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Semester 4 - Reproductive System > Session 10 - Parturition > Flashcards

Session 10 - Parturition Flashcards

1
Q

What is Labour? (Aside from being the most awesomest political party ever!)

A

Expulsion of products of conception after 24 weeks.

So yeh. Actually sounds a bit more like UKIP.

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2
Q

What is a birth <24 weeks called?

A

Spontaneous aboriton

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3
Q

What is a birth <37 weeks called?

A

Pre-term

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4
Q

What is a birth between 37-42 weeks called?

A

Term

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5
Q

Give three different things you should assess about a babies position before labour

A

Lie
Presentation
Position

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6
Q

What is a babies lie?

A
  • Relationship to long axis of uterus
  • Normally longitudinal
  • Fetus normally flexed
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7
Q

What is a babies presentation?

A
  • Which part is adjacent to pelvic inlet
  • Normally head (cephalic)
  • Sometimes buttocks (podalic)
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8
Q

What is a babies position?

A

• Orientation of presenting part

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9
Q

What occurs in the first stage of labour? (2)

A

Creation of birth canal

Onset of labour -> Full cervical dilation

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10
Q

What are two main phases of the onset of labour?

A

Latent phase

Active phase

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11
Q

What occurs in the latent phase of the onset of labour?

A

Onset -> 4cm dilation

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12
Q

What occurs in the active phase of labour?

A

Faster rate of cervical change, 1-1.2 cm/hour

Regular uterine contractions

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13
Q

What is the main event of the second stage of labour?

A

Expulsion of foetus

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14
Q

What is the normal range of time for the second stage of labour?

A

Up to 1 hour

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15
Q

Outline what happens to the baby in the second stage of labour

A
  • Head flexes as it reaches pelvic floor (reduces presentation diameter)
  • Head rotates
  • Head sretches vagina and perineum
  • Head delivered
  • Shoulders rotate and deliver
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16
Q

What occurs in the third stage of delivery?`

A

Expulsion of placenta

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17
Q

How does the body facilitate the expulsion of the placenta?

A

Sheared off by strong contractionas of the uterues
Compresses blod vessels to reduce haemorrhgage
Lasts between five and fifteen minutes

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18
Q

What processes are necessary to create a birth canal?

A

Expansion of soft tissues

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19
Q

Give three tissues which are expanded in creation of a birth canal

A

Cervix
Vagina
Perineum

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20
Q

What does expansion of the cervix cause

A

Foetal membranes to rupture, releasing amniotic fluid

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21
Q

How big is the expansion of the cervix, and what facilitates it?

A

10 cm

Structural changes and a lot of force

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22
Q

What is the normal diameter of a baby’s head?

A

9.5cm

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23
Q

What is maximum size of birth canal?

A

Pelvic inlet typically 11cm

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24
Q

What is the structure and funciton of cervix during pregnancy?

A

Tough, thick collagen which is coiled to give it strength in order to retain the foetus

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25
Q

What is the process of cervical softening called?

A

Cervical ripening

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26
Q

What three things does cervical ripening involve?

A

 Reduction in collagen production (Turnover altered)
 Increase in glycosaminoglycans (Disrupts the matrix)
 Reduces aggregation of collagen fibres (Uncoils)

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27
Q

What is cervical ripening triggered by?

A

Prostaglandins
 PG E2 and F2x
 Locally diffused from the uterus
 Once released the cervix is ready to be stretched

28
Q

What happens to myometrium during pregnancy?

A

Smooth muscles greatly increased in pregnancy

29
Q

How is force generated by myometrium?

A

By rises in intracellular Ca2+, which increases due to action potentials.
Triggered by spontaneous signals from pacemakers

30
Q

What supresses uterine contractions during pregancy?

A

Progesterone

31
Q

What maintains corpus luteum in pregancny?

A

HCG

32
Q

Describe early uterine contractions

A

Low amplitude every 30 minutes, mother usually not aware

33
Q

Describe late uterine contractions

A

Higher amplitude, less frequent

Braxton-Hicks contractions

34
Q

What are the contractions of the uteryus made more forceful and frequent by? 2

A

Prostaglandins (as well as ripening the cervix). Causes increased Ca2+ per action potentional.

Oxytocin
More actionpotentials, threshold lowered

35
Q

What are prostaglandins?

A

o Biologically active lipids
o Local hormones
o Produced mainly in the endometrium

36
Q

What is production of prostaglandins controlled by?

