The onset and management of parturition (Labour 1)

Question 1

What is Parturition

Answer 1

the process of giving birth

Question 2

How many stages is Parturition catogrised into

Answer 2

4

Question 3

How many weeks is an normal labour

Answer 3

37-42 weeks is classed as normal

around 270 days

Question 4

How many ways can babies be delivered

Answer 4

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%

Question 5

name the key pathways that are used to identify the beginning of labour

Answer 5

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)

Question 6

what is the Myometrial quiescence

Answer 6

keeping the uterus quite- stopping the shedding, this is because Throughout pregnancy significant proliferation and hypertrophy in smooth muscle of uterus

Question 7

function of HCG in Myometrial quiescence

Answer 7

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

Question 8

function of progesterone in Myometrial quiescence

Answer 8

inhibits oestrogen (which helps MGJ)

Question 9

function of oxytocin in Myometrial quiescence

Answer 9

promote the release of relaxing prostaglandins until HCG level drop at onset of labour

Question 10

function of relaxin in Myometrial quiescence

Answer 10

causes smooth muscles to relax

Question 11

function of Melatonin in Myometrial quiescence

Answer 11

suppresses myometrial oxytocin receptors, stops oxytocin release

Question 12

what is Prostaglandins

Answer 12

a hormone that induces labour, produced by the uterine tissues / fetal membranes and increased rates of production occur during labour

Question 13

function of Prostaglandins

Answer 13

used to indux labour, causes contractions

Question 14

when is Ocytocin at it’s highest

Answer 14

at night from 32 weeks onwords,

Question 15

what hormone helps the utrine tissue produce prostaglandins

Answer 15

Oytocin

Question 16

define labour

Answer 16

regular, painful uterine contractions leading to progressive effacement and dilation of the cervix.

Question 17

4 stages of labour what happens in them

Answer 17

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

Question 18

what is full ditaltion in labour

Answer 18

10cm

Question 19

why is labour usually quicker in women who have had children before

Answer 19

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

Question 20

what is Cervical effacement

Answer 20

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

Question 21

when dose Cervical effacement start and what is it’s function

Answer 21

May start 2-3 weeks before end of pregnancy

Completed in labour to form lower uterine segment

Question 22

what are some of the symptomes of contractions

Answer 22

Involuntary
Intermittent initially then become regular
Almost always, painful

Question 23

function of uterine contractions

Answer 23

Responsible for achieving effacement and dilatation and for descent and expulsion of the fetus

Question 24

how do contractions work

Answer 24

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

Question 25

what is the forewaters

Answer 25

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

Question 26

what is Progress of labour … 3 Ps

Answer 26

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-

Question 27

what can delay the first stage of labour

Answer 27

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.

Question 28

what do women usually experience in early labour

Answer 28

change in behaviour, nesting
physical symptoms,
low backache / pelvic discomfort
Upset stomach / diarrhoea
Internittant tightenings (Braxton Hicks)
Show – clear or pinky

Question 29

what should care in early labour include

Answer 29

Hydration / nutrition
Rest
Mobilisation

Question 30

when dose the M GAP J form

Answer 30

from w 32

Question 31

function of MGJ

Answer 31

speeds up impulse- streamlines contractions
it is stimulated by oestrogen,proglandinnes, melatonin’
Inhibited by progesterone, HCG relaxin

Question 32

where is prostaglandins produces

Answer 32

utrine tissue, fetal membranes- higer levels in pregnancy

Question 33

what happens in the 0 stage of labour

Answer 33

latent phase, irregular contractions, effacement+ dilation of cervix

Question 34

what happens in the 1st stage of labour

Answer 34

onset of utrine contractions, cervix dilaton

Question 35

in what stage is full dilation

Answer 35

stage 2

Question 36

in what stage is the baby born

Answer 36

stage 3

Question 37

at what stage dose the plecenta and membrans is expelled from the utrus

Answer 37

stage 3

Question 38

is labour stages longer in first time mothers

Answer 38

1 and 2 stage are double as long, 3 stage is around the same time in muligraves

Question 39

are the cervix muscles thinner in muligraves

Answer 39

yes people who have had children before have thinner muscle in cervix

Question 40

do contracts start at 1 speed and stay that speed

Answer 40

No. they start at one speed and get quicker

Question 41

where do contractions originate from

Answer 41

top of the uterus and spread down