungs
  • maintains temperature around the baby, protecting from heat loss
  • protection from outside injury by cushioning sudden blows or movements
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17
Q

How does amniotic fluid help the lungs develop?

A
  • breathe in fluid to expand the lungs
  • works to increase lung volume
  • when born there is a pressure change which expels the fluid
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18
Q

What is meconium?

1 - face forward during labour
2 - shoulder dystocia
3 - 1st faeces of baby
4 - shoulders forward during labour

A

3 - 1st faeces of baby

  • meconium aspiration syndrome occurs when a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery
  • if occurs while in uterus can indicate the baby is under stress
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19
Q

As labour progresses, which is assessed using the descent of the foetus head in relation to the ischial spines​, what happens to the babies position as it moves through the pelvis?

1 - must stay in a straight line to be delivered
2 - must turn over and leave face 1st
3 - leave feet 1st during labour
4 - twists and turns to pass through the cervix

A

4 - twists and turns, called the mechanism of labour

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20
Q

As labour progresses, which is assessed using the descent of the foetus head in relation to the ischial spines​, the baby twists and turns, called the mechanism of labour. Why does this occur and does it need assistance?

A
  • helps baby navigate through the shape and curves of the pelvis
  • this is a ‘hands off’ moment as could cause problems
21
Q

If a mother becomes stressed during labour this can cause an increase in adrenalin. Why is this bad in a woman that is in labour?

1 - contracts muscles around abdomen
2 - increases PVR and patients and babies BP
3 - decreases prolactin
4 - increases prolacin

A

3 - decreases prolactin

- prolactin stimulates the release of oxytocin which is crucial for uterus contractions during labour

22
Q

What is crowning?

A
  • the baby’s head can be seen completely at your vulva

- most painful time for the mother and perineum needs to be protected

23
Q

What is the Ferguson reflex?

A
  • a neuroendocrine reflex comprising the self-sustaining cycle of uterine contractions initiated by pressure at the cervix, more precisely, the internal end of cervix, or vaginal walls
24
Q

What identifies the end of the 2nd stage of labour?

1 - expulsion of the foetus
2 - end of regular contractions
3 - dilation of cervix >12cm
4 - baby is crowning

A

1 - expulsion of the foetus

25
Q

The 3rd stage of delivery is to deliver the placenta. Why is this stage of labour really important?

1 - risk of pre-eclampsia
2 - risk of haemorrhage
3 - risk of uterine contracture
4 - risk of retraction of the uterus

A

2 - risk of haemorrhage

- most dangerous to the woman

26
Q

Following delivery of the baby, what happens to uterus?

1 - uterine muscles contract and uterus moves back inside
2 - uterine muscle fibres shorten and uterus is pulled back through cervix
3 - uterus muscles relax and remain outside of the vagina for a period of time

A

2 - uterine muscle fibres shorten and uterus is pulled back through cervix
- the basal portion of the uterus becomes thicker and pulls up the dilating cervix over the presenting part

27
Q

Following delivery of the baby the uterine muscle fibres remain shortened after contracting during labour. The basal portion of the uterus becomes thicker and pulls up the dilating cervix over the presenting part. If this does not occur this is called uterine atony. Why is this dangerous?

1 - placenta can lead top haemorrhage
2 - cord can get tangled on the pelvis
3 - placenta can pull uterus from inside pelvis causing haemorrhage
4 - uterus can be torn into 2 parts

A

3 - placenta can pull uterus from inside pelvis causing haemorrhage
- the placenta has an extensive blood flow, so rupture of this can be dangerous

28
Q

What is the average time period that it can take for the placenta to be delivered?

1 - 1minute
2 - 1 hour
3 - 3 hours
4 - same time as labour

A

2 - 1 hour

29
Q

During the delivery of the placenta which is the 3rd stage of labour, there is always some blood loss. Generally how much blood is lost?

1 - 10-30ml
2 - 100-150ml
3 - 100-300ml
4 - >300ml

A

3 - 100-300ml

- up to 500ml is normal

30
Q

During the delivery of the placenta which is the 3rd stage of labour, there is always some blood loss. Generally, around 100-300ml, although up to 500ml is normal. However, if excessive blood is lost this is called primary postpartum haemorrhage. What level of blood loss determines if a patient has primary postpartum haemorrhage?

1 - >500ml
2 - >1L
3 - >2L
4 - >3L

A

1 - >500ml

31
Q

What is a retroplacental clot?

1 - bleeding around the cervix to help deliver the placenta
2 - blood clot forms on the fundus to help deliver the placenta
3 - bleeding and blood clot forms between placenta and uterine wall

A

3 - bleeding and blood clot forms between placenta and uterine wall

  • bleeding may occur but the blood may clot between the placenta and the wall of the uterus
  • this limits the vaginal bleeding and helps detach the placenta for delivery
32
Q

The blood around the placenta can be cut off. What facilitates the contraction of the blood vessels of the placenta?

