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Phase 3a - Women's Health > Women's Health : Labour + Parturition > Flashcards

Women's Health : Labour + Parturition Flashcards

1
Q

How many stages is labour divided into?

A

3 stages

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2
Q

What defines the onset of the First Stage of Labour?

A

Progressive contractions and cervical changes

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3
Q

What are the 2 stages of First Stage of Labour?

A

Latent and Active first stage

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4
Q

What is involved in the Latent first stage?

A

Effacement (thinning) of cervix and dilatation to 3cm

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5
Q

What is involved in the Active first stage?

A

Dilatation from 3 - 10cm (i.e. fully dilated)

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6
Q

What occurs during the Second stage of Labour?

A

From full dilation to delivery of the baby

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7
Q

What are the two phases of the Second stage?

A

Passive and Active second stage

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8
Q

Passive second stage

A

head descends down pelvis

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9
Q

Active second stage

A

mother bears down

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10
Q

What happens in the Third stage of Labour?

A

Delivery of placenta and membranes

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11
Q

How long should the Third stage take?

A

Within 30 minutes of delivery of the baby

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12
Q

What are the management options for the Third stage?

A

Can be physiological (i.e. no intervention) or actively managed (oxytocin injection after delivery of anterior shoulder).

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13
Q

What coincides with the onset of labor?

A

passage of the operculum (mucus plug) and spontaneous rupture of membranes (SROM) should coincide with the onset of labour but are not defining features

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14
Q

What hormonal changes are triggered by the fetus to initiate labor?

A

The fetus triggers an increase in maternal oestrogen and a decrease in progesterone, along with factors like uterine stretch, cortisol, and the Ferguson reflex.

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15
Q

What is the result of increased maternal oestrogen and decreased progesterone in labor initiation?

A

It leads to the expression of Contraction-Associated Proteins (CAPs) and increased production of oxytocin and prostaglandins.

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16
Q

What is the role of Contraction-Associated Proteins (CAPs) in labor?

A

CAPs increase the expression of oxytocin receptors, prostaglandin receptors, gap junction proteins, and ion channels to facilitate uterine contractions.

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17
Q

Why is the increase in both agonists (like oxytocin) and receptors important in labor?

A

It prepares the uterus for effective contractions by ensuring that both the molecules initiating contractions and their receptors are present in high amounts.

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18
Q

How does the uterine muscle contract during labor?

A

The uterine muscle contracts due to the spread of action potentials, which open L-type calcium channels, increasing intracellular calcium.

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19
Q

What happens when intracellular calcium levels increase in uterine muscle cells?

A

The increase in calcium initiates actin-myosin sarcomere contraction, leading to muscle contraction in the uterus.

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20
Q

How is the duration of a uterine contraction determined?

A

The duration of a contraction is directly related to intracellular calcium levels; the longer calcium levels remain high, the longer the contraction lasts.

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21
Q

Which substances increase calcium-channel opening in the uterine muscle?

A

Prostaglandin F2-alpha and oestrogen increase calcium-channel opening, promoting uterine contractions.

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22
Q

What is myometrial activation?

A

Uterine contractions synchronized and coordinated at term

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23
Q

What triggers the endocrine cascade for labor?

A

Foetus

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24
Q

What hormones increase due to the endocrine cascade?

A

Maternal oestrogen

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25
Q

What hormone decreases due to the endocrine cascade?

A

Progesterone

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26
Q

What are some contributing factors to labor onset?

A

Uterine stretch, cortisol, Ferguson reflex

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27
Q

What proteins are expressed in response to labor initiation?

A

CAPs

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28
Q

What increases alongside CAP expression?

A

Oxytocin and prostaglandins

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29
Q

What do CAPs increase the expression of?

A

Oxytocin receptors

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30
Q

What do gap junction proteins facilitate?

A

Contractions

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31
Q

What initiates uterine muscle contraction?

A

Action potential spread

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32
Q

What increases intracellular calcium in uterine contractions?

A

L-type calcium channels

33
Q

What hormones increase calcium-channel opening?

A

Prostaglandin F2-alpha and oestrogen

34
Q

What are the 7 stages of labour?

A
  1. Descent 2. Flexion 3. Internal Rotation 4. Extension 5. Resistituion 6. External Rotation 7. Delivery of Shoulders
35
Q

What is the first stage of the second stage of labour?

A

Descent

36
Q

What happens during the “Descent” stage of labour?

A
  • the baby’s head (providing it is in cephalic presentation) descends deeper into the pelvis until it is no longer palpable on abdominal examination.
37
Q

What happens during the “Flexion” stage of labour?

A
  • the baby’s head flexes (chin to chest) to give the narrowest (suboccipitobregmatic) diameter.
38
Q

What happens during the “Internal Rotation” stage of labour?

A

baby’s occiput rotates anteriorly from the lateral position to give the normal occipito-anterior position.

39
Q

What happens during the “Extension” stage of labour?

A

Baby’s occiput contacts pubic rami - it then extends and crowns

40
Q

What happens during the “Restitution” stage of labour?

