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Kofi: Pure Clinical Sem 3 > Repro: Delivery > Flashcards

Repro: Delivery Flashcards

1
Q

What is parturition?

A

-Transition from pregnancy to non-pregnant state

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2
Q

What is labour?

A

Physiologic process by which fetus is expelled form the uterus to outside world

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3
Q

What is delivery?

A

-Method of expulsion of the fetus, transforming fetus to neonate

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4
Q

What are the physiological stages of labour?

A
  1. Creating of the birth canal and descent of fetal head into it
  2. Changes in uterine contractions to expulsive, descent of the fetus through the birth canal and delivery
  3. Expulsion of the placenta and contraction of the uterus. usually lasts between 5 and 15 minutes but can go up to 30-60 minutes depending on circumstances
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5
Q

What are the clinical stages of labour?

A

Stage 1 - Interval between onset of labour and full dilatation of the cervix
Stage 2 - Time between full dilation of the cervix and delivery
Stage 3 - Starts with completed birth of the baby and end with complete expulsion of placenta and membranes

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6
Q

What are the latent and active phases occuring during labour?

A

During Stage 1
-Onset of labour with slow cervical dilatation but softening. Last a variable time (latent)

  • Faster rate of change and regular contractions (active)
  • Descent and rotation of the head internally. Crowning where the head stretches perineal muscle and skin. Extension of head and external rotation. Shoulder rotate and deliver followed rapidly by the body (passive).
  • Maternal effort to expel the fetus and achieve birth (active)
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7
Q

How is labour initiated?

A

Unclear mechanism

  • Prostagladins (lipid) promote labour but don’t initiate.
  • Produced mainly in myometrium and decidua
  • Production controlled by oestrogen:progesterone ratio (increase)
  • Powerful contractor of smooth muscle
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8
Q

How is contractility regulated in labour?

A
  • Progesterone inhibits contractions so it’s levels fall
  • Oestrogen increases gap junctional communication between smooth muscle cells to increase contractility
  • Mechanical stretching of uterine smooth muscle increases contractility.
  • Prostaglandins caused increase in Ca2+ per action potential
  • Oxytocin increase action potential and lowers threshold
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9
Q

What is the role of oxytocin in labour?

A
  • Initiate uterine contractions
  • Action inhibited in pregnancy by progesterone, relaxin and low number of oxytocin receptors
  • Increased number of gap junctions to aid communication between muscle cells
  • By 36 weeks increased number of oxytocin receptors in myometrium therefore uterus can respond to pulsatile release of oxytocin from posterior pituitary gland. Oxytocin release controlled by hypothalamus
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10
Q

What is cervical ripening?

A

Cervix collagen in proteoglycan matrix

Prostaglandins trigger ripening which involves

  • Reduction in collagen
  • Increase in glucosaminoglycans
  • Increase in hyaluronic acid
  • Reduced aggregation of collagen fibres
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11
Q

What is effacement and dilatation?

A

Change to the cervix result in the Labour cervix offering less resistance to presenting part.

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12
Q

What is the size of the birth canal?

A
  • Diameter of presentation of the foetus is 9.5cm

- Birth canal is determined by pelvis and the pelvic inlet is typically 11 cm and softening of ligaments may increase it

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13
Q

What are the changes that occur to the pelvic floor vagina and perineum to allow for labour?

A
  • Levator ani fibres stretch

- Thinning of central portion of the perineum to almost transparent structure

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14
Q

What happens to muscle in myometrium during labour?

A
  • Contractions from two poles of uterus ho to the funds and upper part of the uterus
  • After each contraction, length of each myometrium muscles of uterus can not return to former length
  • Becomes shorter and shorter
  • Contraction and retraction
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15
Q

What are principles of inducing labour?

A
  • Stimulate release of prostagldins (membrane rupture)
  • Artificial prostaglandins
  • Synthetic oxytocin
  • Anti-progesterone agents
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16
Q

How can delivery be facilitated by intervention?

A
  • Caesaerian seton

- Operative delivery (forceps, vacuum extraction)

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17
Q

How does separation and descent of the placenta occur?

A
  • Marked reduction in size of uterus due to powerful contraction and retraction
  • Size of placental site therefore reduced
  • Inelastic placenta squeezed by contraction
18
Q

How is bleeding controlled in labour?

A
  • Powerful contraction/retraction of uterus especially action of interlacing muscle fibres which cobstricts blood vessels running though the myometrium
  • Pressure exerted on placental site by walls of contracted uterus
  • Blood clotting mechanism
19
Q

How does the neonate establish independent life?

A
  • Neonate takes first breath (stimuli are trauma, cold, light, noise)
  • Lungs expand
  • Alveoli inflate and inflation maintained by surfactant
  • Regular breathing enables by neonatal brain pathways triggered at birth
  • Reduced pulmonary vascular resistance
  • Increase arterial pO2
20
Q

What is the hormonal control of growth and development of mammary tissue?

A
  • Hypertrophy in pre-existing alveolar-lobular structures in the breast.
  • Formation of new alveolae by budding from milk ducts with proliferation of milk collecting ducts
  • Hormones used are progesterone, oestrogen, prolactin, growth hormone, adrenal steroids
  • High levels of lactogenic hormone in pregnancy but only minimal amounts of milk hit of progesterone and oestrogen inhibit lactogenic hormones.
21
Q

How is milk produced?