A
  • myofibrils (small muscle fibres) of the uterus contract around the blood vessels
  • create ’living ligatures’
  • placenta essentially dies and drops off
33
Q

Why is the 3rd stage where the placenta is delivered described as a physiological process?

A
  • placenta is naturally delivered with contractions
34
Q

The 3rd stage where the placenta is delivered is often described as a physiological process, where the placenta is naturally delivered with contractions. However, if this is not the case there needs to be active management of the 3rd stage of delivery, which can divided into 3 stages. What are the 3 stages?

1 - drug is provided (oxytocis), clamped cord, pressure applied to uterus and cord pulled
2 - clamped cord, drug is provided (oxytocis), pressure applied to uterus and cord pulled
3 - drug is provided (oxytocis), clamped cord, pressure applied to uterus and cord pulled
4 - pressure applied to uterus and cord pulled, drug is provided (oxytocis) and clamped cord

A

3 - drug is provided (oxytocis), clamped cord, pressure applied to uterus and cord pulled
1st stage = drug is provided (normally oxytocics, synthetic oxytocin)
2nd stage = the cord is clamped
3rd stage = pressure is applied to the uterus and the cord is pulled

35
Q

During the 3rd stage if the placenta is not delivered it needs to be actively delivered. During this why should the cord not be pulled straight away?

A
  • synthetic oxytocin needs to be administered

- if the cord is pulled there is risk of uterine inversion

36
Q

What anatomical position can be used to identify if the uterus has contracted following the delivery of the placenta?

A
  • umbilical cord
37
Q

What natural process can increase the production of endogenous oxytocin?

A
  • sight and smell of the baby

- skin-to-skin contact with the baby which will increase oxytocin and help deliver the placenta naturally

38
Q

Why is the continued production and secretion of oxytocin during stage 3 of labour (delivery of the placenta) important?

A
  • oxytocin increases uterine contractions

- uterine contraction helps the placenta separate from the uterus

39
Q

The maternal side of the placenta has something called cotyledons, what are these?

A
  • lobes with a main stem of a chorionic villus as well as its branches and subbranches
  • deliver nutrients from the mother to the baby
40
Q

What are the 2 main membranes of the placenta?

1 - chorion and amnion
2 - chorion and trophoblasts
3 - trophoblasts and amnion
4 - syncytiotrophoblasts and chorion

A

1 - chorion and amnion
1 - chorion (surrounds amnion)
2 - amnion (surrounds amniotic fluid)

41
Q

The chorion membrane is a thick, opaque, friable membrane. It is the closest to the maternal side of the placenta. What is the chorion membrane layer derived from?

1 - endometrium
2 - myometrium
3 - trophoblasts
4 - syncytiotrophoblasts

A

3 - trophoblasts

  • trophoblast and is a continuous with the edge of the placenta
  • closely adherent to the decidua and forms the base of the placenta
42
Q

The amnion membrane is the layer that lies close to the foetus and surrounds the amniotic fluid and is a tough and translucent membrane. What cells does the amnion membrane derive from and what does this layer secrete?

1 - blastocoel
2 - blastocyst
3 - trophoblasts
4 - syncytiotrophoblasts

A

2 - blastocyst

  • amnion is derived from the inner cell mass of the blastocyst
  • amnion secretes amniotic fluid and protects the placenta and foetus from injury and ascending infection
43
Q

What is antepartum (before childbirth) haemorrhage?

1 - genital bleeding <16 weeks
2 - genital bleeding <24 weeks
3 - genital bleeding from 24 weeks
4 - genital bleeding from 30 weeks

A

3 - genital bleeding from 24 weeks

44
Q

Antepartum haemorrhage is defined as genital tract bleeding from 24+0 weeks’ gestation. One of the most common causes is placenta praevia, what is this?

1 - placenta attaches on the wall of the uterus close to the cervical open
2 - ectopic pregnancy in fallopian tubes
3 - ectopic pregnancy at the cornua (entrance to uterus from fallopian tubes)
4 - placena attached to myometrium

A

1 - placenta attaches on the wall of the uterus close to the cervical open
- abnormal position near or over the cervical opening, can be dangerous

45
Q

Antepartum haemorrhage is defined as genital tract bleeding from 24+0 weeks’ gestation. One of the most common causes is placenta abruption, what is this?

A
  • placenta separates from the inner wall of the uterus before birth
  • staves the baby of O2 and nutrients
  • causes heavy bleeding in the mother
46
Q

Primary and secondary postpartum haemorrhage (PPH) is one of the leading causes of maternal death. What is the difference between primary and secondary PPH?

A
  • primary PPH = loss of >500 ml blood from the genital tract within 24 hours of the birth of a baby
  • secondary PPH is defined as abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally
47
Q

When a woman is in labour and the term breeched is used, what does this mean?

A
  • baby is head up and feet facing the cervix (opposite way it should be)
48
Q

What is a cord prolapse?

A
  • umbilical cord slips down in front of the baby after the waters have broken
  • cord can then come through the open cervix (entrance of the womb)
  • usually happens during labour but can occur when the waters break before labour starts

Year 2 RE (53 decks)

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