A

Oestrogen: Progesterone ratio

37
Q

What happens to prostglandin production when oestrogen > progesterone?

A

Increased prostaglandins

38
Q

What happens to prostaglandins when oestrogen < progesterone

A

Low prostaglandins, feature throughout pregnancy

39
Q

Where is oxytocin secreted?

A

Posterior pituitary

40
Q

Outline the ferguson reflex

A

 Mechanical stimulation of the cervix due to prostaglandin contractions increases oxytocin secretions, strengthening contractions, stimulating the cervix more, releasing more oxytocin

41
Q

When is oxytocin more effective?

A

Oestrogen > Progesterone

More smooth muscle receptors

42
Q

What is brachstasis?

A

Uterine smooth muscle relaxes less than it contracts.
o Unique feature of uterine smooth muscle
o Fibres shorten in the body of the uterus
o Drives the presenting part of the fetus to the cervix

43
Q

Give the normal physiological processes which initiate labour? (8)

A

o ↑ Fetal Cortisol (?)
o Oestrogen > Progesterone
o ↑↑↑ Prostaglandins from Endometrium of Uterus
o Increased force of uterine contractions
o Cervix Stretched
o Oxytocin released from Posterior Pituitary under the Control of Hypothalamus
 Ferguson Reflex
o Increased frequency of uterine contraction
o Cervix stretched more

44
Q

What causes neonate to take first breath?

A

Multiple stimuli, such a trauma from the birth and cold cause the neonate to take its first breath

45
Q

What are the two main change causing features of first breath

A

Reduction in pulmonary vascular resistance

Increased arterial pO2

46
Q

What are the three features of a reduction in pulmonary vascular resistance?

A

 Blood fills lungs, increased return to LA
 Pressure in LA > RA
 Foramen ovale closes

47
Q

What does increased arterial pO2 cause?

A

 Ductus Arteriosus contracts

48
Q

How is condition of a neonate scored?

A

Apgar score

49
Q

What limits maternal blood loss after birth?

A

Contraction of the unterus, which shears off and expels the placenta (normally after 10 minutes)

50
Q

Why can bleeding after birth be severe?

A

Blood flow through placenta is normally 500-800ml/minute (10-15% cardiac output).

51
Q

How can post-partum bleeding be treated?

A

Oxytocic drug

52
Q

What is the most common presenation of a baby?

A

Most commonly the baby lies longitudinally, in a cephalic presentation, well flexed so that the vertex presents to the pelvic inlet`

53
Q

What are the three P’s of labour, problems with which can cause a difficult birth?

A

Powers
Passage
Passenger

54
Q

What are the powers of labour?

A

Delivery dependent on myometrium

Contraction and retraction of multidirectional smooth muscle fibres casues progressive shortening

55
Q

In what three ways can uterine contractons be assesed?

A

Frequency, amplitude and duration

56
Q

What is the passage made up of?

A

Pelvic inlet
Pelvic cavity
Pelvic outlet

57
Q

What are the measurements of pelvic inlet?

A

 Shorter in the anterior-posterior plane

 10.5cm diameter

58
Q

What are the measurements of pelvic cavity?

A

 Circular

 12cm diameter

59
Q

What are the measurements of the plevic outlet?

A

o Pelvic Outlet
 Shorter in the medio-lateral plane
 11cm diameter

60
Q

What is the passenger?

A

The size and presentation of the foetus

61
Q

What are the main tree reasons labour is unable to progress?

A 
o	Inadequate Power
	Insufficient uterine contraction
o	Inadequate Passage
	Abnormal bony pelvis
	Rigid perineum
o	Abnormalities of the Passenger
	Fetus too big
62
Q

How can labour be induced?

A

Labour can be induced by giving the mother Prostaglandins and Oxytocic drugs. These drugs will cause the cervix to begin to ripen and the uterus to begin its contractions.

63
Q

How can the physiological state of the foetus be monitored?

A

During labour fetal heart rate can be assessed using a Fetal Scalp Electrode.

64
Q

Describe a C-section

A

Subrapubic Incision
o Linea alba and anterior layers of the rectus sheaths are transected and resected superiorly,
o Rectus muscles are retracted laterall or divided through their tendinous parts allowing reattachment without muscle fibre injury

65
Q

Give two methods of operative delivery?

A

Forceps

Vacuum extraction

Semester 4 - Reproductive System (30 decks)

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