A
  • Prolactin controlled
  • Released by action of suckling at a nipple that has become exquisitely sensitive post delivery.
  • Neuro-endocrine reflex causes less dopamine and increase VIP.
  • Prolactin levels and milk production are dependent on the frequency and duration of suckling.
  • Levels are at their highest in the early puerperium and reduce slowly, only returning to normal after weaning.
22
Q

Which hormone is reponsible for milk let down?

A

Oxytocin

  • Causes contraction of the myoepithelial cells situated around the alveolae to cause them to contract and expel the milk into the milk collecting ducts.
  • Milk collecting ducts have longitudinal muscle cells, which are also stimulated, causing them to dilate and improve the free flow of milk towards the nipple along these dilated ducts.
23
Q

What controls the release of hormone in milk let down?

A

Oxytocin

  • Release is stimulated by suckling, seeing or hearing the baby but is also readily inhibited by emotional stress or anxiety.
  • 90-minute cycle of ‘let down’ irrespective of suckling, because oxytocin is released in a pulsatile manner from the pituitary.
24
Q

How does cessation of lactation occur?

A
  • Key to maintaining milk production is sufficient suckling stimulation at each feed to maintain prolactin secretion and to remove accumulated milk.
  • If suckling stops, milk production ceases gradually. Due to turgor induced damage to secretory cells and low prolactin level. Suppression can also be achieved via steroids
25
Q

What is the result of damage to the neuroendocrine axis of breastfeeding?

A
  • Inadequate emptying of secreting glands of the breast to feed the infant
  • Distension and atrophy of glandular epithelium.
26
Q

What are the functions of the pelvic floor muscles

A
  • Support the pelvic organs
  • Maintain urinary and faecal continence (bladder and rectum)
  • Maintain intra-abdominal pressure during coughing, vomiting, sneezing and laughing
  • Facilitate defaecation and micturition
  • Facilitate childbirth
27
Q

What are the components of the levator ani muscles from medial to lateral?

A
  • Puborectalis
  • Pubococcygeus
  • Illiococcygeus
28
Q

What is the function of the perineal body?

A
  • Fibrous point of insertion of the elevator ani muscles

- Support of the perineal structures rely on it

29
Q

Which muscles make up the pelvic side walls?

A
  • Obturator internus

- Piriformis

30
Q

What makes up the pelvic floor (diaphragm) ?

A
  • Levator ani
  • Coccygeus
  • Urogenital diaphragm
  • Perineal body
  • Perineal muscles
  • Posterior compartment
31
Q

What makes up the deep layer of the perineal muscles?

A
  • Compressor urethra and external urethral sphincter

- Deep transverse perineal

32
Q

What makes up the superficial layer of perineal muscles?

Pubic symphysis to Ischial tuberosity

A
  • Ischicavernoousus
  • Bulbospongiosus
  • External anal sphincter
  • Superficial transverse perineal
33
Q

What is the innervation of the pelvic floor musculature?

A

-Pudendal nerve

S2,S3,S4 keeps shit of the floor

34
Q

How can damage to pelvic body occur?

A

Childbirth in women

  • Muscles strecthced
  • Nerve damage
  • Perineal body disrupted
  • Episiotomy
35
Q

What is the blood supply to the pelvic floor?

A

Blood supply - Internal and external pudendal arteries and drains via corresponding veins

Lymphatic - Inguinal nodes

36
Q

What are examples of pelvic floor dysfunction?

A
  • Pelvic organ prolapse

- Incontinence

37
Q

What is pelvic organ prolapse?

A
  • Loss of support for the uterus, bladder, colon or rectum leading to prolapse of one or more organs into the vagina
  • Can affect body image and cause depressive symptoms and is more than an anatomical defect
  • Common problem
38
Q

What are causes and risk factors of pelvic organ prolapse?

A

Aetiology is complex

Risk factors:

  • Age
  • Parity
  • Vaginal delivery-4x increased risk after 1stchild; 11x increase after >/= 4 deliveries
  • Postmenopausal oestrogen deficiency.
  • Obesity and causes of chronic raised intra-abdominal pressure
  • Gennective connective tissue disorder
  • Neurological
39
Q

What are structures involved in an episiotomy?

A
  • Vaginal epithelium
  • Transverse perineal muscle
  • Bulbocavernosus muscle
  • Bulbospongiosus
  • Perineal skin
40
Q

What is an episiotomy?

A

Cutting the vagina medial laterally

41
Q

What are complications of an episiotomy?

A
  • Haemorrhage
  • Extension to the anal sphincters
  • Infection
  • Perineal pain
  • Dyspareunia
  • Cosmetic disfigurement due to poor alignment during suturing
42
Q

What are the types of FGM?

A

Type 1 - Removal of clitoris
Type 2 - Removal of vulva and clitoris
Type 3 - Removal of vulva, clitoris and infibulation
Type 4 - All the above + sewing up

Kofi: Pure Clinical Sem 3 (44 decks)

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