T2 L22:Pregnancy and birth

Question 1

in the initiation of birth what is stimulated in the foetus and the mother at very first ?(p1)

Answer 1

• Fetal hypothalamus is triggered
• Fetal release of cortisol
• Maternal post pituitary releases oxytocin
• Decidua releases prostaglandins

Question 2

how is labour initiated (p2)

Answer 2

• increase in oestrogen pro-labour hormone
• decrease in progesterone pro-pregnancy hormone
• Release of oxytocin by the mother’s posterior pituitary gland
• Prostaglandins from the decidua
• Together creating uterine contractions
• Mechanical stimulation of the uterus and cervix caused by overstretching and pressure from the pp

Question 3

what are the 4 stages of labour

Answer 3

Latent phase

1st stage of labour

2nd stage of labour

3rd Stage of labour.

Question 4

what are the 3 Latent phase of labour

Answer 4

Effacement of cervix

Contractions.

Intensity varies.

Question 5

what is the effacement of the cervix

Answer 5

• Effacement- pulling up of the cervix to presenting part ​

Question 6

How do you diagnose active labour/1st stage of labour ?

Answer 6

​
Painful regular contractions-12-14hours ​
​
Cervical effacement​
​
Dilatation of the cervix of 4cms or more.

Question 7

how is the progress of the Fetal head in relation to the ischial spines measured?

Answer 7

Progress measured by dilatation and descent of the fetal head (in relation to the pelvic brim and the ischial spines)​

Question 8

how do you diagnose the second stage of labour

Answer 8

From full dilatation to the delivery of the baby​

Fetal ejection reflex​
​

Question 9

what is the ideal position for the Fetal head to move through the pelvic inlet

Answer 9

The brim is oval except where the promontory projects​

The anteroposterior diameter is 12cm​

Question 10

what is the ideal position for the Fetal head to move through the pelvic outlet

Answer 10

The outlet is diamond shaped​

Its three diameters are:​

1 - anteroposterior (as the coccyx is deflected backwards this is the space available during birth)​
2 - oblique​
3 - transverse​

Question 11

look at slide 17-18 for pictures of the Fetal skull and fontanelles

Answer 11

how was it

Question 12

what fontanelles do you want to feel and which ones don’t you want to feel ?

Answer 12

Anterior fontanelle (bregma)-don’t want to feel ​
• diamond shaped intersection of 4 
-closes at 18 months 

-Posterior fontanelle-want to feel ​
• Y shaped intersection of 3 sutures​
• closes at 6-8 weeks​

Question 13

diameters of the Fetal skull due to position

Answer 13

Suboccipitobregmatic (9.5cms) = OA position-best position-occipito-anterior position​
​
Occitopitofrontal ( 11cms) = OP position-trouble position​
​
Supraoccipitomental ( 13.5 cms) = brow-rarely does it come out vaginally ​
​
Submentalbregmatic (9.5cms) = face-coming out​
​

Question 14

what is the mechanism of birth

Answer 14

Head at pelvic brim OccipitalTransverse (OT) position​

Flexion of neck (Suboccipitobregmatic)​

Head descends and engages​

Head reaches pelvic floor- rotates to Occipital Anterior​

Head delivers by extension​

Head “restitutes” (comes in line with the shoulders)​

Shoulders rotate into anterior/posterior diameter of pelvis​

Anterior shoulder delivered by lateral flexion from downward pressure on baby’s head​

Posterior shoulder by upward lateral flexion​

Question 15

what characterises the 3rd stage of labour

Answer 15

​
-Delivery of placenta​
​
-Normal Estimated Blood loss 300-500mls​
​
-Inspection of placenta to ensure completion​
Otherwise infection or hemorrhage ​

Question 16

how is the third stage of labour managed

Answer 16

1.Active management (CCT)​
Oxytocin

i.m. given into maternal thigh ​
Cause sustained uterine contraction​
Aids delivery of the placenta & contraction of the placental bed​
Decreases risk of Post Partum Haemorrhage (PPH) ​

Or​

2.Physiologigal: Mother naturally expels the placenta and membranes with contractions. ​
​

Question 17

what is monitored in the foetus during labour

Answer 17

-detection of Fetal hypoxia

How- screening the Fetal heart rate by:

-Intermittent auscultation by Pinard or Sonicaid ​

• CTG
  (cardiotocograph) ​

-FBS​
​

-to see if baby needs delivery earlier

Question 18

what Intermittent Auscultation

Answer 18

• Every 15 mins before and after a contraction during the first stage​
• Every 5 minutes in the second stage-PH can drop and there is a higher chance of hypoxia ​

-Any abnormality heard would lead to the use of the CTG​
​

Question 19

what is a Cardiotograph used for

Answer 19

-Continuous print out of fetal heart rate and contractions​

• Abdominal ultrasound​
• –detects cardiac movements and hence heart rate​
• A clip applied to the fetal scalp (FSE)​
• –detects the R-R wave of the fetal ECG​

Most usual is the abdominal ultrasound​
​

Question 20

look at slide 28

Answer 20

How was it

Question 21

what is the purpose of Fetal blood sampling

Answer 21

• CTG is highly sensitive e.g. if normal, baby OK​
• But poorly specific e.g. if abnormal only a few babies are hypoxic​

-Use of CTG leads to a 4 fold increase in Caesareans Sections for fetal distress​
therefore​

-Need to check the CTG findings with FBS​
​

Question 22

what is FBS

Answer 22

Stab on the fetal scalp​

Blood collected via a glass pipette​

pH and base excess result​

Contraindications:​

-Infection such as HIV, Hepatitis B ​
-Fetal Bleeding disorder​
-Prematurity less than 32 weeks ​
​