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Reproduction > Week 4- normal labour > Flashcards

Week 4- normal labour Flashcards

1
Q

What is the definition of labour?

A

The physiological process of expelling the fetus membranes, umbilical cord and placenta from the uterus.

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2
Q

What three key factors interplay throughout labour?

A

Power- have to have enough power to push the baby out Passage- the passage must be patent Passenger- the baby must be in the correct position.

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3
Q

What is progesterones role on the uterus?

A

Keeps the uterus settled.

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4
Q

What is estrogens role on the uterus?

A

Makes the uterus contract. Promotes prostaglandin production

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5
Q

What is oxytocins role on the uterus?

A

Initiates and sustains contractions. Acts on decidual (endometrial) tissue to promote prostaglandin release.

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6
Q

What factors are thought to cause labour to initiate?

A

Change in estrogen/progesterone ratio. Fetal adrenals and pituitary hormones may also. Myometrial stretch increases the excitability of myometrial fibres. Mechanical stretch of the cervix and stripping of fetal membranes. Fergusons reflex.

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7
Q

What is Ferguson’s reflex?

A

The more the baby pushes down, the more the cervix contracts.

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8
Q

What effect does pulmonary surfactant have on labour?

A

Its secreted into the amniotic fluid and is reported to stimulate prostaglandin release.

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9
Q

What is Bishops score and what is the significance of the score?

A

Five elements are examined -Position- whether the cervix is pointing forwards or back -Consistency- is the cervix firm or soft? -Effacement- the cervix preparing for delivery -Dilatation- how dilated you are? -Station in pelvis- how far down the baby is? Score of less than 4 would mean you want to initiate labour.

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10
Q

Where do cervix’s tend to sit in labour?

A

They tend to be brought forward in labour.

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11
Q

How is the first stage of labour split up?

A

Into latent stage (up to 3-4cm dilation) and active stage.(4cm-10cm full dilation)

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12
Q

What are the three stages of labour and briefly describe them?

A

First stage- active and latent- when the cervix is dilating Second stage- delivery of the baby Third stage- delivery of the placenta.

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13
Q

Describe contractions in the latent phase of the first stage of labour? What happens to the cervix in this time?

A

Mild, irregular uterine contractions. Cervix shortens and softens.

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14
Q

Describe contractions in the active phase of the first stage of labour? Describe the passage in this time?

A

They become progressively more rhythmic and stronger. Slow descent of the passenger.

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15
Q

How quickly does dilation progress in the active stage of the first stage of labour?

A

Should be 1-2cm more dilated an hour.

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16
Q

When does the second stage of labour start?

A

When the patient becomes fully dilated (10cm).

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17
Q

When is the second stage of labour considered long in nulliparous (women who has never given birth before) women?

A

If it exceeds 3 hours in someone with regional anaesthesia If it exceeds 2 hours in someone who has not had regional anaesthesia.

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18
Q

When is the second stage of labour considered long in multiparous (women who has had multiple pregnancies before?

A

Considered prolonged if it exceeds 2 hours with regional anaesthesia or 1 hour without.

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19
Q

When does the third stage of labour start?

A

Starts when the baby is delivered Ends when the membranes and tissues are delivered.

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20
Q

What is the average duration of the third stage of labour?

A

10 mins

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21
Q

If the third stage of labour hasn’t finished in an hour, what is the management?

A

Preparation for removal of placenta under general anaesthetic.

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22
Q

What management can aid the third stage of labour? What does this lower the risk of?

A

Use of oxytocic drugs and controlled cord traction is preferred for lowering the risk of postpartum haemorrhage.

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23
Q

How would you ‘actively’ manage the third stage of labour?

A

Prophylactic administration of syntometerine. or oxytocin. Cord clamping and cutting Controlled cord traction Bladder emptying.

24
Q

Describe the process of cervical softening?

A

An increase in hyaluronic acid gives an increase in molecules among collagen fibres. This decreases the bridging among collagen fibres and therefore decreases the firmness of the cervix.

25
Q

What is cervical ripening?

A

Decrease in collagen fibre alignment Decrease in collagen fibre strength Decrease in tensile strength of the cervical matrix Increase in cervical decorin.

26
Q

What are Braxton Hicks contractions? When do they start?

A

Tightening of the uterine muscles to aid in labour. Kind of like menstrual cramps, “practice contractions”. They are irregular, painless and resolve with a change in activity. Can start 6 weeks into pregnancy but generally come around the third trimester.

