The onset and management of parturition (Labour 1) Flashcards
What is Parturition
the process of giving birth
How many stages is Parturition catogrised into
4
How many weeks is an normal labour
37-42 weeks is classed as normal
around 270 days
How many ways can babies be delivered
2- vaginaly and C-section
Approx 70-75% vaginal delivery
C-section should be around 15% of all women but is usally around 25-30%
name the key pathways that are used to identify the beginning of labour
The activation of the myometrium-
The action of placental steroids,
The action of prostaglandins / Inflammatory uterocervical processes
The action of oxytocin
Positive biofeedback mechanisms (Ferguson reflex)
what is the Myometrial quiescence
keeping the uterus quite- stopping the shedding, this is because Throughout pregnancy significant proliferation and hypertrophy in smooth muscle of uterus
function of HCG in Myometrial quiescence
inhibits formation of myometrial gap junctions (MGJ)- this coordinates the impulse to the smooth muscle in the uterus (spends up impulse), also helps with formation of CL- pregnancy hormone in P tests
function of progesterone in Myometrial quiescence
inhibits oestrogen (which helps MGJ)
function of oxytocin in Myometrial quiescence
promote the release of relaxing prostaglandins until HCG level drop at onset of labour
function of relaxin in Myometrial quiescence
causes smooth muscles to relax
function of Melatonin in Myometrial quiescence
suppresses myometrial oxytocin receptors, stops oxytocin release
what is Prostaglandins
a hormone that induces labour, produced by the uterine tissues / fetal membranes and increased rates of production occur during labour
function of Prostaglandins
used to indux labour, causes contractions
when is Ocytocin at it’s highest
at night from 32 weeks onwords,
what hormone helps the utrine tissue produce prostaglandins
Oytocin
define labour
regular, painful uterine contractions leading to progressive effacement and dilation of the cervix.
4 stages of labour what happens in them
0-(latent phase)-irregular contractions, effacement and dilatation of the cervix
1-onset of regular uterine contractions, accompanied by effacement of the cervix and dilation of the cervical os to full dilatation
2-full dilation of the os uteri to birth of the baby
3 – birth of baby to expulsion of placenta and membranes
what is full ditaltion in labour
10cm
why is labour usually quicker in women who have had children before
this is because Cervical effacement is usally more open and the smooth muscle of the cervix is thinner in women who have had children then those who have not
what is Cervical effacement
shortening of cervix
This occurs as a result of contraction and retraction of uterine muscle
this happens due to changes in soubility of collagen in the cervix
when dose Cervical effacement start and what is it’s function
May start 2-3 weeks before end of pregnancy
Completed in labour to form lower uterine segment
what are some of the symptomes of contractions
Involuntary
Intermittent initially then become regular
Almost always, painful
function of uterine contractions
Responsible for achieving effacement and dilatation and for descent and expulsion of the fetus
how do contractions work
Contractions start from the fundus and pass in waves inwards and downwards
Start at the top – fundal dominance
Uterine fibres contract and gradually shorten throughout labour
what is the forewaters
bag of membranes and forms a pocket of fluid in front of the babies head. this often ruptures but in 6-19% women this doesn’t rupture
what is Progress of labour … 3 Ps
The progress of labour is influenced by three factors:
the powers (uterine activity),
the passenger (the fetus) and
the passages (the pelvis).
each one can causes issues if not correct-
what can delay the first stage of labour
Cervical dilation of less that 2 cm in 4 h for first labours
Cervical dilation of less than 2 cm in 4 h or a slowing in progress of labour for the second or subsequent labours
Descent and rotation of the head
Changes in the strength, duration and frequency of uterine contractions.
what do women usually experience in early labour
change in behaviour, nesting physical symptoms, low backache / pelvic discomfort Upset stomach / diarrhoea Internittant tightenings (Braxton Hicks) Show – clear or pinky
what should care in early labour include
Hydration / nutrition
Rest
Mobilisation
when dose the M GAP J form
from w 32
function of MGJ
speeds up impulse- streamlines contractions
it is stimulated by oestrogen,proglandinnes, melatonin’
Inhibited by progesterone, HCG relaxin
where is prostaglandins produces
utrine tissue, fetal membranes- higer levels in pregnancy
what happens in the 0 stage of labour
latent phase, irregular contractions, effacement+ dilation of cervix
what happens in the 1st stage of labour
onset of utrine contractions, cervix dilaton
in what stage is full dilation
stage 2
in what stage is the baby born
stage 3
at what stage dose the plecenta and membrans is expelled from the utrus
stage 3
is labour stages longer in first time mothers
1 and 2 stage are double as long, 3 stage is around the same time in muligraves
are the cervix muscles thinner in muligraves
yes people who have had children before have thinner muscle in cervix
do contracts start at 1 speed and stay that speed
No. they start at one speed and get quicker
where do contractions originate from
top of the uterus and spread down