A
  • baby’s occiput re-aligns with its shoulders, which lie in between the anterior-posterior and lateral positions
41
Q

What happens during the “External Rotation” stage of labour?

A

baby’s shoulders rotate into anterior-posterior position (i.e. perpendicular to mother’s). At this point, the baby’s head is delivered - it is aligned with its shoulders, so the face looks laterally at the mother’s thigh

42
Q

How are the shoulders delivered?

A

the anterior shoulder is delivered first from beneath the pubic ramus; the head is then gently lifted anteriorly to deliver the posterior shoulder. The rest of the baby’s body rapidly follows.

43
Q

What is included in the initial assessment during monitoring in labour?

A

Take history, assess risk factors, assess pain

44
Q

Which vital signs are monitored during initial assessment?

A

Pulse, blood pressure, respiratory rate

45
Q

What does abdominal palpation determine?

A

Lie, presentation, engagement, contraction strength

46
Q

What does a vaginal examination determine?

A

Station, position, cervical effacement and dilatation, presence or absence of membranes, caput or cranial moulding

47
Q

What is recorded on a partogram?

A

progression of Labour, foetal, maternal wellbeing

48
Q

What progress measurements are recorded?

A

Cervical dilatation, descent, contractions (frequency and duration)

49
Q

How is foetal wellbeing monitored?

A

Heart rate, amniotic fluid (liqour)

50
Q

What maternal wellbeing measurements are recorded?

A

Pulse, blood pressure, temperature, urinalysis

51
Q

Heart rate can be monitored by …..

A

intermittent auscultation with a Doppler probe (in low risk deliveries) or continuously with a cardiotocograph (CTG, in higher risk deliveries)

52
Q

How is heart rate monitored in higher risk deliveries?

A

Continuous cardiotocograph (CTG)

53
Q

Normal CTG

A

No non-reassuring features

54
Q

Suspicious CTG

A

One non-reassuring

55
Q

Pathological CTG

A

Two non-reassuring or one abnormal

56
Q

Reassuring features of the CTG : baseline HR

A

110-160 bpm

57
Q

Reassuring features of the CTG : decelerations

A

(drops of 15 bpm for 15s): absent

58
Q

Reassuring features of the CTG : accelerations

A

(increases of 15 bpm for 15s): present

59
Q

Reassuring features of the CTG : Baseline variability

A

5-25 bpm

60
Q

Non-reassuring features of the CTG : Baseline Rate

A

100-109 / +20 from start of labour

61
Q

Non-reassuring features of the CTG : Accelerations

A

Absent

62
Q

Non-reassuring features of the CTG : Decelerations

A

Repetitive variable for <30 mins / variable for <30 mins / repetitive late for 30 mins

63
Q

Non-reassuring features of the CTG : Variability

A

<5 for 30-50 mins / >25 for <10 mins

64
Q

Abnormal features of the CTG : Baseline Rate

A

<100 / >160

65
Q

Abnormal features of the CTG : Accelerations

A

Absent

66
Q

Abnormal features of the CTG : Decelerations

A

Repetitive variable with concerning characteristics >30 mins / repetitive late >30 mins / 3 min bradycardia

67
Q

Abnormal features of the CTG : Variability

A

<5 for 50 mins / >25 for >10 mins / sinusoidal pattern

68
Q

Non-pharmacological analgesia methods in labour

A

Breathing, relaxation, birthing pool

69
Q

Non-regional analgesia methods in labour

A

: Entonox (‘gas and air’ - 50:50 mix of nitrous oxide and oxygen), intramuscular opioids e.g. diamorphine or morphine

70
Q

Regional analgesia methods in labour

A

: Epidural - local anaesthetic e.g. bupivacaine combined with fentanyl bolused into L3-4 epidural space, where it acts upon nerve roots to provide analgesia. N.B. a ‘passive hour’ without active pushing upon full dilatation is required.

71
Q

Entonox composition

A

50:50 nitrous oxide and oxygen (gas and air)

72
Q

Labour can be induced artificially, and is usually done so for what indications?

A
  1. Prolonged pregnancy >41 weeks 2. Preterm prelabour rupture of membranes (usually offered at 37+0) 3. Term prelabour rupture of membranes (offer 24hrs expectant management as well) 4. Maternal request 5. Maternal health issues e.g. pre-eclampsia, obstetric cholestasis 6. Intrauterine foetal death (IUFD)
73
Q

At what gestation is induction of labour usually offered for prelabour rupture of membranes?

A

37+0

74
Q

What is recommended for term prelabour rupture of membranes?

A

24 hours expectant management

75
Q

What are the methods for inducing labour?

A

Membrane Sweep

76
Q

Describe the membrane sweep

A

finger passed through cervix to separate part of the chorionic membrane from the decidua; offered from 39+0.

77
Q

Method for inducing labour if Bishop Score < 6

A

prostaglandin E2 pessary (dinoprostone) or osmotic dilator

78
Q

Method for inducing labour if Bishop Score > 6

A

amniotomy (artificial rupture of membranes) +/- oxytocin infusion.

Phase 3a - Women's Health (21 decks)

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