27
Q

What do true labour contractions feel like? How will the abdomen feel during a true contraction? At the start of labour, how far apart are these contractions?

A

Like a wave. The pain starts low, rises to a peak and then ebbs away. The mothers abdomen will feel hard during contraction. About 5-10 mins apart.

28
Q

What causes true labour contractions to start?

A

Oxytocin hormone is released stimulating the uterus to contract.

29
Q

As labour goes on, how will the true contractions change? What accompanies the change in contractions? What do contractions do in the uterus?

A

They will become more frequent Last longer. They also get more intense and painful over time. The change in contractions is accompanied by cervical softening, effacement and dilatation. They tighten the top of the uterus to push the baby down.

30
Q

What sort of muscle is in the uterus?

A

Smooth muscle. With density highest at the fundus.

31
Q

What controls the frequency and timing of contractions?

A

Pacemaker- a region of tubal ostia. Wave spreads from here in a downward direction.

32
Q

When is the intensity of contractions at its maximum?

A

In the second stage of labour.

33
Q

How many contractions is normal in 10 minutes in the second stage of labour?

A

3-4.

34
Q

How long are contractions in the second stage of labour?

A

Start at about 10-15 seconds Maximum is about 45 seconds

35
Q

When is the baby 5/5

A

Head is mobile above the pubic symphysis

36
Q

When is the baby 2/5

A

When the head is 2/5ths above the pubic symphysis.

NOTE- baby becomes engaged before labour starts. It occurs in the third trimester. This is different to station.

37
Q

During what type of examination is the cervix assessed?

A

A vaginal examination.

38
Q

What is the fontanelle at the occiput called? How can you distinguish between this one and the other one?

A

Called the posterior fontanelle- it has three things coming off of it whereas the other has 4.

39
Q

What is the most suitable pelvic shape for birth?

A

Gynaecoid pelvis

40
Q

Describe an anthropoid pelvis?

A

An oval shaped inlet with a large anteroposterior diameter and comparatively smaller transverse diameter.

41
Q

Describe an android pelvis? Who is more at risk of having this pelvis?

A

It has a triangular or heart shaped inlet and is narrower at the front. African- Caribbean

42
Q

What is meant by right occiput posterior position?

A

The babies occiput is on the right side of the pelvis posteriorly.

43
Q

What is meant by right occiput anterior?

A

The babies occiput is on the right side of the pelvis anteriorly.

44
Q

What is liquor?

A

Nurtures and protects fetus and facilitates movement.

45
Q

What does the babies head do through the pelvic opening?

A

It flexes it so it gets out easier.

46
Q

What is meant by restitution and external rotation?

A

Adopting the optimum position for the shoulder to get out.

47
Q

Which shoulder comes out first?

A

Anterior shoulder.

48
Q

What is meant by crowning? What might the mother feel at this point?

A

The babies head is coming out. Its visible. The mothers labia are stretched as much as they can be. The largest diameter of the fetal head is encircled in the vulval ring. Mother will feel a stinging or burning. Encourage breathing at this point.

49
Q

What are the three classic signs indicating the placenta is separating?

A

Uterus contracts, hardens and risens Umbilical cord lengthens permanently Gush of blood- variable in amount.

50
Q

What analgesia options are available during labour?

A

Paracetamol/cocodamol TENS Entanox (nitrous oxide) Diamorphine Epidural Remifentanyl Combined spinal/epidural

51
Q

What is the normal volume of blood lost during labour?

A

500ml or less. Abnormal if over this (really only if greater than 1500)

52
Q

What can be causes of haemostasis in labour?

A

Tonic contraction- lattice pattern of uterine muscles strangulate blood vessels Thrombosis of torn end vessels- pregnancy is a hyper coagulable state Myo-tamponade- opposition of the anterior/posterior walls.

53
Q

What is peurperium? How long does it last?

A

Period of repair and recovery. Return of tissues to non-pregnant state. Takes about 6 weeks.

54
Q

What occurs during peurperium?

A

You get vaginal discharge containing blood, mucus and endometrial castings- usually goes from heavy to light over time. Also uterine involution (decreases in size). Fundal height reduces within 2 weeks. Endometrium is replaced in 2 weeks. Lactation is initiated.

55
Q

Describe lactation in puerperium?

A

Initiated by placental expulsion Decrease in oestrogen and progesterone but prolactin is maintained. The colostrum is rich in immunoglobulins

Reproduction (34 decks)

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